Provider Notice issued 08/30/12

Bed Reserve Coverage Changes Resulting from the Save Medicaid Access and Resources Together (SMART) Act

Governor Quinn signed into law Public Act 097-0689 (pdf) on June 14, 2012. Termed the SMART Act, this law became effective July 1, 2012, and required changes in the Department’s coverage of payment for holding a bed while a resident is temporarily absent from a facility.

Effective 7/1/2012 payment for bed reserve has been discontinued for all residents of nursing facilities (skilled nursing facilities and intermediate care facilities) and Institutions for Mental Diseases.

Bed reserves must still be reported electronically using the MEDI system. If a resident is admitted to the hospital and there is no bed reserve information reported, conflicts between long term care and hospital dates of service will cause the entire month’s LTC claim to be rejected.

The Nursing Home Care Act still requires a nursing facility to hold a bed for a maximum of ten days when a resident is hospitalized. The facility must hold a bed (not necessarily that specific bed) for up to 10 days during a hospitalization. On the 11th day there is no requirement to hold a bed but the resident is still a resident and should receive the next available bed when they are ready to return even if there is a waiting list.

There is no requirement under the Nursing Home Care Act to hold a bed for ten days during a therapeutic home visit. However the client is still considered a resident and must be given the next available bed when they are ready to return even if there is a waiting list.

Bed reserve payments have been discontinued for residents of Intermediate Care Facilities for the Developmentally Disabled who are 21 years of age and older. These facilities are regulated by the ID/DD Community Care Act which contains language stating the facility must provide the resident with seven days notice to terminate the contract if resident is compelled to leave the facility for physical or mental health reasons.

Bed reserve payments will continue with no changes for residents of Intermediate Care Facilities for the Developmentally Disabled who are under 21 years of age.

Hospitalization

• 100 percent of a facility's Medicaid per Diem for days 1-10 per hospitalization.

• 75 percent of a facility's Medicaid per Diem for days 11-30 per hospitalization.

• 50 percent of a facility's Medicaid per Diem for days 31-45 per hospitalization.

Therapeutic visits

• 100 percent of a facility's Medicaid per Diem for days 1 -10 per State fiscal year.

• 75 percent of a facility's Medicaid per Diem for all days after 10. There is no maximum number of covered days.

Payment for temporary absence from Supportive Living Facilities will continue with no changes.

Hospital and Therapeutic

• 100 percent of a facility’s Medicaid per diem for up to 30 days per calendar year.

The Department of Human Services’ Policy Manual addresses allowable medical expenses and outlines when a long term care resident’s income can be reduced for this purpose. Since holding a bed in a facility while a resident is temporarily absent is not a medical service resident income cannot be used as an allowable medical expense as outlined in PM 15-08-05.

If you have questions, contact HFS’ Bureau of Long Term Care at 217-524-7245.

Theresa A. Eagleson, Administrator

Division of Medical Programs