Medicaid Benefits: Services in Institutions for Mental Disease, Age 65 and Older
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2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 42 No - 4 NR - 5 | 2018 data limited to CN | Yes - 1 | Yes - 13 | Included in "Limits on Services" for 2018 | Not included in 2018 survey |
| Alabama | Yes | CN | $50 for each admission | No | - | - |
| Alaska | Yes | CN | No | No | - | - |
| Arizona | Yes | CN | No | Prior authorization required | - | - |
| Arkansas | Yes | CN | NR | NR | - | - |
| California | Yes | CN | No | Limitations vary by type of admission and services rendered. | - | - |
| Colorado | Yes | CN | No | NR | - | - |
| Connecticut | No | - | - | |||
| Delaware | Yes | CN | No | No | - | - |
| District of Columbia | Yes | CN | No | Requires UR review | - | - |
| Florida | Yes | CN | No | No | - | - |
| Georgia | Yes | CN | NR | NR | - | - |
| Hawaii | No | - | - | |||
| Idaho | Yes | CN | No | No | - | - |
| Illinois | NR | NR | NR | NR | - | - |
| Indiana | Yes | CN | No | Coverage limitations dependent on type of facility and service required, leave days not covered. | - | - |
| Iowa | NR | NR | NR | NR | - | - |
| Kansas | Yes | CN | No | No | - | - |
| Kentucky | Yes | CN | No | Must meet patient status - level of care requirements | - | - |
| Louisiana | Yes | CN | No | Coverage is limited to services provided in Title XVIII certified pyschiatric hospitals enrolled in Title XIX, and IMDs are not reimbursed for leave days. | - | - |
| 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 | Yes | CN | No | NR | - | - |
| 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 | No | - | - | |||
| New Hampshire | NR | NR | NR | NR | - | - |
| New Jersey | Yes | CN | No | No | - | - |
| New Mexico | Yes | CN | No | No | - | - |
| New York | NR | NR | NR | NR | - | - |
| North Carolina | Yes | CN | No | No | - | - |
| North Dakota | Yes | CN | No | No | - | - |
| Ohio | No | - | - | |||
| Oklahoma | Yes | CN | No | Limited to those members whose Medicare, Part A benefits are exhausted for this particular service and/or those members who are not eligible for Medicare services. | - | - |
| 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 lave 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 | No | - | - |
| Vermont | Yes | CN | No | No | - | - |
| Virginia | Yes | CN | No | NR | - | - |
| Washington | Yes | CN | No | Prior authorization required | - | - |
| West Virginia | Yes | CN | No | Based upon medical necessity | - | - |
| Wisconsin | Yes | CN | No | No | - | - |
| Wyoming | Yes | CN | No | Prior authorization required | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 46 No - 10 | Yes - 3 No - 43 | ||||
| Alabama | Yes | CN | $50/admission | 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, full per diem paid for leave days | |
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | 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 | No | |||||
| California | Yes | CN & MN | Limitations vary by type of admission and services rendered | Prospective cost based per diem | ||
| Colorado | Yes | CN | 45 days/stay | Prospective cost based per diem | ||
| Connecticut | Yes | CN & MN | 15 hosp leave days/hospitalization, 21 therapeutic leave days/year, facility must have fewer than 3 vacancies to be paid | Prospective cost based per diem or cost based payment, 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 paid by state mental health agency, full per diem paid for leave days | ||
| District of Columbia | Yes | CN & MN | 18 days hosp or therapeutic leave/year from nursing facility | Prospective cost based per diem, full per diem paid to nursing facilities for leave days | ||
| Florida | Yes | CN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem, full per diem paid for leave days | ||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | No | |||||
| Idaho | Yes | CN | Hosp leave days not covered, 3 therapeutic leave days/home visit up to 15 days/year, facility must have fewer than 5 or 5% of its licensed beds vacant to be paid | Prospective cost based per diem with limits, leave days paid at 75% of facility's rate | ||
| Illinois | Yes | CN & MN | LOS in private hospitals limited by State's Utilization Review authority | Yes | Per diem based on certified cost for state-operated facilities, prospective cost based per diem for all other facilities | |
| Indiana | Yes | CN | Coverage limitations dependent upon type of facility and service required, leave days not covered | Prospective cost based per diem | ||
| Iowa | Yes | CN | 10 hosp leave days/hospitalization, 18 therapeutic leave days/year | Prospective cost based per diem, leave days paid at 75% of facility's rate | ||
| Kansas | Yes | CN & MN | $48/hospital admission | 10 hosp leave days/acute care hospitalization, 21 hosp leave days/psychiatric hospitalization, leave days are from nursing facilities only | Cost based payment for state-operated hospitals, prospective payment/discharge using DRG for other hospitals, prospective cost based per diem with leave days paid at 67% of facility's rate for nursing facilities | |
| Kentucky | Yes | B & C - See state-specific FN | Benefit limited to short-term acute conditions, leave days must be medically necessary and included in care plan | Admission and at subsequent intervals of continued stay | 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 | Limited to inpatient hospital settings | Admission and LOS certification | Prospective cost based per diem | |
| Maine | Yes | CN & MN | 4 hosp leave days/year, 1 therapeutic leave day/year | Cost based payment using percentage of charge, full per diem paid for leave days | ||
| Maryland | Yes | CN & MN | Prospective cost set by rate commission | |||
| Massachusetts | Yes | CN & MN | Prospective cost based per diem | |||
| Michigan | Yes | CN & MN | 10 hosp leave days/year, 18 therapeutic leave days/year | Prospective payment/discharge using DRG or prospective per diem, state-owned hospitals paid allowable costs under Medicare principles | ||
| Minnesota | Yes | A - See state-specific FN | Prospective payment per discharge using DRG | |||
| Mississippi | No | |||||
| Missouri | Yes | CN | 3 hospital leave days/hospitalization if specified criteria met, 12 therapeutic leave days/6 months | Prospective per diem with limits, 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, up to Medicare limits, full per diem paid for leave days | |
| Nebraska | Yes | CN & MN | Admission and continued stay | Prospective cost based per diem | ||
| Nevada | Yes | CN | Hosp leave days not covered but 8 hour passes covered with physician order, therapeutic leave limited to rehabilitative and pre-discharge transitional home and community visits up to 24 days/year | Cost based payment, full per diem paid for leave days | ||
| New Hampshire | Yes | CN & MN | Admission to nursing facility | Prospective cost based per diem | ||
| New Jersey | Yes | CN | Nursing Facility only: 10 hosp leave days/hospitalization, 24 therapeutic leave days/year | Prospective cost based per diem; payment to facilities for bed holds during leave days is not covered | ||
| New Mexico | Yes | CN | A - 25 days/year in combination with inpatient acute and psych care, physical rehab and home health care, inpatient detox limited to 72 hours per occurrence and is included in the 25 day limit | Admission | Cost based payment with limits | |
| New York | Yes | CN & MN | 15 hosp leave days/hosp; 18 therapeutic leave days/year; facility must have 95% or higher occupancy rate to be paid | Prospective cost based per diem, some services may be paid on a fee for service basis, 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, 3 administrative leave days to facilitate transfer to less restrictive setting | Admission review required to assure appropriate level of care | Prospective cost based per diem settled annually, reduced/flat per diem rate paid for leave days | |
| North Dakota | Yes | CN & MN | Cost based per diem, with limits | |||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | Services limited to hospital settings, leave days not covered | Prospective payment/discharge using DRG | ||
| Oklahoma | Yes | CN | Prospective cost based per diem | |||
| Oregon | Yes | A - See state-specific FN | Services limited to funded conditions on the priority list, leave days not covered | Prospective cost based per diem | ||
| Pennsylvania | Yes | CN & MN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Per diem using case-mix payment system, hosp leave days paid at 1/3 of nursing facility's rate and therapeutic leave days paid at full rate | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | See state-specific FN | Leave days not covered | Prospective cost based per diem | ||
| South Carolina | Yes | CN | $25/admission | 10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year | Prospective cost based per diem, full per diem paid for leave days | |
| South Dakota | Yes | CN | 5 hosp leave days/hospitalization, 15 consecutive therapeutic leave days, therapy services limited to those provided through the facility | Prospective cost based per diem,, full per diem paid for leave days | ||
| Tennessee | Yes | A, B & C - See state-specific FN | Admission to nursing facilities | Reimbursement rates established and paid by managed care contractors | ||
| Texas | Yes | CN & MN | Limited to inpatient hospital settings | Prospective payment | ||
| Utah | Yes | A - See state-specific FN | Hosp leave days not covered, 12 therapeutic leave days/year | Prospective cost based per diem, full per diem paid for leave days | ||
| Vermont | Yes | A - See state-specific FN | Prospective payment/discharge using DRG | |||
| 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 in LTC setting | Admission | Prospective per diem or cost based payment, full per diem paid for leave days | |
| Washington | Yes | CN & MN | Hosp leave days not covered, 18 therapeutic leave days/year | Yes | Reimbursement rates generally determined by Regional Support Networks; leave day reimbursement factored into census caps for state hospitals but may not be allowed in all community facilities | |
| West Virginia | No | |||||
| Wisconsin | Yes | CN & MN | Prospective payment/discharge using DRG for private hospital IMDs, prospective cost based per diem for nursing facility and state-operated IMDs | |||
| Wyoming | Yes | CN | 14 leave days of any type/year | Nursing facilities paid prospective cost based per diem, 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 - 44 No - 12 | Yes - 1 No - 43 | ||||
| Alabama | No | |||||
| 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 | |
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | 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 | No | |||||
| California | Yes | CN & MN | Prospective cost based per diem | |||
| Colorado | Yes | CN | 45 days/stay | Prospective cost based per diem | ||
| Connecticut | Yes | CN & MN | 15 hosp leave days/hospitalization, 21 therapeutic leave days/year, facility must have fewer than 3 vacancies to be paid | Prospective cost based per diem or cost based payment | ||
| Delaware | Yes | CN | 7 hosp leave days/month, 18 therapeutic leave days/year | Prospective cost based per diem paid by state mental health agency | ||
| District of Columbia | Yes | CN & MN | 18 days hosp or therapeutic leave/year | Prospective cost based per diem | ||
| Florida | Yes | CN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem | ||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | No | |||||
| Idaho | Yes | CN | Hosp leave days not covered, 3 therapeutic leave days/home visit up to 15 days/year, facility must have fewer than 5 or 5% of its licensed beds vacant to be paid | Prospective cost based per diem with limits, leave days paid at 75% of facility's rate | ||
| Illinois | Yes | CN & MN | LOS in private hospitals limited by State's Utilization Review authority, nursing facility residents limited to and 10 hosp leave days/month and 10 therapeutic leave days/month (7 consecutive); facility must have minimum 93% occupancy rate and 90% Medicaid-eligible occupancy to be paid | Yes | Per diem based on certified cost for state-operated facilities, prospective cost based per diem for all other facilities, nursing facilities paid for leave days at 75% of facility's rate | |
| Indiana | Yes | CN | Services limited to hospital settings, 60 therapeutic leave days/year | 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, leave days paid at 75% of facility's rate | ||
| Kansas | Yes | CN & MN | $48/hospital admission | 10 hosp leave days/acute care hospitalization, 21 hosp leave days/psychiatric hospitalization and 21 therapeutic leave days/year - leave days apply to nursing facilities for mental health only | Cost based payment for state-operated hospitals, prospective payment/discharge using DRG for other hospitals, prospective cost based per diem with leave days paid at 67% of facility's rate for nursing facilities | |
| Kentucky | Yes | B & C - See state-specific FN | Benefit limited to short-term acute conditions, leave days must be medically necessary and included in care plan | Admission and at subsequent intervals of continued stay | Prospective cost based per diem, cost based payment for ancillary services | |
| Louisiana | Yes | CN & MN | Limited to inpatient hospital settings | Admission and LOS certification | Prospective cost based per diem | |
| Maine | Yes | CN & MN | 10 hosp leave days/year, 36 therapeutic leave days/year | Cost based payment using percentage of charge | ||
| Maryland | Yes | CN & MN | Prospective cost set by rate commission | |||
| Massachusetts | Yes | CN & MN | Prospective cost based per diem | |||
| Michigan | Yes | CN & MN | Prospective cost based per diem for public facilities, private facility reimbursement determined by contracted PIHPs | |||
| Minnesota | Yes | A - See state-specific FN | Prospective payment per discharge using DRG | |||
| Mississippi | No | |||||
| Missouri | Yes | CN | 3 hospital leave days/hospitalization if specified criteria met, 12 therapeutic leave days/6 months | Prospective per diem with limits | ||
| 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, up to Medicare limits | |
| Nebraska | Yes | CN & MN | Admission and continued stay | Prospective cost based per diem | ||
| Nevada | Yes | CN | Hosp leave days not covered but 8 hour passes covered with physician order, therapeutic leave limited to rehabilitative and pre-discharge transitional home and community visits up to 24 days/year | Cost based payment | ||
| New Hampshire | Yes | CN & MN | Admission to nursing facility | Prospective cost based per diem | ||
| New Jersey | Yes | CN | Nursing Facility only: 10 hosp leave days/hospitalization, 24 therapeutic leave days/year | Prospective cost based per diem | ||
| New Mexico | Yes | CN | A - 25 days/year in combination with inpatient acute and psych care, physical rehab and home health care, inpatient detox limited to 72 hours per occurrence and is included in the 25 day limit | Admission | Cost based payment with limits | |
| New York | Yes | CN & MN | 15 hosp leave days/hosp; 18 therapeutic leave days/year; facility must have 95% or higher occupancy rate to be paid | Prospective cost based per diem, some services may be paid on a fee for service basis | ||
| North Carolina | Yes | CN & MN | Hosp leave days not covered, 15 consecutive therapeutic leave days up to 60 days/year, 3 administrative leave days to facilitate transfer to less restrictive setting | Admission review required to assure appropriate level of care | Prospective cost based per diem | |
| North Dakota | Yes | CN & MN | 4 therapeutic leave days/year | Cost based per diem, with limits | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | Services limited to hospital settings, leave days not covered | Prospective payment/discharge using DRG | ||
| Oklahoma | Yes | CN | Prospective cost based per diem | |||
| Oregon | Yes | A - See state-specific FN | Services limited to funded conditions on the priority list, leave days not covered | Prospective cost based per diem | ||
| Pennsylvania | Yes | CN & MN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Per diem using case-mix payment system, hosp leave days paid at 1/3 of nursing facility's rate and therapeutic leave days paid at full rate | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | See state-specific FN | Leave days not covered | Prospective cost based per diem | ||
| South Carolina | Yes | CN | 10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year | Prospective cost based per diem | ||
| South Dakota | Yes | CN | 5 hosp leave days/hospitalization, 15 consecutive therapeutic leave days | Prospective cost based per diem | ||
| Tennessee | Yes | A & B - See state-specific FN | B - Care in nursing facilities not covered | Admission to nursing facilities | Hospital payment rate established by managed care contractor, nursing facility-specific prospective cost based per diem for level 1 and lower of facility's cost, charge or 65th percentile per diem cost of similar facilities for level 2 | |
| Texas | No | |||||
| Utah | Yes | A - See state-specific FN | Hosp leave days not covered, 12 therapeutic leave days/year | Prospective cost based per diem | ||
| Vermont | Yes | A - See state-specific FN | Prospective payment/discharge using DRG | |||
| 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 in LTC setting | Admission | Prospective per diem or cost based payment | |
| Washington | Yes | CN & MN | Hosp leave days not covered, 18 therapeutic leave days/year | Prospective cost based per diem | ||
| West Virginia | No | |||||
| Wisconsin | Yes | CN & MN | Prospective payment/discharge using DRG for private hospital IMDs, prospective cost based per diem for nursing facility and state-operated IMDs | |||
| Wyoming | Yes | CN | 14 leave days of any type/year | Private facilities paid contracted rates, public facilities paid prospective cost based per diem |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 45 No - 11 | Yes - 2 No - 43 | ||||
| Alabama | Yes | CN | Hosp leave days not covered, 6 therapeutic leave days/quarter limited to 3 days/leave up to 24 days/year | Prospective 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 | |
| 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 | No | |||||
| California | Yes | CN & MN | Prospective cost based per diem | |||
| Colorado | Yes | CN | Prospective cost based per diem | |||
| Connecticut | Yes | CN & MN | 15 hosp leave days/hospitalization, 21 therapeutic leave days/year, facility must have fewer than 3 vacancies to be paid | Prospective cost based per diem or cost based payment | ||
| Delaware | Yes | CN | 18 therapeutic leave days/year | Prospective cost based per diem | ||
| District of Columbia | Yes | CN & MN | 18 days hosp or therapeutic leave/year | Prospective cost based per diem | ||
| Florida | Yes | CN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem | ||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | No | |||||
| Idaho | Yes | CN | Hosp leave days not covered, 3 therapeutic leave days/home visit up to 15 days/year, facility must have fewer than 5 or 5% of its licensed beds vacant to be paid | Prospective cost based per diem with limits, leave days paid at 75% of facility's rate | ||
| Illinois | Yes | CN & MN | LOS in private hospitals limited by State's Utilization Review authority, nursing facility residents limited to 7 therapeutic leave days/absence up to 10/month with no coverage of hosp leave days and facility must have 93% occupancy rate to be paid | Yes | Per diem based on certified cost for state-operated facilities, prospective cost based per diem for all other facilities, nursing facilities paid for leave days at 75% of facility's rate | |
| Indiana | Yes | CN | Services limited to hospital settings, 60 therapeutic leave days/year | 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, leave days paid at 75% of facility's rate | ||
| Kansas | Yes | CN & MN | $48/hospital admission | 10 hosp leave days/acute care hospitalization, 21 hosp leave days/psychiatric hospitalization and 21 therapeutic leave days/year - leave days apply to nursing facilities for mental health only | Cost based payment for state-operated hospitals, prospective payment/discharge using DRG for other hospitals, prospective cost based per diem with leave days paid at 67% of facility's rate for nursing facilities | |
| Kentucky | Yes | B & C - See state-specific FN | Leave days must be medically necessary and included in care plan | Prospective cost based per diem, cost based payment for ancillary services | ||
| Louisiana | Yes | CN & MN | Limited to inpatient hospital settings | Admission and LOS certification | Prospective cost based per diem | |
| Maine | Yes | CN & MN | 10 hosp leave days/year, 36 therapeutic leave days/year | Cost based payment using percentage of charge | ||
| Maryland | Yes | CN & MN | Nursing facility and intermediate care facility residents limited to 15 hosp leave days/hospitalization, 18 therapeutic leave days/year | Prospective cost set by rate commission | ||
| Massachusetts | Yes | CN & MN | Prospective cost based per diem | |||
| Michigan | Yes | CN & MN | Prospective cost based per diem for public facilities, private facility reimbursement determined by contracted PIHPs | |||
| Minnesota | Yes | A - See state-specific FN | Prospective payment per discharge using DRG | |||
| Mississippi | No | |||||
| Missouri | Yes | CN | 12 therapeutic leave days/6 months | Prospective cost based per diem | ||
| 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, up to Medicare limits | |
| Nebraska | Yes | CN & MN | Preadmission certification | Prospective cost based per diem | ||
| 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 | Cost based payment | ||
| New Hampshire | Yes | CN & MN | Admission to nursing facility | Prospective cost based per diem | ||
| New Jersey | Yes | CN | Nursing Facility only: 10 hosp leave days/hospitalization, 24 therapeutic leave days/year | Prospective cost based per diem | ||
| New Mexico | Yes | CN | Admission | Cost based payment with limits | ||
| New York | Yes | CN & MN | Prospective cost based per diem, some services may be paid on a fee for service basis | |||
| North Carolina | Yes | CN & MN | Hosp leave days not covered, 15 consecutive therapeutic leave days up to 60 days/year, 3 administrative leave days to facilitate transfer to less restrictive setting | Admission | Prospective cost based per diem | |
| North Dakota | Yes | CN & MN | 28 therapeutic leave days/year | Cost based per diem, with limits | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | Services limited to hospital settings, leave days not covered | Prospective payment/discharge using DRG | ||
| Oklahoma | Yes | CN | Prospective cost based per diem | |||
| Oregon | Yes | A - See state-specific FN | Leave days not covered | Prospective cost based per diem | ||
| Pennsylvania | Yes | CN & MN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Per diem using case-mix payment system, hosp leave days paid at 1/3 of nursing facility's rate and therapeutic leave days paid at full rate | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Leave days not covered | Prospective cost based per diem | ||
| South Carolina | Yes | CN | 10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year | Prospective cost based per diem | ||
| South Dakota | Yes | CN | 5 hosp leave days/hospitalization, 15 consecutive therapeutic leave days | Prospective cost based per diem | ||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $100/hospital admission, B2 - $200/hospital admission | B - Care in nursing facilities not covered | Admission to nursing facilities | Hospital payment rate established by MCC, nursing facility-specific prospective cost based per diem for level 1 and lower of facility's cost, charge or 65th percentile per diem cost of similar facilities for level 2 |
| Texas | No | |||||
| Utah | Yes | A - See state-specific FN | Hosp leave days not covered, 12 therapeutic leave days/year | Prospective cost based per diem | ||
| Vermont | Yes | A - See state-specific FN | Prospective payment/discharge using DRG | |||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN | Hosp leave days not covered, 7 consecutive therapeutic leave days up to 18 days/year | Admission | Prospective per diem or cost based payment | |
| Washington | Yes | CN & MN | Hosp leave days not covered, 18 therapeutic leave days/year | Prospective cost based per diem | ||
| West Virginia | No | |||||
| Wisconsin | Yes | CN & MN | Prospective payment/discharge using DRG for private hospital IMDs, prospective cost based per diem for nursing facility and state-operated IMDs | |||
| Wyoming | Yes | CN | 14 leave days of any type/year | Private facilities paid contracted rates, public facilities paid prospective cost based per diem |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 45 No - 11 | Yes - 2 No - 43 | ||||
| Alabama | Yes | CN | Hosp leave days not covered, 3 therapeutic leave days/absence up to 2 absences/quarter or 6/year | Prospective 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 | |
| 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 | No | |||||
| California | Yes | CN & MN | Prospective cost based per diem | |||
| Colorado | Yes | CN | Hosp leave days not covered, 42 therapeutic leave days/year | Prospective cost based per diem | ||
| Connecticut | Yes | CN & MN | 15 hosp leave days/hospitalization, 21 therapeutic leave days/year, facility must have fewer than 3 vacancies to be paid | Prospective cost based per diem or cost based payment | ||
| Delaware | Yes | CN | 18 therapeutic leave days/year | Prospective cost based per diem | ||
| District of Columbia | Yes | CN & MN | 18 days hosp or therapeutic leave/year | Prospective cost based per diem | ||
| Florida | Yes | CN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem | ||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | No | |||||
| Idaho | Yes | CN | Hosp leave days not covered, 3 therapeutic leave days/home visit up to 15 days/year, facility must have fewer than 5 or 5% of its licensed beds vacant to be paid | Prospective cost based per diem, leave days paid at 75% of facility's rate | ||
| Illinois | Yes | CN & MN | LOS in private hospitals limited by State's Utilization Review authority, nursing facility residents limited to 7 therapeutic leave days/absence up to 10/month with no coverage of hosp leave days and facility must have 93% occupancy rate to be paid | Yes | Per diem based on certified cost for state-operated facilities, prospective cost based per diem for all other facilities, nursing facilities paid for leave days at 75% of facility's rate | |
| Indiana | Yes | CN | Services limited to hospital settings, 60 therapeutic leave days/year | 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, leave days paid at 75% of facility's rate | ||
| Kansas | Yes | CN & MN | $48/admission | 10 hosp leave days/hospitalization, 21 therapeutic leave days/year | Prospective cost based per diem, leave days paid at 67% of facility's rate | |
| Kentucky | Yes | B & C - See state-specific FN | Leave days must be medically necessary and included in care plan | Prospective cost based per diem, cost based payment for ancillary services | ||
| Louisiana | Yes | CN & MN | Limited to inpatient hospital settings | Admission and LOS certification | Prospective cost based per diem | |
| Maine | Yes | CN & MN | 10 hosp leave days/year, 36 therapeutic leave days/year | Cost based payment using percentage of charge | ||
| Maryland | Yes | CN & MN | Prospective cost set by rate commission | |||
| Massachusetts | Yes | CN & MN | Prospective cost based per diem | |||
| Michigan | Yes | CN & MN | 10 hosp leave days/year, 18 therapeutic leave days/year | Prospective cost based per diem for public facilities, private facility reimbursement determined by contracted PIHPs | ||
