Medicaid Benefits: Intermediate Care Facility Services for Individuals with Intellectual Disabilities
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2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 44 No - 2 NR - 5 | 2018 data limited to CN | Yes - 6 | Yes - 18 | Included in "Limits on Services" for 2018 | Not included in 2018 survey |
| Alabama | Yes | CN | Patient Liability for ICF Residents | No | - | - |
| Alaska | Yes | CN | No | No | - | - |
| Arizona | Yes | CN | No | Prior authorization required | - | - |
| Arkansas | Yes | CN | NR | NR | - | - |
| California | Yes | CN | No | 7 hospital leave days/hospitalization, 73 therapeutic leave days/year | - | - |
| Colorado | Yes | CN | No | NR | - | - |
| Connecticut | Yes | CN | No | No | - | - |
| Delaware | No | - | - | |||
| District of Columbia | Yes | CN | No | Requires a level of care determination | - | - |
| Florida | Yes | CN | No | No | - | - |
| Georgia | Yes | CN | NR | NR | - | - |
| Hawaii | Yes | CN | No | No | - | - |
| Idaho | Yes | CN | No | No | - | - |
| Illinois | NR | NR | NR | NR | - | - |
| Indiana | Yes | CN | No | Prior authorization for LOC determination upon admission, 15 hosp leave days/hospitalization, 60 therapeutic leave days/year. | - | - |
| Iowa | NR | NR | NR | NR | - | - |
| Kansas | Yes | CN | No | Reserve days are limited to 10 per confinement. | - | - |
| Kentucky | Yes | CN | Yes - Not Specified | Must meet patient status - level of care requirements | - | - |
| Louisiana | Yes | CN | No | No | - | - |
| Maine | Yes | CN | No | Limits imposed on number of hospital leave and therapeutic leave days per year | - | - |
| Maryland | Yes | CN | No | Level of care pre authorization | - | - |
| Massachusetts | Yes | CN | No | No | - | - |
| Michigan | No | - | - | |||
| Minnesota | Yes | CN | No | No | - | - |
| Mississippi | Yes | CN | No | No | - | - |
| Missouri | Yes | CN | No | No | - | - |
| Montana | Yes | CN | No | No | - | - |
| Nebraska | Yes | CN | No | No | - | - |
| Nevada | Yes | CN | Patient Liability | Level of Care required | - | - |
| New Hampshire | NR | NR | NR | NR | - | - |
| New Jersey | Yes | CN | No | No | - | - |
| New Mexico | Yes | CN | The cost sharing is in the form of a recipient liability, which is based on the recipient's financial ability to pay some amount toward their own nursing home care. | No | - | - |
| New York | NR | NR | NR | NR | - | - |
| North Carolina | Yes | CN | No | No | - | - |
| North Dakota | Yes | CN | No | 15 leave days for hospitalization per year 30 therapeutic leave days per year | - | - |
| Ohio | Yes | CN | No | Must be diagnosed w/Intellectual Disability. | - | - |
| Oklahoma | Yes | CN | No | Must be determined that a member is medically eligible to receive such care. | - | - |
| Oregon | Yes | CN | No | No | - | - |
| Pennsylvania | Yes | CN | No | No | - | - |
| Rhode Island | Yes | CN | No | No | - | - |
| South Carolina | NR | NR | NR | NR | - | - |
| South Dakota | Yes | CN | No | 5 hospital leave days/hospitalization, 15 consecutive therapeutic leave days if in plan of care, therapy services limited to those provided through the facility | - | - |
| Tennessee | Yes | CN | No | No | - | - |
| Texas | Yes | CN | No | No | - | - |
| Utah | Yes | CN | No | Medical necessity and level of care criteria must be met | - | - |
| Vermont | Yes | CN | No | No | - | - |
| Virginia | Yes | CN | No | NR | - | - |
| Washington | Yes | CN | No | Prior authorization required | - | - |
| West Virginia | Yes | CN | Financial eligibility evaluation completed monthly | Member must be re-evaluated annually for continued eligibility of the program | - | - |
| Wisconsin | Yes | CN | Cost share amounts vary based on Medicaid eligibility, however, long-term skilled nursing facility residents who are not veterans are generally limited to a personal needs allowance of $45 per month. | Bedhold days limited to 15 hospital leave days per hospitalization. Therapeutic bedhold leave is unlimited. A facility must have >94% occupancy in the prior calendar month to bill for bedhold. | - | - |
| Wyoming | Yes | CN | No | LT-MR-104 must be completed for all ICF/ID residents. | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 48 No - 8 | Yes - 0 No - 48 | ||||
| Alabama | Yes | CN | Cost based per diem | |||
| Alaska | Yes | CN | Hosp leave days not covered, 5 therapeutic leave days/year | Initially to determine LOC, initially and periodically for LOS | Prospective cost based per diem with limits, full per diem paid for leave days | |
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | 12 hosp leave days/year, 9 therapeutic leave days/year | Capitated payment through contractor, full per diem rate paid for leave days | ||
| Arkansas | Yes | CN | 5 hosp leave days/hospitalization, facility must have 85% occupancy rate to be paid, unlimited therapeutic leave days up to 14 consecutive days | Prospective cost based class rate for facilities with fewer than 16 beds, prospective cost based per diem for larger private facilities, cost based payment for public facilities; enhanced care add-on applied to address increase in federal minimum wage, full per diem rate paid for leave days | ||
| California | Yes | CN & MN | 7 hosp leave days/hospitalization, 73 therapeutic leave days/year | Admission | Private facilities paid standard per diem by facility size, cost based payment for public facilities; reduced per diem rates paid for leave days with reduction value set annually | |
| Colorado | Yes | CN | Hosp leave days not covered, 42 therapeutic leave days/year | Cost based payment , full per diem paid for leave days | ||
| Connecticut | Yes | CN & MN | 15 hosp leave days/hospitalization, 36 therapeutic leave days/year | Prospective cost based per diem with limits, full per diem paid for leave days | ||
| Delaware | Yes | CN | 7 hosp leave days/month, 18 therapeutic leave days/year | Prospective cost based per diem with limits, full per diem paid for leave days | ||
| District of Columbia | Yes | CN & MN | 15 hosp leave days and 45 therapeutic leave days/year | Prospective cost based per diem with efficiency incentives, up to Medicare limits, full per diem paid for leave days less one-to-one services | ||
| Florida | Yes | CN | 15 hosp leave days/hospitalization, 45 therapeutic leave days/year, 30 infirmary leave days/year with each less than 16 days and with hosp leave not covered if immediately following infirmary leave, facility must have 95% occupancy rate to be paid | Prospective cost based per diem with limits, full per diem paid for leave days | ||
| Georgia | Yes | CN | 7 hospital leave days/hospitalization, 16 therapeutic leave days/year | Yes | Prospective cost based per diem with limits, leave days paid 95% of per diem | |
| Guam | No | |||||
| Hawaii | Yes | CN & MN | 12 hosp or therapeutic leave days/year with up to 3 consecutive days | Yes | Prospective cost based per diem with limits, full per diem paid for leave days | |
| Idaho | Yes | CN | Services limited to Enhanced Plan and Medicare/Medicaid Coordinated Plan, hosp leave days not covered, 14 therapeutic leave days covered per home visit up to 36 days/year - See state-specific FN | Prospective cost based per diem with limits, leave days paid at 75% of facility's rate | ||
| Illinois | Yes | CN & MN | Yes | Prospective cost based per diem with limits for private facilities | ||
| Indiana | Yes | CN | 15 hosp leave days/hospitalization, 60 therapeutic leave days/year | For LOC determination upon admission | Prospective cost based per diem, leave days paid at 50% of facility's rate | |
| Iowa | Yes | CN | 10 hosp leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem with limits, leave days paid at 80% of facility's rate for facilities with more than 15 beds or at 95% if fewer beds | ||
