Ala. Admin. Code r. 560-X-42-.06

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-42-.06 - Resident Days

(1) A resident day is incurred when any one of the following conditions have been met:

(a)Care is rendered to a resident in the facility. This results when a resident is rendered services between the census taking hour (12:00 midnight) on two (2) successive days. The following procedure illustrates the proper method of determining the number of resident days resulting from care rendered to residents in the facility, using the midnight census method:

1. Number of residents in the facility at midnight.

2. Add/subtract residents admitted/discharged (including deaths) prior to midnight of the following day (Exception - a resident admitted and discharged on the same day counts as a resident day). The provider may bill for the date of admission, but not for the day of discharge.

(b)When pre-admission payments are received to ensure a bed is kept open for a particular resident. The rationale for including these payments lies in the fact that this bed is not available for occupancy by another resident. Since the facility is receiving payment for a bed which is, in effect, unavailable to any other resident, it should be included in resident day totals.

(c) When a resident is out of the facility, regardless of the reason, and the facility is receiving payment for the bed, this day is counted in the same manner as pre-admission payments as stated above. If the facility is not receiving payment for the bed, it will not be counted as a resident day.

(d) Medicaid payments to ICF/IIDs for therapeutic visits will be limited to 14 days per calendar month, not to exceed 14 consecutive days at one time.

(2) Minimum records required to be kept at the facility are:

(a) Midnight census by resident name at least one time per calendar month. More frequent census taking is recommended.

(b) Ledger of all admissions and discharges/deaths.

(c) Complete therapeutic leave records.

(d) A monthly analysis sheet which summarizes all admissions and discharges, paid hold bed days, and therapeutic leave days. (Schedule 6A at the end of this Chapter is the recommended analysis sheet; however, providers may utilize any form of their own design which provides the same information.)

(3) In the event that payment for a pre-admission day is not received and the charges are subsequently written off as uncollectable, the facility will not count those days as resident days. The facility must keep a separate ledger to indicate days in this category. The ledger must indicate the following:

(a) Resident name.

(b) Dates of pre-admission days charged.

(c) Dates of pre-admission days written off as uncollectable.

(d) Reason for uncollectability.

Ala. Admin. Code r. 560-X-42-.06

Rule effective October 13, 1988. Amended: Filed: June 8, 1993; effective July 13, 1993.

Amended by Alabama Administrative Monthly Volume XXXV, Issue No. 08, May 31, 2017, eff. 6/26/2017.

Author: Robin Arrington, Associate Director, LTC Provider/Recipient Services Unit

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§ 447.250 - .255, etseq.