Date: June 13, 2018
To: Long Term Care Facilities - Facilities Licensed as Specialized Mental Health Rehabilitation Facilities (SMHRF)
Re: Payment Change for Therapeutic Leaves of Absence
Pursuant to Public Act 100-0587 (pdf), payment shall be made for therapeutic visits that have been indicated by an interdisciplinary team as therapeutically beneficial. This payment is limited to holding a room while the resident is temporarily away from the facility for a “therapeutic leave” only. Payment shall be at a rate of 75% of the facility’s rate as of June 4, 2018. Payment shall not exceed 20 days per fiscal year and shall not exceed 10 days consecutively.
The coding for therapeutic leaves of absence will remain very similar to what is currently required for billing of claims. The only change is that a therapeutic leave of absence billed with a Revenue Code of 0183 will be translated by Healthcare and Family Services (HFS) to a payable bed reserve code if it meets the requirements in the preceding paragraph. Revenue Code 0182 (Patient Convenience) should be used for therapeutic leaves that have not been indicated by the interdisciplinary team as therapeutically beneficial.
All therapeutic leaves of absence, whether using Revenue Code 0182 or 0183 should continue to:
1) Have a corresponding non-covered Occurrence Span Code of 74, and
2) Be included in the non-covered days with a Value Code of 81.
Below is a summary of available coding:
0182 – Leave of Absence Days, Patient Convenience = Non Payable Legacy BR code 21
0183 – Leave of Absence Days Therapeutic = Payable Legacy BR code 20
0185 – Leave of Absence Days Hospitalization = Non Payable Legacy BR code 11
Occurrence Span Codes and Dates:
74 – Non-covered Level of Care/Leave of Absence Dates
80 – Covered Days
81 – Non-covered Days (LOA days)
Although the change in payment is effective upon the Act becoming law (June 4, 2018), the claim pricing logic will require some time to develop, test and implement. Prior to the implementation of the updated pricing logic, any claims submitted with a Revenue Code of 0183 will continue to price those days at $0.
HFS is estimating this change will be implemented by September 1, 2018. Prior to that date, providers can either:
1) Hold claims that contain a Revenue Code 0183, or
2) Submit claims with a Revenue Code 0183, and then void and rebill the claim once the pricing logic is implemented.
An additional Notice will be posted when the programming logic is complete.
Paid therapeutic leaves of absence are subject to Healthcare and Family Services (HFS) review. Documentation of the interdisciplinary team’s approval must be retained and made available to reviewers upon request.
Note: No changes are being made to the required coding or payment for leaves of absence due to “hospitalization”.
If you have questions regarding the policy or billing requirements, contact the Bureau of Long Term Care toll free at 844-528-8444.
Felicia F. Norwood