| Kansas | Yes | CN & MN | 10 hosp leave days per acute care hospitalization, 21 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities, full per diem paid for leave days | ||
| Kentucky | Yes | B - See state-specific FN | Benefit limited to short-term acute conditions, maximum of 45 leave days of any type/quarter, up to 15 hosp leave days per stay for hospitalization, combined hosp and therapeutic leave limited to 30 consecutive days | Prospective cost based per diem, cost based payment for ancillary services, leave days paid at 75% of facility's rate if occupancy reported at 95% or more and 50% of rate if lower or not reported | ||
| Louisiana | Yes | CN & MN | 7 hosp leave days/hospitalization, 30 consecutive therapeutic leave days up to 45/year | For medical necessity and LOC determination upon admission | Private facilities paid standard per diem with LOC and facility size adjustors, public facilities paid cost based per diem up to Medicare upper limit; leave days paid at 75% of 2/2009 per diem rate | |
| Maine | Yes | CN & MN | 30 hosp leave days/year, 52 therapeutic leave days/year | Prospective cost based per diem with limits, full per diem paid for leave days | ||
| Maryland | Yes | CN & MN | Care rendered in state-operated institutions only | Cost based per diem up to Medicare limits | ||
| Massachusetts | Yes | CN & MN | Leave days covered if in plan of care, no annual limit | Prospective cost based per diem with limits, facilities not paid for leave days | ||
| Michigan | No | |||||
| Minnesota | Yes | A - See state-specific FN | 18 hosp leave days/hospitalization, 72 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities, leave day payment dependent on occupancy level | ||
| Mississippi | Yes | CN | 30 hosp leave days/year, 84 therapeutic leave days/year | Prospective cost based per diem with limits, full per diem paid for leave days | ||
| Missouri | Yes | CN | 3 hospital leave days/hospitalization if specified criteria met, 12 therapeutic leave days/6 months | Prospective per diem with limits for private facilities, cost based payment for public facilities, full per diem paid for leave days | ||
| Montana | Yes | A - See state-specific FN | Hosp leave days not covered, 24 therapeutic leave days/year | Therapeutic leave exceeding 3 days | Prospective cost based per diem with limits, full per diem paid for leave days | |
| Nebraska | Yes | CN & MN | 15 hosp leave days/hospitalization, 36 therapeutic leave days/year | Yes | Private facilities paid prospective cost based per diem with limits, cost based payment for state-operated facility; full per diem paid for leave days | |
| Nevada | Yes | CN | Hosp leave days not covered, therapeutic leave limited to rehabilitative and pre-discharge transitional home and community visits up to 24 days/year | Prospective cost based per diem with limits, full per diem paid for leave days | ||
| New Hampshire | No | |||||
| New Jersey | Yes | CN | Cost based payment | |||
| New Mexico | Yes | CN | 65 leave days/year of any type with additional 6 days allowed if approved plus 6 leave days for discharge planning, A - this benefit is not covered | Prospective cost based per diem with limits, leave days paid at rate for lowest level of acuity | ||
| New York | Yes | CN & MN | 15 hosp leave days/hosp; 18 therapeutic leave days/year; facility with fewer than 30 beds must have 95% or higher occupancy rate to be paid | Prospective cost based per diem with limits, full per diem paid for leave days | ||
| North Carolina | Yes | CN & MN | Hosp leave days not covered, 15 consecutive therapeutic leave days up to 60 days/year | Admission | Prospective cost based per diem with limits for private facilities, cost based per diem for public facilities settled annually, full per diem rate paid for leave days | |
| North Dakota | Yes | CN & MN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Cost based payment, full per diem paid for leave days | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | 30 hosp or therapeutic leave days/year | Prospective cost based per diem with limits, leave days paid full per diem rate | ||
| Oklahoma | Yes | CN | 14 consecutive therapeutic leave days up to 60/year | Prospective cost based per diem with limits, leave days paid 75% of facility's rate | ||
| Oregon | No | |||||
| Pennsylvania | Yes | CN & MN | 15 hosp leave days/hospitalization, 75 therapeutic leave days/year | Prospective cost based per diem with limits, full per diem rate paid for leave days | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | See state-specific FN | Prospective cost based per diem | |||
| South Carolina | Yes | CN | 10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year, additional days allowed for approved rehab programs or transition to community placement | Cost based payment, full per diem paid for leave days | ||
| South Dakota | Yes | CN | 5 hosp leave days/hospitalization, 15 consecutive therapeutic leave days if in plan of care, therapy services limited to those provided through the facility | Prospective cost based per diem with limits, full per diem paid for leave days | ||
| Tennessee | Yes | A - See state-specific FN | 15 hosp leave days/admission if return to facility intended, 60 therapeutic leave days/year with no more than 14 days/occurrence for home visit or other therapeutic absence | Lower of reasonable cost or charge, reimbursement for hospital leave days only if 85% occupancy requirement met | ||
| Texas | Yes | CN & MN | Unlimited therapeutic leave episodes up to 3 days and one therapeutic leave episode up to 10 days/year | Private facilities paid acuity adjusted cost based per diem that varies by facility size, cost based per diem for public facilities | ||
| Utah | Yes | A - See state-specific FN | Hosp leave days not covered, 25 therapeutic leave days/quarter | Private facilities paid negotiated cost based per diem, cost based payment for public facilities, full per diem paid for leave days | ||
| Vermont | Yes | A & B - See state-specific FN | 6 hosp leave days per acute care hospitalization, 15 therapeutic leave days/quarter up to 60 days/year | Prospective per diem, full per diem paid for leave days | ||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN | Hosp leave days not covered, 7 consecutive rehab or therapeutic leave days up to 18 days/year | Admission | Cost based payment, full per diem paid for leave days | |
| Washington | Yes | CN & MN | Hosp leave days not covered, 18 therapeutic leave days/year | More than 7 consecutive therapeutic leave days | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities; leave day reimbursement factored into per diem through adjustments | |
| West Virginia | Yes | A, B & C | 14 consecutive hosp leave days/hospitalization, 21 therapeutic leave days/year | Private facilities paid prospective cost related and acuity adjusted per diem with limits based on operating costs plus capital, leave days paid at the rate for lowest level of acuity | ||
| Wisconsin | Yes | CN & MN | 15 hosp leave days/hospitalization, unlimited therapeutic leave days, facility must have 95% occupancy or fewer than 9 vacant beds to be paid | Prospective cost based per diem with some settlement, leave days paid at 85% of facility's rate | ||
| Wyoming | Yes | CN | 14 leave days of any type/year | Prospective cost based per diem with limits, full per diem paid for leave days if facility has at least 90% occupancy |
2010
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 48 No - 8 | Yes - 0 No - 48 | ||||
| Alabama | Yes | CN | Hosp leave days not covered, 14 therapeutic leave days/month, may be consecutive | Prospective cost based per diem with limits | ||
