Provider Notice issued 12/11/2006

Completion and Submittal of Form HFS 2234, Bed Reserve/Temporary Absence Form

ICF/DDs should submit a properly completed Form HFS 2234 to the Department of Healthcare and Family Services (HFS) on the 1 st day of the month following a hospital stay or therapeutic home visit. Timely submitted and accurately completed bed reserve forms assure accurate payments and reduce rejects and adjustments.

Bed reserves should be entered electronically by facilities enrolled with a REV vendor or mailed to:

Illinois Department of Healthcare and Family Services
P. O. Box 19108
Springfield, IL 62794-9108

Bed reserves should not be submitted until the recipient has been assigned a Medicaid Recipient Identification Number (RIN) and the long-term care admission is completed by the DHS local office caseworker.

Do not mail or fax a completed Form HFS 2234 directly to the Bureau of Long Term Care unless you are reporting a correction or deletion of a previously reported bed reserve. This adds to the processing time, which may result in bed reserve information not being reflected correctly on the prepayment report (HFS 3402), which is generated on the 15 th day of each month that reflects the prior month’s service period.

Form HFS 2234 should only be faxed when there is a correction to a form that has already been submitted or a bed reserve needs to be deleted. The requested action “Correction” or “Delete” should be noted at the top of the form and faxed to 217-557-5061.

• HFS staff is not allowed to delete a bed reserve or change a non-payable bed reserve to payable if the date of service is over twelve (12) months old.

Form HFS 2234 should only be used to report hospital (Type 10 - Payable or 11 - Nonpayable) or therapeutic (Type 20 - Payable or 21 - Nonpayable) bed reserves.

When completing Form HFS 2234 only report bed reserve days in the allowed increments listed below, which are based on programming limitations and assist in the data entry process.

• Ten (10) payable hospital bed reserve days (Type 10) per line.
• Seven (7) payable therapeutic reserve days (Type 20) per line
• No limit for non-payable hospital (Type 11) and non-payable therapeutic (Type 21)

Do not discharge a resident from the facility by completing a Form HFS 1156, LTC Facility Notification and submitting it to the local DHS office due to a resident being on bed reserve (payable or nonpayable).

Level of care changes should not be submitted on the Form HFS 2234. Level of care changes should be reported on Form HFS 1156 and submitted to your DHS local office caseworker or electronically if the facility is currently enrolled with a REV vendor.

Hospice bed reserves (Type 41) should not be submitted on the Form HFS 2234. Notice of election or disenrollment forms must be completed and submitted by the hospice provider to the Bureau of Comprehensive Health Services at:

Illinois Department of Healthcare and Family Services
Bureau of Comprehensive Health Services
P. O. Box 19128
Springfield, IL 62794-9128

Questions regarding the submittal of Form HFS 2234, Bed Reserve/Temporary Absence Form, should be directed to Sarah Rickard at 217-782-0557.

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs