October 6, 2020 Clarification to Nursing Facilities and Bed Hold Days

October 6, 2020 Clarification to Nursing Facilities and Bed Hold Days

Effective today, October 6, 2020, MaineCare will not reimburse nursing facilities (NF) for direct care costs on Bed Holds During Hospitalizations (bed hold days) and Therapeutic Leaves of Absence (LOA). These are days when a NF is not providing direct care to a member because the member is not in the facility, but the NF is receiving a bed hold or LOA payment for that member.

Per Chapter III, Section 67 of the MaineCare Benefits Manual (paragraph 9.5), in order for MaineCare to reimburse for direct care wages, those wages, “to be allowable, must be reasonable and for services that are necessary and related  to resident care and pertinent to the operation of the facility. The services must actually be performed and must be paid in full.” [emphasis added] No direct care services are provided to a resident during bed hold days/LOAs. 

This clarification is being made in response to Governor Mills’ September 17^th Executive Order and associated curtailment order, which requires DHHS to curtail spending by eliminating any payments for direct care cost claims on nursing facility bed hold days. 

Nursing Facilities that are currently submitting claims for direct care costs during bed hold days/LOAs will need to discontinue billing Rev Code 0022 (Direct Care/RUG rates) on these days), starting on October 6, 2020.

The Department will recoup any payments to nursing facilities that bill for direct care costs during bed hold days for dates of service on or after October 6, 2020.

Facilities are reimbursed for fixed costs associated with holding a bed for the member until they return through Rev Codes 0185 and 0183.

Please contact Provider Relations Specialist, Tammy Usher, with questions.