| Minnesota | Yes | A - See state-specific FN | Prospective payment per discharge using DRG | |||
| Mississippi | No | |||||
| Missouri | Yes | CN | 12 therapeutic leave days/6 months | Prospective cost based per diem | ||
| 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, up to Medicare limits | ||
| Nebraska | Yes | CN & MN | Preadmission certification | Prospective cost based per diem | ||
| 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 | Cost based payment | ||
| New Hampshire | Yes | CN & MN | Admission to nursing facility | Prospective cost based per diem | ||
| New Jersey | Yes | CN | 10 hosp leave days/hospitalization, 24 therapeutic leave days/year | Prospective cost based per diem | ||
| New Mexico | Yes | CN | Admission | Cost based payment with limits | ||
| New York | Yes | CN & MN | Prospective cost based per diem | |||
| North Carolina | Yes | CN & MN | Hosp leave days not covered, 15 consecutive therapeutic leave days up to 60 days/year, 3 administrative leave days to facilitate transfer to less restrictive setting | Admission | Prospective cost based per diem | |
| North Dakota | Yes | CN & MN | 28 therapeutic leave days/year | Cost based per diem, with limits | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | Services limited to hospital settings, leave days not covered | Prospective payment/discharge using DRG | ||
| Oklahoma | Yes | CN | Prospective cost based per diem | |||
| Oregon | Yes | A - See state-specific FN | Leave days not covered | Prospective cost based per diem | ||
| Pennsylvania | Yes | CN & MN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Per diem using case-mix payment system, hosp leave days paid at 1/3 of nursing facility's rate and therapeutic leave days paid at full rate | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Leave days not covered | Prospective cost based per diem | ||
| South Carolina | Yes | CN | 10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year | Prospective cost based per diem | ||
| South Dakota | Yes | CN | 5 hosp leave days/hospitalization, 15 consecutive therapeutic leave days | Prospective cost based per diem | ||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $100/hospital admission, B2 - $200/hospital admission | B - Care in nursing facilities not covered | Admission to nursing facilities | Hospital payment rate established by MCC, nursing facility-specific prospective cost based per diem for level 1 and lower of facility's cost, charge or 65th percentile per diem cost of similar facilities for level 2 |
| Texas | No | |||||
| Utah | Yes | A - See state-specific FN | Hosp leave days not covered, 12 therapeutic leave days/year | Prospective cost based per diem | ||
| Vermont | Yes | A - See state-specific FN | Prospective payment/discharge using DRG | |||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN | Hosp leave days not covered, 7 consecutive therapeutic leave days up to 18 days/year | Admission | Prospective per diem | |
| Washington | Yes | CN & MN | Hosp leave days not covered, 18 therapeutic leave days/year | Prospective cost based per diem | ||
| West Virginia | No | |||||
| Wisconsin | Yes | CN & MN | Prospective payment/discharge using DRG for private hospital IMDs, prospective cost based per diem for nursing facility and state-operated IMDs | |||
| Wyoming | Yes | CN | 14 leave days of any type/year | Private facilities paid contracted rates, public facilities paid prospective cost based per diem |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 45 No - 11 | Yes - 2 No - 43 | ||||
| Alabama | Yes | CN | Hosp leave days not covered, 3 therapeutic leave days/absence up to 2 absences/quarter or 6/year | Prospective 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 | |
| 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 | No | |||||
| California | Yes | CN & MN | Prospective cost based per diem | |||
| Colorado | Yes | CN | Hosp leave days not covered, 42 therapeutic leave days/year | Prospective cost based per diem | ||
| Connecticut | Yes | CN & MN | 15 hosp leave days/hospitalization, 21 therapeutic leave days/year, facility must have fewer than 3 vacancies to be paid | Prospective cost based per diem or cost based payment | ||
| Delaware | Yes | CN | 18 therapeutic leave days/year | Prospective cost based per diem | ||
| District of Columbia | Yes | CN & MN | 18 days hosp or therapeutic leave/year | Prospective cost based per diem | ||
| Florida | Yes | CN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem | ||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | No | |||||
| Idaho | Yes | CN | Hosp leave days not covered, 3 therapeutic leave days/home visit up to 15 days/year, facility must have fewer than 5 or 5% of its licensed beds vacant to be paid | Prospective cost based per diem, leave days paid at 75% of facility's rate | ||
| Illinois | Yes | CN & MN | LOS in private hospitals limited by State's Utilization Review authority, nursing facility residents limited to 7 therapeutic leave days/absence up to 10/month with no coverage of hosp leave days and facility must have 93% occupancy rate to be paid | Yes | Per diem based on certified cost for state-operated facilities, prospective cost based per diem for all other facilities, nursing facilities paid for leave days at 75% of facility's rate | |
| Indiana | Yes | CN | Services limited to hospital settings, 60 therapeutic leave days/year | 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, leave days paid at 75% of facility's rate | ||