| Alaska | Yes | CN | Hosp leave days not covered, 5 therapeutic leave days/year | Initially to determine LOC, initially and periodically for LOS | Prospective cost based per diem with limits | |
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | 12 hosp leave days/year, 9 therapeutic leave days/year | Capitated payment through contractor | ||
| Arkansas | Yes | CN | 5 hosp leave days/hospitalization, facility must have 85% occupancy rate to be paid, unlimited therapeutic leave days up to 14 consecutive days | Prospective cost based class rate for facilities with fewer than 16 beds, prospective cost based per diem for larger private facilities, cost based payment for public facilities; enhanced care add-on applied to address increase in federal minimum wage | ||
| California | Yes | CN & MN | 7 hosp leave days/hospitalization, 73 therapeutic leave days/year | Admission | Private facilities paid standard per diem by facility size, cost based payment for public facilities | |
| Colorado | Yes | CN | Hosp leave days not covered, 42 therapeutic leave days/year | Cost based payment | ||
| Connecticut | Yes | CN & MN | 15 hosp leave days/hospitalization, 36 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Delaware | Yes | CN | 7 hosp leave days/month, 18 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| District of Columbia | Yes | CN & MN | 60 hosp or therapeutic leave days/year | Prospective cost based per diem with efficiency incentives, up to Medicare limits | ||
| Florida | Yes | CN | 15 hosp leave days/hospitalization, 45 therapeutic leave days/year, 30 infirmary leave days/year with each less than 16 days and with hosp leave not covered if immediately following infirmary leave, facility must have 95% occupancy rate to be paid | Prospective cost based per diem with limits | ||
| Georgia | Yes | CN | 7 hospital leave days/hospitalization, 30 therapeutic leave days/year | Yes | Prospective cost based per diem with limits, leave days paid 95% of per diem | |
| Guam | No | |||||
| Hawaii | Yes | CN & MN | 12 hosp or therapeutic leave days/year with up to 3 consecutive days | Yes | Prospective cost based per diem with limits | |
| Idaho | Yes | CN | Services limited to Enhanced Plan and Medicare/Medicaid Coordinated Plan, hosp leave days not covered, 14 therapeutic leave days covered per home visit up to 36 days/year - See state-specific FN | Prospective cost based per diem with limits, leave days paid at 75% of facility's rate | ||
| Illinois | Yes | CN & MN | 45 hosp leave days/hospitalization and unlimited therapeutic leave days | Yes | Prospective cost based per diem with limits for private facilities and leave days paid at percentage of facility's rate (50-100%) depending on length of absence | |
| Indiana | Yes | CN | 15 hosp leave days/hospitalization, 60 therapeutic leave days/year | For LOC determination upon admission | Prospective cost based per diem, leave days paid at 50% of facility's rate | |
| Iowa | Yes | CN | 10 hosp leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem with limits, leave days paid at 80% of facility's rate for facilities with more than 15 beds or at 95% if fewer beds | ||
| Kansas | Yes | CN & MN | 10 hosp leave days per acute care hospitalization, 21 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities | ||
| Kentucky | Yes | B - See state-specific FN | Benefit limited to short-term acute conditions, maximum of 45 leave days of any type/quarter, 15 hosp leave days/hospitalization, combined hosp and therapeutic leave limited to 30 consecutive days | Prospective cost based per diem, cost based payment for ancillary services | ||
| Louisiana | Yes | CN & MN | 7 hosp leave days/hospitalization, 30 consecutive therapeutic leave days up to 45/year | For medical necessity and LOC determination upon admission | Private facilities paid standard per diem with LOC and facility size adjustors, public facilities paid cost based per diem up to Medicare upper limit; leave days paid at 75% of 2/2009 per diem rate | |
| Maine | Yes | CN & MN | 30 hosp leave days/year, 52 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Maryland | Yes | CN & MN | Care rendered in state-operated institutions only | Cost based per diem up to Medicare limits | ||
| Massachusetts | Yes | CN & MN | Leave days covered if in plan of care, no annual limit | Prospective cost based per diem with limits, facilities not paid for leave days | ||
| Michigan | No | |||||
| Minnesota | Yes | A - See state-specific FN | 18 hosp leave days/hospitalization, 72 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities, leave day payment dependent on occupancy level | ||
| Mississippi | Yes | CN | 30 hosp leave days/year, 84 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Missouri | Yes | CN | 3 hospital leave days/hospitalization if specified criteria met, 12 therapeutic leave days/6 months | Prospective per diem with limits for private facilities, cost based payment for public facilities | ||
| Montana | Yes | A - See state-specific FN | Hosp leave days not covered, 24 therapeutic leave days/year | Therapeutic leave exceeding 3 days | Prospective cost based per diem with limits | |
| Nebraska | Yes | CN & MN | 15 hosp leave days/hospitalization, 36 therapeutic leave days/year | Yes | Private facilities paid prospective cost based per diem with limits, cost based payment for state-operated facility | |
| Nevada | Yes | CN | Hosp leave days not covered, therapeutic leave limited to rehabilitative and pre-discharge transitional home and community visits up to 24 days/year | Prospective cost based per diem with limits | ||
| New Hampshire | No | |||||
| New Jersey | Yes | CN | Cost based payment | |||
| New Mexico | Yes | CN | 65 leave days/year of any type with additional 6 days allowed if approved plus 6 leave days for discharge planning, A - this benefit is not covered | Prospective cost based per diem with limits | ||
| New York | Yes | CN & MN | 15 hosp leave days/hosp; 18 therapeutic leave days/year; facility with fewer than 30 beds must have 95% or higher occupancy rate to be paid | Prospective cost based per diem with limits | ||
| North Carolina | Yes | CN & MN | Hosp leave days not covered, 15 consecutive therapeutic leave days up to 60 days/year | Admission | Prospective cost based per diem with limits for private facilities, cost based payment for public facilities | |
| North Dakota | Yes | CN & MN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Cost based payment | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | 30 hosp or therapeutic leave days/year | Prospective cost based per diem with limits, leave days paid full per diem rate | ||
| Oklahoma | Yes | CN | 14 consecutive therapeutic leave days up to 60/year | Prospective cost based per diem with limits, leave days paid 75% of facility's rate | ||
| Oregon | No | |||||
| Pennsylvania | Yes | CN & MN | 15 hosp leave days/hospitalization, 75 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | See state-specific FN | Prospective cost based per diem | |||
| South Carolina | Yes | CN | 10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year, additional days allowed for approved rehab programs or transition to community placement | Cost based payment | ||
| South Dakota | Yes | CN | 5 hosp leave days/hospitalization, 15 consecutive therapeutic leave days if in plan of care | Prospective cost based per diem with limits | ||
| Tennessee | Yes | A - See state-specific FN | 15 hosp leave days/admission if return to facility intended, 60 therapeutic leave days/year with no more than 14 days/occurrence for home visit or other therapeutic absence | Lower of reasonable cost or charge, reimbursement for hospital leave days only if 85% occupancy requirement met | ||
| Texas | Yes | CN & MN | Unlimited therapeutic leave episodes up to 3 days and one therapeutic leave episode up to 10 days/year | Private facilities paid acuity adjusted cost based per diem that varies by facility size, cost based per diem for public facilities | ||
| Utah | Yes | A - See state-specific FN | Hosp leave days not covered, 25 therapeutic leave days/quarter | Private facilities paid negotiated cost based per diem, cost based payment for public facilities | ||
| Vermont | Yes | A & B - See state-specific FN | 6 hosp leave days per acute care hospitalization, 15 therapeutic leave days/quarter up to 60 days/year | Prospective per diem | ||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN | Hosp leave days not covered, 7 consecutive rehab or therapeutic leave days up to 18 days/year | Admission | Cost based payment | |
| Washington | Yes | CN & MN | Hosp leave days not covered, 18 therapeutic leave days/year | More than 7 consecutive therapeutic leave days | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities | |
| West Virginia | Yes | A, B & C | 14 consecutive hosp leave days/hospitalization, 21 therapeutic leave days/year | Private facilities paid prospective cost related and acuity adjusted per diem with limits based on operating costs plus capital | ||
| Wisconsin | Yes | CN & MN | 15 hosp leave days/hospitalization, unlimited therapeutic leave days, facility must have 95% occupancy or fewer than 9 vacant beds to be paid | Prospective cost based per diem with some settlement, leave days paid at 85% of facility's rate | ||
| Wyoming | Yes | CN | 14 leave days of any type/year | Prospective cost based per diem with limits |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 50 No - 6 | Yes - 0 No - 50 | ||||
| Alabama | Yes | CN | Hosp leave days not covered, 14 therapeutic leave days/month, may be consecutive | Prospective cost based per diem with limits | ||
| Alaska | Yes | CN | Hosp leave days not covered, 5 therapeutic leave days/year | Initially to determine LOC, initially and periodically for LOS | Prospective cost based per diem with limits | |
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | 12 hosp leave days/year, 9 therapeutic leave days/year | Acute Care program - capitated payment through contractor, ALTCS program - prospective acuity-based per diem or negotiated rate for heavy care residents and certain facilities | ||
| Arkansas | Yes | CN | 5 hosp leave days/hospitalization, facility must have 85% occupancy rate to be paid, unlimited therapeutic leave days up to 14 consecutive days | Prospective cost based class rate for facilities with fewer than 16 beds, prospective cost based per diem for larger private facilities, cost based payment for public facilities | ||
| California | Yes | CN & MN | 7 hosp leave days/hospitalization, 73 therapeutic leave days/year | Admission | Private facilities paid standard per diem by facility size, cost based payment for public facilities | |
| Colorado | Yes | CN | Hosp leave days not covered, 42 therapeutic leave days/year | Cost based payment | ||
| Connecticut | Yes | CN & MN | 15 hosp leave days/hospitalization, 36 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Delaware | Yes | CN | 7 hosp leave days/month, 18 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| District of Columbia | Yes | CN & MN | 60 hosp or therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Florida | Yes | CN | 15 hosp leave days/hospitalization, 45 therapeutic leave days/year, 30 infirmary leave days/year with each less than 16 days and with hosp leave not covered if immediately following infirmary leave, facility must have 95% occupancy rate to be paid | Prospective cost based per diem with limits | ||
| Georgia | Yes | CN | 7 hospital leave days/hospitalization, 30 therapeutic leave days/year | Yes | Prospective cost based per diem with limits, leave days paid 75% of per diem | |
| Guam | No | |||||
| Hawaii | Yes | CN & MN | 12 hosp or therapeutic leave days/year with up to 3 consecutive days | Yes | Prospective cost based per diem with limits | |
| Idaho | Yes | CN | Services limited to Enhanced Plan and Medicare/Medicaid Coordinated Plan, hosp leave days not covered, 14 therapeutic leave days covered per home visit up to 36 days/year - See state-specific FN | Prospective cost based per diem with limits, leave days paid at 75% of facility's rate | ||
| Illinois | Yes | CN & MN | Residents in private facilities limited to 45 hosp leave days/hospitalization and unlimited therapeutic leave days, facility must have 93% occupancy rate to be paid | Yes | Prospective cost based per diem with limits for private facilities and leave days paid at 75% of facility's rate, per diem based on certified cost for State-operated facilities | |
| Indiana | Yes | CN | 15 hosp leave days/hospitalization, 60 therapeutic leave days/year | For LOC determination upon admission | Prospective cost based per diem, leave days paid at 50% of facility's rate | |
| Iowa | Yes | CN | 10 hosp leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem with limits, leave days paid at 80% of facility's rate for facilities with more than 15 beds or at 95% if fewer beds | ||
| Kansas | Yes | CN & MN | 10 hosp leave days per acute care hospitalization, 21 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities | ||
| Kentucky | Yes | B - See state-specific FN | 45 leave days of any type/quarter, 15 hosp leave days/hospitalization, combined hosp and therapeutic leave limited to 30 consecutive days | Prospective cost based per diem, cost based payment for ancillary services | ||
| Louisiana | Yes | CN & MN | 7 hosp leave days/hospitalization, 30 consecutive therapeutic leave days up to 45/year | For LOC determination upon admission | Private facilities paid standard per diem with LOC and facility size adjustors, public facilities paid cost based per diem up to Medicare upper limit | |
| Maine | Yes | CN & MN | 25 hosp leave days/year, 52 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Maryland | Yes | CN & MN | Care rendered in state-operated institutions only | Cost based per diem up to Medicare limits | ||
| Massachusetts | Yes | CN & MN | Leave days covered if in plan of care, no annual limit | Prospective cost based per diem with limits, facilities not paid for leave days | ||
| Michigan | Yes | CN & MN | Prospective cost based per diem with limits | |||
| Minnesota | Yes | A - See state-specific FN | 18 hosp leave days/hospitalization, 72 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities, leave day payment dependent on occupancy level | ||
| Mississippi | Yes | CN | 15 hosp leave days/year, 84 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Missouri | Yes | CN | 12 therapeutic leave days/6 months | Prospective cost based per diem with limits for private facilities, cost based payment for public facilities | ||
| Montana | Yes | A - See state-specific FN | Hosp leave days not covered, 24 therapeutic leave days/year | Therapeutic leave exceeding 3 days | Prospective cost based per diem with limits | |
| Nebraska | Yes | CN & MN | 15 hosp leave days/hospitalization, 36 therapeutic leave days/year | Yes | Private facilities paid prospective cost based per diem with limits, cost based payment for state-operated facility | |
| Nevada | Yes | CN | Hosp leave days not covered, therapeutic leave limited to rehabilitative and pre-discharge transitional home and community visits up to 24 days/year | Prospective cost based per diem with limits | ||
| New Hampshire | No | |||||
| New Jersey | Yes | CN | Cost based payment | |||
| New Mexico | Yes | CN | 65 leave days/year of any type with additional 6 days allowed if approved plus 6 leave days for discharge planning | Prospective cost based per diem with limits | ||
| New York | Yes | CN & MN | Prospective cost based per diem with limits | |||
| North Carolina | Yes | CN & MN | Hosp leave days not covered, 15 consecutive therapeutic leave days up to 60 days/year | Admission | Prospective cost based per diem with limits for private facilities, cost based payment for public facilities | |
| North Dakota | Yes | CN & MN | 15 hosp leave days/hospitalization, 28 therapeutic leave days/year | Cost based payment | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | 30 hosp or therapeutic leave days/year | Prospective cost based per diem with limits, leave days paid full per diem rate | ||
| Oklahoma | Yes | CN | 14 consecutive therapeutic leave days up to 60/year | Prospective cost based per diem with limits, leave days paid 75% of facility's rate | ||
| Oregon | Yes | A - See state-specific FN | 14 leave days/month of any type | Cost based payment | ||
| Pennsylvania | Yes | CN & MN | 15 hosp leave days/hospitalization, 75 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Prospective cost based per diem | |||
| South Carolina | Yes | CN | 10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year, additional days allowed for approved rehab programs or transition to community placement | Cost based payment | ||
| South Dakota | Yes | CN | 5 hosp leave days/hospitalization, 15 consecutive therapeutic leave days if in plan of care | Prospective cost based per diem with limits | ||
| Tennessee | Yes | A - See state-specific FN | 15 hosp leave days/admission if return to facility intended, 60 therapeutic leave days/year with no more than 14 days/occurrence for home visit or other therapeutic absence | Lower of reasonable cost or charge, reimbursement for hospital leave days only if 85% occupancy requirement met | ||
| Texas | Yes | CN & MN | Unlimited therapeutic leave episodes up to 3 days and one therapeutic leave episode up to 10 days/year | Private facilities paid acuity adjusted cost based per diem that varies by facility size, cost based per diem for public facilities | ||
| Utah | Yes | A - See state-specific FN | Hosp leave days not covered, 25 therapeutic leave days/quarter | Private facilities paid negotiated cost based per diem, cost based payment for public facilities | ||
| Vermont | Yes | A & B - See state-specific FN | 6 hosp leave days per acute care hospitalization, 15 therapeutic leave days/quarter up to 60 days/year | Prospective per diem | ||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN | Hosp leave days not covered, 7 consecutive therapeutic leave days up to 18 days/year | Admission | Cost based payment | |
| Washington | Yes | CN & MN | Hosp leave days not covered, 18 therapeutic leave days/year | More than 7 consecutive therapeutic leave days | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities | |
| West Virginia | Yes | A, B & C | 14 consecutive hosp leave days/hospitalization, 21 therapeutic leave days/year | Private facilities paid prospective cost related and acuity adjusted per diem with limits based on operating costs plus capital | ||
| Wisconsin | Yes | CN & MN | 15 hosp leave days/hospitalization, unlimited therapeutic leave days, facility must have 95% occupancy or fewer than 9 vacant beds to be paid | Prospective cost based per diem with some settlement, leave days paid at 85% of facility's rate | ||
| Wyoming | Yes | CN | 14 leave days of any type/year | Prospective cost based per diem with limits |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 51 No - 5 | Yes - 0 No - 51 | ||||
| Alabama | Yes | CN | Hosp leave days not covered, 14 therapeutic leave days/month, may be consecutive | Prospective cost based per diem with limits | ||
| Alaska | Yes | CN | Hosp leave days not covered, 5 therapeutic leave days/year | Initially to determine LOC, initially and periodically for LOS | Prospective cost based per diem with limits | |
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | 12 hosp leave days/year, 9 therapeutic leave days/year | Acute Care program - capitated payment through contractor, ALTCS program - prospective acuity-based per diem or negotiated rate for heavy care residents and certain facilities | ||
| Arkansas | Yes | CN | 5 hosp leave days/hospitalization, facility must have 85% occupancy rate to be paid, unlimited therapeutic leave days up to 14 consecutive days | Prospective cost based class rate for facilities with fewer than 16 beds, prospective cost based per diem for larger private facilities, cost based payment for public facilities | ||
| California | Yes | CN & MN | 7 hosp leave days/hospitalization, 73 therapeutic leave days/year | Admission | Private facilities paid standard per diem by facility size, cost based payment for public facilities | |
| Colorado | Yes | CN | Hosp leave days not covered, 42 therapeutic leave days/year | Cost based payment | ||
| Connecticut | Yes | CN & MN | 15 hosp leave days/hospitalization, 36 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Delaware | Yes | CN | 7 hosp leave days/month, 18 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| District of Columbia | Yes | CN & MN | 60 hosp or therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Florida | Yes | CN | 15 hosp leave days/hospitalization, 45 therapeutic leave days/year, 30 infirmary leave days/year with each less than 16 days and with hosp leave not covered if immediately following infirmary leave, facility must have 95% occupancy rate to be paid | Prospective cost based per diem with limits | ||
| Georgia | Yes | CN | 7 hospital leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem with limits, leave days paid 75% of per diem | ||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | 12 hosp or therapeutic leave days/year with up to 3 consecutive days | Prospective cost based per diem with limits | ||
| Idaho | Yes | CN | Services limited to Enhanced Plan, hosp leave days not covered, 14 therapeutic leave days covered per home visit up to 36 days/year - See state-specific FN | Prospective cost based per diem with limits | ||
| Illinois | Yes | CN & MN | Residents in private facilities limited to 45 hosp leave days/hospitalization and unlimited therapeutic leave days, facility must have 93% occupancy rate to be paid | Yes | Prospective cost based per diem with limits for private facilities and leave days paid at 75% of facility's rate, per diem based on certified cost for State-operated facilities | |
| Indiana | Yes | CN | 15 hosp leave days/hospitalization, 60 therapeutic leave days/year | For LOC determination upon admission | Prospective cost based per diem, leave days paid at 50% of facility's rate | |
| Iowa | Yes | CN | 10 hosp leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem with limits, leave days paid at 80% of facility's rate for facilities with more than 15 beds or at 95% if fewer beds | ||
| Kansas | Yes | CN & MN | 10 hosp leave days per acute care hospitalization, 21 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities | ||
| Kentucky | Yes | B - See state-specific FN | 45 leave days of any type/quarter, 15 hosp leave days/hospitalization, combined hosp and therapeutic leave limited to 30 consecutive days | Prospective cost based per diem, cost based payment for ancillary services | ||
| Louisiana | Yes | CN & MN | 7 hosp leave days/hospitalization, 30 consecutive therapeutic leave days up to 45/year | For LOC determination upon admission | Private facilities paid standard per diem with LOC and facility size adjustors, public facilities paid cost based per diem up to Medicare upper limit | |
| Maine | Yes | CN & MN | 25 hosp leave days/year, 52 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Maryland | Yes | CN & MN | Care rendered in state-operated institutions only | Cost based per diem up to Medicare limits | ||
| Massachusetts | Yes | CN & MN | Leave days covered if in plan of care, no annual limit | Prospective cost based per diem with limits, facilities not paid for leave days | ||
| Michigan | Yes | CN & MN | 10 hosp leave days/year, 18 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Minnesota | Yes | A - See state-specific FN | 18 hosp leave days/hospitalization, 72 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities, leave day payment dependent on occupancy level | ||
| Mississippi | Yes | CN | 15 hosp leave days/year, 84 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Missouri | Yes | CN | 12 therapeutic leave days/6 months | Prospective cost based per diem with limits for private facilities, cost based payment for public facilities | ||
| Montana | Yes | A - See state-specific FN | Hosp leave days not covered, 72 hour maximum therapeutic leave up to 24 days/year | Prospective cost based per diem with limits | ||
| Nebraska | Yes | CN & MN | 15 hosp leave days/hospitalization, 36 therapeutic leave days/year | Yes | Private facilities paid prospective cost based per diem with limits, cost based payment for state-operated facility | |
| Nevada | Yes | CN | Hosp leave days not covered, therapeutic leave limited to rehabilitative and pre-discharge transitional home and community visits up to 24 days/year | Prospective cost based per diem with limits | ||
| New Hampshire | Yes | CN & MN | Cost based payment | |||
| New Jersey | Yes | CN | 10 hosp leave days/hospitalization, 24 therapeutic leave days/year | Cost based payment | ||
| New Mexico | Yes | CN | 65 leave days/year of any type with additional 6 leave days for discharge planning | Prospective cost based per diem with limits | ||
| New York | Yes | CN & MN | Prospective cost based per diem with limits | |||
| North Carolina | Yes | CN & MN | Hosp leave days not covered, 15 consecutive therapeutic leave days up to 60 days/year | Admission | Prospective cost based per diem with limits for private facilities, cost based payment for public facilities | |
| North Dakota | Yes | CN & MN | 15 hosp leave days/hospitalization, 28 therapeutic leave days/year | Cost based payment | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | 30 hosp or therapeutic leave days/year | Prospective cost based per diem with limits, leave days paid full per diem rate | ||
| Oklahoma | Yes | CN | 14 consecutive therapeutic leave days up to 60/year | Prospective cost based per diem with limits, leave days paid 75% of facility's rate | ||
| Oregon | Yes | A - See state-specific FN | 14 leave days/month of any type | Cost based payment | ||
| Pennsylvania | Yes | CN & MN | 15 hosp leave days/hospitalization, 75 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Prospective cost based per diem | |||
| South Carolina | Yes | CN | 10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year, additional days allowed for approved rehab programs or transition to community placement | Cost based payment | ||
| South Dakota | Yes | CN | 5 hosp leave days/hospitalization, 15 consecutive therapeutic leave days if in plan of care | Prospective cost based per diem with limits | ||
| Tennessee | Yes | A - See state-specific FN | 15 hosp leave days/admission if return to facility intended, 60 therapeutic leave days/year with no more than 14 days/occurrence for home visit or other therapeutic absence | Lower of reasonable cost or charge, reimbursement for hospital leave days only if 85% occupancy requirement met | ||
| Texas | Yes | CN & MN | Unlimited therapeutic leave episodes up to 3 days and one therapeutic leave episode up to 10 days/year | Private facilities paid standard per diem based on facility size, prospective cost based per diem for public facilities | ||
| Utah | Yes | A - See state-specific FN | Hosp leave days not covered, 25 therapeutic leave days/quarter | Private facilities paid negotiated cost based per diem, cost based payment for public facilities | ||
| Vermont | Yes | A & B - See state-specific FN | 6 hosp leave days per acute care hospitalization, 15 therapeutic leave days/quarter up to 60 days/year | Cost based payment | ||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN | Hosp leave days not covered, 7 consecutive therapeutic leave days up to 18 days/year | Admission | Cost based payment | |
| Washington | Yes | CN & MN | Hosp leave days not covered, 18 therapeutic leave days/year | More than 7 consecutive therapeutic leave days | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities | |
| West Virginia | Yes | CN & MN | 14 consecutive hosp leave days/hospitalization, 21 therapeutic leave days/year | Private facilities paid prospective cost related and acuity adjusted per diem with limits based on operating costs plus capital | ||
| Wisconsin | Yes | CN & MN | 15 hosp leave days/hospitalization, unlimited therapeutic leave days, facility must have 95% occupancy or fewer than 9 vacant beds to be paid | Prospective cost based per diem with some settlement, leave days paid at 85% of facility's rate | ||
| Wyoming | Yes | CN | 14 leave days of any type/year | Prospective cost based per diem with limits |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 51 No - 5 | Yes - 0 No - 51 | ||||
| Alabama | Yes | CN | Hosp leave days not covered, 14 therapeutic leave days/month, may be consecutive | Prospective cost based per diem with limits | ||
| Alaska | Yes | CN | Hosp leave days not covered, 5 therapeutic leave days/year | Initially to determine LOC, initially and periodically for LOS | Prospective cost based per diem with limits | |
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | 12 hosp leave days/year, 9 therapeutic leave days/year | Acute Care program - capitated payment through contractor, ALTCS program - prospective acuity-based per diem or negotiated rate for heavy care residents and certain facilities | ||
| Arkansas | Yes | CN | 5 hosp leave days/hospitalization, facility must have 85% occupancy rate to be paid, unlimited therapeutic leave days up to 14 consecutive days | Prospective cost based class rate for facilities with fewer than 16 beds, prospective cost based per diem for larger private facilities, cost based payment for public facilities | ||
| California | Yes | CN & MN | 7 hosp leave days/hospitalization, 73 therapeutic leave days/year | Admission | Private facilities paid standard per diem by facility size, cost based payment for public facilities | |
| Colorado | Yes | CN | Hosp leave days not covered, 42 therapeutic leave days/year | Cost based payment | ||
| Connecticut | Yes | CN & MN | 15 hosp leave days/hospitalization, 36 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Delaware | Yes | CN | 7 hosp leave days/month, 18 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| District of Columbia | Yes | CN & MN | 18 hosp or therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Florida | Yes | CN | 15 hosp leave days/hospitalization, 45 therapeutic leave days/year, 30 infirmary leave days/year with each less than 16 days and with hosp leave not covered if immediately following infirmary leave, facility must have 95% occupancy rate to be paid | Prospective cost based per diem with limits | ||
| Georgia | Yes | CN | 7 hosp leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem with limits, leave days paid 75% of per diem | ||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | 12 hosp or therapeutic leave days/year with up to 3 consecutive days | Prospective cost based per diem with limits | ||
| Idaho | Yes | CN | Hosp leave days not covered, 14 therapeutic leave days/home visit up to 36 days/year | Prospective cost based per diem with limits | ||
