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    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyNorth Dakota Reserved-Bed Payment Update | OpenPay…
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    CurrentNorth Dakota Department of Health & Human ServicesPolicy 23-0040

    Reserved-Bed Payment Limits

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    This policy governs reserved-bed payment when a Medicaid recipient is absent from a nursing facility or an intermediate care facility for individuals with intellectual disabilities, including maximum payable days for inpatient hospitalization and therapeutic leave.

    Policy Summary
    PayerNorth Dakota Department of Health & Human Services
    PolicyReserved-Bed Payment Limits
    Policy CodePolicy 23-0040
    Change TypeRevision: nursing facility therapeutic leave limit increased from 24 to 30 days per rate year
    Effective DateJan 1, 2024
    Next Review DateNot specified
    Key ActionApply the reserved-bed payment limits of 15 days for inpatient hospitalization and 30 days for therapeutic leave.
    SourceLink
    POLICY UPDATE CHANGES

    The maximum therapeutic leave payment for a recipient absent from a nursing facility was revised from 24 to 30 days per rate year.

    15 daysNursing facility inpatient hospitalization
    30 daysNursing facility therapeutic leave per rate year
    15 daysICF/IID inpatient hospitalization
    30 days

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    ICF/IID therapeutic leave per calendar year

    Reserved-Bed Payment Eligibility

    Reserved-bed payment criteria

    Payment for a reserved bed is made when the recipient is absent from the applicable facility, subject to the following maximums.

    ALL of the following

    • ONE of

      • ALL of the following

        • Recipient is absent from a nursing facility due to inpatient hospitalization.15 days maximum
      • ALL of the following

        • Recipient is absent from a nursing facility for therapeutic leave.30 days maximum per rate year
    • ONE of

      • ALL of the following

        • Recipient is absent from an intermediate care facility for individuals with intellectual disabilities due to inpatient hospitalization.15 days maximum
      • ALL of the following

        • Recipient is absent from an intermediate care facility for individuals with intellectual disabilities for therapeutic leave.30 days maximum per calendar year

    Maximum Payable Absence Periods

    Nursing Facility Inpatient Hospitalization
    Payment absence typeInpatient hospitalization
    Maximum reserved-bed payment15 days maximum
    FacilityNursing facility
    Nursing Facility Therapeutic Leave
    Payment absence typeTherapeutic leave
    Maximum reserved-bed payment30 days per rate year maximum
    FacilityNursing facility

    Applying Reserved-Bed Payment Limits

    Billing Rule

    Nursing facility reserved-bed payment limits

    Apply the reserved-bed payment limits when a recipient is absent from a nursing facility. Payment is limited to 15 days for periods of inpatient hospitalization and 30 days per rate year for therapeutic leave of absences.

    • Inpatient hospitalization: 15 days maximum
    • Therapeutic leave: 30 days maximum per rate year
    Billing Rule

    ICF/IID reserved-bed payment limits

    Apply the reserved-bed payment limits when a recipient is absent from an intermediate care facility for individuals with intellectual disabilities. Payment is limited to 15 days for periods of inpatient hospitalization and 30 days per calendar year for therapeutic leave of absences.

    • Inpatient hospitalization: 15 days maximum
    Policy Summary
    PayerNorth Dakota Department of Health & Human Services
    PolicyReserved-Bed Payment Limits
    Policy CodePolicy 23-0040
    Change TypeRevision: nursing facility therapeutic leave limit increased from 24 to 30 days per rate year
    Effective DateJan 1, 2024
    Next Review DateNot specified
    Key ActionApply the reserved-bed payment limits of 15 days for inpatient hospitalization and 30 days for therapeutic leave.
    SourceLink
    On This Page
    Reserved-Bed Payment EligibilityMaximum Payable Absence PeriodsApplying Reserved-Bed Payment Limits
    ICF/IID Inpatient Hospitalization
    Payment absence typeInpatient hospitalization
    Maximum reserved-bed payment15 days maximum
    FacilityIntermediate care facility for individuals with intellectual disabilities (ICF/IID)
    ICF/IID Therapeutic Leave
    Payment absence typeTherapeutic leave
    Maximum reserved-bed payment30 days per calendar year maximum
    FacilityIntermediate care facility for individuals with intellectual disabilities (ICF/IID)
  1. Therapeutic leave: 30 days maximum per calendar year