| Kansas | Yes | CN & MN | $48/admission | 10 hosp leave days/hospitalization, 21 therapeutic leave days/year | Prospective cost based per diem, leave days paid at 67% of facility's rate | |
| Kentucky | Yes | CN & MN | Leave days must be medically necessary and included in care plan | Prospective cost based per diem, cost based payment for ancillary services | ||
| Louisiana | Yes | CN & MN | Limited to inpatient hospital settings | Admission and LOS certification | Prospective cost based per diem | |
| Maine | Yes | CN & MN | 10 hosp leave days/year, 36 therapeutic leave days/year | Cost based payment using percentage of charge | ||
| Maryland | Yes | CN & MN | Prospective cost set by rate commission | |||
| Massachusetts | Yes | CN & MN | Prospective cost based per diem | |||
| Michigan | Yes | CN & MN | 10 hosp leave days/year, 18 therapeutic leave days/year | Prospective cost based per diem with limits, reduced per diem paid for hospital leave days | ||
| Minnesota | Yes | A - See state-specific FN | Prospective payment per discharge using DRG | |||
| Mississippi | No | |||||
| Missouri | Yes | CN | 3 hosp leave days/hospitalization, 12 therapeutic leave days/6 months | Prospective cost based per diem | ||
| 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, up to Medicare limits | ||
| Nebraska | Yes | CN & MN | Preadmission certification | Prospective cost based per diem | ||
| 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 | Cost based payment | ||
| New Hampshire | Yes | CN & MN | Admission to nursing facility | Prospective cost based per diem | ||
| New Jersey | Yes | CN | 10 hosp leave days/hospitalization, 24 therapeutic leave days/year | Prospective cost based per diem | ||
| New Mexico | Yes | CN | Admission | Cost based payment with limits | ||
| New York | Yes | CN & MN | Prospective cost based per diem | |||
| North Carolina | Yes | CN & MN | Hosp leave days not covered, 15 consecutive therapeutic leave days up to 60 days/year, 3 administrative leave days to facilitate transfer to less restrictive setting | Admission | Prospective cost based per diem | |
| North Dakota | Yes | CN & MN | 28 therapeutic leave days/year | Cost based per diem, with limits | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | Services limited to hospital settings, leave days not covered | Prospective payment/discharge using DRG | ||
| Oklahoma | Yes | CN | Prospective cost based per diem | |||
| Oregon | Yes | A - See state-specific FN | Leave days not covered | Prospective cost based per diem | ||
| Pennsylvania | Yes | CN & MN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Per diem using case-mix payment system, hosp leave days paid at 1/3 of nursing facility's rate and therapeutic leave days paid at full rate | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Leave days not covered | Prospective cost based per diem | ||
| South Carolina | Yes | CN | 10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year | Prospective cost based per diem | ||
| South Dakota | Yes | CN | 5 hosp leave days/hospitalization, 15 consecutive therapeutic leave days | Prospective cost based per diem | ||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $100/hospital admission, B2 - $200/hospital admission | B - Care in nursing facilities not covered | Admission to nursing facilities | Hospital payment rate established by BHO, nursing facility-specific prospective cost based per diem for level 1 and lower of facility's cost, charge or 65th percentile per diem cost of similar facilities for level 2 |
| Texas | No | |||||
| Utah | Yes | A - See state-specific FN | Hosp leave days not covered, 12 therapeutic leave days/year | Prospective cost based per diem | ||
| Vermont | Yes | A - See state-specific FN | Prospective payment/discharge using DRG | |||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN | Hosp leave days not covered, 7 consecutive therapeutic leave days up to 18 days/year | Prospective cost based per diem | ||
| Washington | Yes | CN & MN | Hosp leave days not covered, 18 therapeutic leave days/year | Prospective cost based per diem | ||
| West Virginia | No | |||||
| Wisconsin | Yes | CN & MN | Prospective payment/discharge using DRG for private hospital IMDs, prospective cost based per diem for nursing facility and state-operated IMDs | |||
| Wyoming | Yes | CN | 14 leave days of any type/year | Private facilities paid contracted rates, public facilities paid prospective cost based per diem |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 46 No - 10 | Yes - 2 No - 44 | ||||
| Alabama | Yes | CN | Hosp leave days not covered, 3 therapeutic leave days/absence up to 2 absences/quarter or 6/year | Prospective cost based per diem | ||
| Alaska | Yes | CN | Hosp leave days not covered, 5 therapeutic leave days/year | Yes | Prospective cost based per diem | |
| 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 | No | |||||
| California | Yes | CN & MN | Prospective cost based per diem | |||
| Colorado | Yes | CN | Hosp leave days not covered, 42 therapeutic leave days/year | Prospective cost based per diem | ||
| Connecticut | Yes | CN & MN | 15 hosp leave days/hospitalization, 21 therapeutic leave days/year, facility must have fewer than 3 vacancies to be paid | Prospective cost based per diem or cost based payment | ||
| Delaware | Yes | CN | 18 therapeutic leave days/year | Prospective cost based per diem | ||
| District of Columbia | Yes | CN & MN | 18 days hosp or therapeutic leave/year | Prospective cost based per diem | ||
| Florida | Yes | CN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Prospective cost based per diem | ||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | No | |||||