| Illinois | Yes | CN & MN | Residents in private facilities limited to 45 hosp leave days/hospitalization and unlimited therapeutic leave days, facility must have 93% occupancy rate to be paid | Yes | Prospective cost based per diem with limits for private facilities and leave days paid at 75% of facility's rate, per diem based on certified cost for State-operated facilities | |
| Indiana | Yes | CN | 15 hosp leave days/hospitalization, 60 therapeutic leave days/year | For LOC determination upon admission | Prospective cost based per diem, leave days paid at 50% of facility's rate | |
| Iowa | Yes | CN | 10 hosp leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem with limits, leave days paid at 80% of facility's rate for facilities with more than 15 beds or at 95% if fewer beds | ||
| Kansas | Yes | CN & MN | 10 hosp leave days per acute care hospitalization, 21 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities | ||
| Kentucky | Yes | CN & MN | 45 leave days of any type/quarter, 15 hosp leave days/hospitalization, combined hosp and therapeutic leave limited to 30 consecutive days | Prospective cost based per diem, cost based payment for ancillary services | ||
| Louisiana | Yes | CN & MN | 7 hosp leave days/hospitalization, 30 consecutive therapeutic leave days up to 45/year | For LOC determination upon admission | Private facilities paid standard per diem with LOC and facility size adjustors, public facilities paid cost based per diem up to Medicare upper limit | |
| Maine | Yes | CN & MN | 25 hosp leave days/year, 52 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Maryland | Yes | CN & MN | Care rendered in state-operated institutions only | Cost based per diem up to Medicare limits | ||
| Massachusetts | Yes | CN & MN | Leave days covered if in plan of care, no annual limit | Prospective cost based per diem with limits, facilities not paid for leave days | ||
| Michigan | Yes | CN & MN | 10 hosp leave days/year, 18 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities, reduced per diem paid for hospital leave days | ||
| Minnesota | Yes | A - See state-specific FN | 18 hosp leave days/hospitalization, 72 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities, leave day payment dependent on occupancy level | ||
| Mississippi | Yes | CN | 15 hosp leave days/year, 84 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Missouri | Yes | CN | 3 hosp leave days/hospitalization, 12 therapeutic leave days/6 months | Prospective cost based per diem with limits for private facilities, cost based payment for public facilities | ||
| Montana | Yes | A - See state-specific FN | Hosp leave days not covered, 72 hour maximum therapeutic leave up to 24 days/year | Prospective cost based per diem with limits | ||
| Nebraska | Yes | CN & MN | 15 hosp leave days/hospitalization, 36 therapeutic leave days/year | Yes | Private facilities paid prospective cost based per diem with limits, cost based payment for state-operated facility | |
| Nevada | Yes | CN | Hosp leave days not covered, therapeutic leave limited to rehabilitative and pre-discharge transitional home and community visits up to 24 days/year | Prospective cost based per diem with limits | ||
| New Hampshire | Yes | CN & MN | Cost based payment | |||
| New Jersey | Yes | CN | 10 hosp leave days/hospitalization, 24 therapeutic leave days/year | Cost based payment | ||
| New Mexico | Yes | CN | 65 leave days/year of any type with additional 6 days allowed for discharge planning | Prospective cost based per diem with limits | ||
| New York | Yes | CN & MN | Prospective cost based per diem with limits | |||
| North Carolina | Yes | CN & MN | Hosp leave days not covered, 15 consecutive therapeutic leave days up to 60 days/year | Admission | Prospective cost based per diem with limits for private facilities, cost based payment for public facilities | |
| North Dakota | Yes | CN & MN | 15 hosp leave days/hospitalization, 28 therapeutic leave days/year | Cost based payment | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | 30 hosp or therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Oklahoma | Yes | CN | 14 consecutive therapeutic leave days up to 60/year | Prospective cost based per diem with limits, leave days paid 75% of facility's rate | ||
| Oregon | Yes | A - See state-specific FN | 14 leave days/month of any type | Cost based payment | ||
| Pennsylvania | Yes | CN & MN | 15 hosp leave days/hospitalization, 75 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Leave days not limited but must be reported monthly | Prospective cost based per diem with limits | ||
| South Carolina | Yes | CN | 10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year, additional days allowed for approved rehab programs or transition to community placement | Cost based payment | ||
| South Dakota | Yes | CN | 5 hosp leave days/hospitalization, 15 consecutive therapeutic leave days if in plan of care | Prospective cost based per diem with limits | ||
| Tennessee | Yes | A - See state-specific FN | Lower of facility cost, charge or statewide average per diem of similar facilities | |||
| Texas | Yes | CN & MN | 10 therapeutic leave days/year, may be consecutive | Private facilities paid standard per diem based on facility size, prospective cost based per diem for public facilities | ||
| Utah | Yes | A - See state-specific FN | Hosp leave days not covered, 25 therapeutic leave days/quarter | Private facilities paid negotiated cost based per diem, cost based payment for public facilities | ||
| Vermont | Yes | A & B - See state-specific FN | 6 hosp leave days per acute care hospitalization, 15 therapeutic leave days/quarter up to 60 days/year | Cost based payment | ||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN | Hosp leave days not covered, 7 consecutive therapeutic leave days up to 18 days/year | Cost based payment | ||
| Washington | Yes | CN & MN | Hosp leave days not covered, 18 therapeutic leave days/year | More than 7 consecutive therapeutic leave days | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities | |
| West Virginia | Yes | CN & MN | 14 hosp leave days/hospitalization, 21 therapeutic leave days/year | Private facilities paid prospective cost related and acuity adjusted per diem with limits based on operating costs plus capital | ||
| Wisconsin | Yes | CN & MN | 15 hosp leave days/hospitalization, unlimited therapeutic leave days, facility must have 95% occupancy or fewer than 9 vacant beds to be paid | Prospective cost based per diem with some settlement, leave days paid at 85% of facility's rate | ||
| Wyoming | Yes | CN | 14 leave days of any type/year | Prospective cost based per diem with limits |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 51 No - 5 | Yes - 0 No - 51 | ||||
| Alabama | Yes | CN | Hosp leave days not covered, 14 therapeutic leave days/month, may be consecutive | Prospective cost based per diem with limits | ||
| Alaska | Yes | CN | Hosp leave days not covered, 5 therapeutic leave days/year | Yes | Prospective cost based per diem with limits | |
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | 12 hosp leave days/year, 9 therapeutic leave days/year | Acute Care program - capitated payment through contractor, ALTCS program - prospective acuity-based per diem or negotiated rate for heavy care residents and certain facilities | ||
| Arkansas | Yes | CN | 5 hosp leave days/hospitalization, facility must have 85% occupancy rate to be paid, unlimited therapeutic leave days up to 14 consecutive days | Prospective cost based class rate for facilities with fewer than 16 beds, prospective cost based per diem for larger private facilities, cost based payment for public facilities | ||
| California | Yes | CN & MN | 7 hosp leave days/hospitalization, 73 therapeutic leave days/year | Admission | Private facilities paid standard per diem by facility size, cost based payment for public facilities | |
