Administrative Days (Concurrent Review)
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Defines Maryland Physicians Care's business standards and operating protocol for use and payment of administrative days during inpatient admissions for Medicaid members; applies to MPC internal Medicaid Health Plans and affiliated personnel and providers involved in discharge planning and utilization management.
Updated the definitions section.
Deleted section about provider documenting physical or emotional reasons not to move member; removed QMUM and QMOC from interdependencies.
Administrative Day Payment Criteria
Administrative Day Payment Criteria
Administrative days may be paid when the member no longer requires acute care and the provider documents specified discharge planning and UM determinations.
ALL of the following
- Provider documents that the member no longer needs acute care.
- Provider has implemented a pre-discharge plan and initiated placement activities for the member.
- Provider documents an active plan for discharge during the period of administrative days and is actively pursuing placement at an appropriate level of care for the member.
- Provider has received determination from MPC that the member no longer needs the level of care for which the hospital is licensed to provide.
OR
- Provider has received a determination from MPC that the member requires the level of care provided by a pediatric specialty hospital, nursing facility, or a chronic level of care facility.
- Provider has notified MPC Utilization Management of the pre-discharge planning before the termination of the need for inpatient hospitalization at the level the facility is licensed and certified to provide.
- Hospital has submitted documentation to MPC UM that placement activity is conducted (at least 2-3 referrals on each workday) for each administrative day for which payment is requested.
Coding and Related Operational Metrics
Notification and Documentation Requirements
Notify MPC UM and submit placement documentation for administrative day payment
Providers must notify MPC Utilization Management (UM) of pre‑discharge planning before the termination of the need for inpatient hospitalization and submit documentation to MPC UM showing placement activity for each administrative day requested. Documentation must show that placement activities are being actively pursued and include at least 2–3 referrals on each workday for which administrative day payment is requested; the business UM application is used to document the admission and level of care including administrative days.
- Notify MPC UM of pre‑discharge planning prior to termination of inpatient need.
- Submit documentation to MPC UM that placement activity is conducted for each administrative day requested.
- Document at least 2–3 referrals on each workday for which payment is requested.
- Use the business UM application to document the admission, level of care, and administrative days.
Defined Terms
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