| Idaho | Yes | CN | Hosp leave days not covered, 3 therapeutic leave days/home visit up to 15 days/year, facility must have fewer than 5 or 5% of its licensed beds vacant to be paid | Prospective cost based per diem, leave days paid at 75% of allowable costs | ||
| Illinois | Yes | CN & MN | LOS in private hospitals limited by State's Utilization Review authority, nursing facility residents limited to 7 therapeutic leave days/absence up to 10/month with no coverage of hosp leave days and facility must have 93% occupancy rate to be paid | Yes | Per diem based on certified cost for state-operated facilities, prospective cost based per diem for all other facilities, nursing facilities paid for leave days at 75% of facility's rate | |
| Indiana | Yes | CN | Services limited to hospital settings, 30 therapeutic leave days/year | 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, leave days paid at 75% of facility's rate | ||
| Kansas | Yes | CN & MN | $48/admission | 10 hosp leave days/hospitalization, 21 therapeutic leave days/year | Prospective cost based per diem, leave days paid at 67% of facility's rate | |
| Kentucky | Yes | CN & MN | Leave days must be medically necessary and included in care plan | Prospective cost based per diem, cost based payment for ancillary services | ||
| Louisiana | Yes | CN & MN | Limited to inpatient hospital settings | Admission and LOS certification | Prospective cost based per diem | |
| Maine | Yes | CN & MN | 10 hosp leave days/year, 36 therapeutic leave days/year | Cost based payment using percentage of charge | ||
| Maryland | Yes | CN & MN | Prospective cost set by rate commission | |||
| Massachusetts | Yes | CN & MN | Prospective cost based per diem | |||
| Michigan | Yes | CN & MN | 10 hosp leave days/year, 18 therapeutic leave days/year | Prospective cost based per diem with limits, reduced per diem paid for hospital leave days | ||
| Minnesota | Yes | A - See state-specific FN | Prospective payment per discharge using DRG | |||
| Mississippi | No | |||||
| Missouri | Yes | CN | 3 hosp leave days/hospitalization, 12 therapeutic leave days/6 months | Prospective cost based per diem | ||
| Montana | Yes | CN & MN | Hosp leave days not covered, 72 hour maximum therapeutic leave up to 24 days/year | Prospective cost based per diem, up to Medicare limits | ||
| Nebraska | Yes | CN & MN | Preadmission certification | Prospective cost based per diem | ||
| Nevada | Yes | CN | Hosp leave days not covered, one 72-hour maximum therapeutic leave/month or 96 hours if weekend included | Cost based payment | ||
| New Hampshire | Yes | CN & MN | Admission to nursing facility | Prospective cost based per diem | ||
| New Jersey | Yes | CN | 10 hosp leave days/hospitalization, 24 therapeutic leave days/year | Prospective cost based per diem | ||
| New Mexico | Yes | CN | Admission | Cost based payment with limits | ||
| New York | Yes | CN & MN | Prospective cost based per diem | |||
| North Carolina | Yes | CN & MN | Hosp leave days not covered, 15 consecutive therapeutic leave days up to 60 days/year, 3 administrative leave days to facilitate transfer to less restrictive setting | Admission | Prospective cost based per diem | |
| North Dakota | Yes | CN & MN | 28 therapeutic leave days/year | Cost based per diem, with limits | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | Services limited to hospital settings, leave days not covered | Prospective payment/discharge using DRG | ||
| Oklahoma | Yes | CN | Prospective cost based per diem | |||
| Oregon | Yes | CN & MN | Leave days not covered | Prospective cost based per diem | ||
| Pennsylvania | Yes | CN & MN | 15 hosp leave days/hospitalization, 30 therapeutic leave days/year | Per diem using case-mix payment system, hosp leave days paid at 1/3 of nursing facility's rate and therapeutic leave days paid at full rate | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Leave days not covered | Prospective cost based per diem | ||
| South Carolina | Yes | CN | 10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year | Prospective cost based per diem | ||
| South Dakota | Yes | CN | 5 hosp leave days/hospitalization, 15 consecutive therapeutic leave days | Prospective cost based per diem | ||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $100/hospital admission, B2 - $200/hospital admission | B - Care in nursing facilities not covered | Admission to nursing facilities | Hospital payment rate established by BHO, nursing facility-specific prospective cost based per diem for level 1 and lower of facility's cost, charge or 65th percentile per diem cost of similar facilities for level 2 |
| Texas | Yes | CN & MN | Leave days not covered | Prospective cost based per diem | ||
| Utah | Yes | A - See state specific FN | Hosp leave days not covered, 12 therapeutic leave days/year | Prospective cost based per diem | ||
| Vermont | Yes | A - See state-specific FN | Prospective payment/discharge using DRG | |||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN | Hosp leave days not covered, 7 consecutive therapeutic leave days up to 18 days/year | Prospective cost based per diem | ||
| Washington | Yes | CN & MN | Hosp leave days not covered, 18 therapeutic leave days/year | Prospective cost based per diem | ||
| West Virginia | No | |||||
| Wisconsin | Yes | CN & MN | Prospective cost based per diem | |||
| Wyoming | Yes | CN | 14 leave days of any type/year | Private facilities paid contracted rates, public facilities paid prospective cost based per diem |