| Colorado | Yes | CN | Hosp leave days not covered, 42 therapeutic leave days/year | Cost based payment | ||
| Connecticut | Yes | CN & MN | 15 hosp leave days/hospitalization, 36 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Delaware | Yes | CN | 14 hosp leave days/hospitalization, 18 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| District of Columbia | Yes | CN & MN | 18 hosp or therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Florida | Yes | CN | 15 hosp leave days/hospitalization, 45 therapeutic leave days/year, 30 infirmary leave days/year with each less than 16 days and with hosp leave not covered if immediately following infirmary leave, facility must have 80% occupancy rate to be paid | Prospective cost based per diem with limits | ||
| Georgia | Yes | CN | 7 hosp leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | 12 hosp or therapeutic leave days/year with up to 3 consecutive days | Prospective cost based per diem with limits | ||
| Idaho | Yes | CN | Hosp leave days not covered, 14 therapeutic leave days/home visit up to 36 days/year | Prospective cost based per diem with limits | ||
| Illinois | Yes | CN & MN | Residents in private facilities limited to 45 hosp leave days/hospitalization and unlimited therapeutic leave days, facility must have 93% occupancy rate to be paid | Yes | Prospective cost based per diem with limits for private facilities and leave days paid at 75% of facility's rate, per diem based on certified cost for State-operated facilities | |
| Indiana | Yes | CN | 15 hosp leave days/hospitalization, 60 therapeutic leave days/year | For LOC determination upon admission | Prospective cost based per diem, leave days paid at 50% of facility's rate | |
| Iowa | Yes | CN | 10 hosp leave days/hospitalization, 18 therapeutic leave days/year | Prospective cost based per diem with limits, leave days paid at 75% of facility's rate for facilities with more than 15 beds or at 95% if fewer beds | ||
| Kansas | Yes | CN & MN | 10 hosp leave days per acute care hospitalization, 21 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities | ||
| Kentucky | Yes | CN & MN | 45 leave days of any type/quarter, 15 hosp leave days/hospitalization, combined hosp and therapeutic leave limited to 30 consecutive days | Prospective cost based per diem, cost based payment for ancillary services | ||
| Louisiana | Yes | CN & MN | 7 hosp leave days/hospitalization, 30 consecutive therapeutic leave days up to 45/year | For LOC determination upon admission | Private facilities paid standard per diem with LOC and facility size adjustors, public facilities paid cost based per diem up to Medicare upper limit | |
| Maine | Yes | CN & MN | 25 hosp leave days/year, 52 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Maryland | Yes | CN & MN | Care rendered in state-operated institutions only | Cost based per diem up to Medicare limits | ||
| Massachusetts | Yes | CN & MN | Leave days covered if in plan of care, no annual limit | Prospective cost based per diem with limits, facilities not paid for leave days | ||
| Michigan | Yes | CN & MN | 10 hosp leave days/year, 18 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities, reduced per diem paid for hospital leave days | ||
| Minnesota | Yes | A - See state-specific FN | 18 hosp leave days/year, 72 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities, leave day payment dependent on occupancy level | ||
| Mississippi | Yes | CN | 15 hosp leave days/year, 84 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Missouri | Yes | CN | 3 hosp leave days/hospitalization, 12 therapeutic leave days/6 months | Prospective cost based per diem with limits for private facilities, cost based payment for public facilities | ||
| Montana | Yes | CN & MN | Hosp leave days not covered, 72 hour maximum therapeutic leave up to 24 days/year | Prospective cost based per diem with limits | ||
| Nebraska | Yes | CN & MN | 15 hosp leave days/hospitalization, 36 therapeutic leave days/year | Yes | Private facilities paid prospective cost based per diem with limits, cost based payment for state-operated facility | |
| Nevada | Yes | CN | Hosp leave days not covered, 20 consecutive therapeutic leave days with no annual limit | Prospective cost based per diem with limits | ||
| New Hampshire | Yes | CN & MN | Cost based payment | |||
| New Jersey | Yes | CN | 10 hosp leave days/hospitalization, 24 therapeutic leave days/year | Cost based payment | ||
| New Mexico | Yes | CN | 65 leave days/year of any type plus 6 additional leave days for discharge planning | Prospective cost based per diem with limits | ||
| New York | Yes | CN & MN | Prospective cost based per diem with limits | |||
| North Carolina | Yes | CN & MN | Hosp leave days not covered, 15 consecutive therapeutic leave days up to 60 days/year | Admission | Prospective cost based per diem with limits for private facilities, cost based payment for public facilities | |
| North Dakota | Yes | CN & MN | 15 hosp leave days/hospitalization, 28 therapeutic leave days/year | Cost based payment | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | 30 hosp or therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Oklahoma | Yes | CN | 14 consecutive therapeutic leave days up to 60/year | Prospective cost based per diem with limits, leave days paid 75% of facility's rate | ||
| Oregon | Yes | CN & MN | 14 leave days/month of any type | Cost based payment | ||
| Pennsylvania | Yes | CN & MN | 15 hosp leave days/hospitalization, 75 therapeutic leave days/year | Prospective cost based per diem with limits | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Leave days not limited but must be reported monthly | Prospective cost based per diem with limits | ||
| South Carolina | Yes | CN | 10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year, additional days allowed for approved rehab programs or transition to community placement | Cost based payment | ||
| South Dakota | Yes | CN | 5 hosp leave days/hospitalization, 15 consecutive therapeutic leave days if in plan of care | Prospective cost based per diem with limits | ||
| Tennessee | Yes | A - See state-specific FN | Lower of facility cost, charge or statewide average per diem of similar facilities | |||
| Texas | Yes | CN & MN | 10 therapeutic leave days/year, may be consecutive | Cost based payment | ||
| Utah | Yes | A - See state specific FN | Hosp leave days not covered, 25 therapeutic leave days/quarter | Private facilities paid negotiated cost based per diem, cost based payment for public facilities | ||
| Vermont | Yes | A & B - See state-specific FN | 6 hosp leave days per acute care hospitalization, 15 therapeutic leave days/quarter up to 60 days/year | Cost based payment | ||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN | Hosp leave days not covered, 7 consecutive therapeutic leave days up to 18 days/year | Cost based payment | ||
| Washington | Yes | CN & MN | Hosp leave days not covered, 18 therapeutic leave days/year | More than 7 consecutive therapeutic leave days | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities | |
| West Virginia | Yes | CN & MN | 14 hosp leave days/hospitalization, 21 therapeutic leave days/year | Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities | ||
| Wisconsin | Yes | CN & MN | 15 hosp leave days/hospitalization, unlimited therapeutic leave days, facility must have 95% occupancy or fewer than 9 vacant beds to be paid | Prospective cost based per diem with some settlement, leave days paid at 85% of facility's rate | ||
| Wyoming | Yes | CN | 14 leave days of any type/year | Prospective cost based per diem with limits |