AGING AND DISABILITY SERVICES ADMINISTRATION

October 20, 2003

ADSA: AFH #2003-017
CENTRALIZED PROCESSING FOR BED HOLDS

Dear Adult Family Home Provider:

You are receiving this letter as notification that the Aging and Disability Services Administration (ADSA) is changing the way Home and Community Services (HCS) processes requests for bed holds for existing Medicaid clients temporarily discharged to a hospital or rehabilitation facility. The requirements related to requesting a bed hold remain unchanged .

Effective October 10, 2003 authorization of payments for bed holds for clients temporarily discharged for medical leave will be done at Aging and Disability Services Headquarters.

As you know, WAC 388-76-675(3)(b) requires immediate notification of the case manager when medical discharges due to injury, trauma, or significant change occur. This also assists the department in making accurate and timely payments for bed hold authorizations. Bed hold requests submitted after the fifteenth of each month will normally not be processed for payment until the supplemental SSPS run the following month.

Facility reporting requirements remain the same, except that, if a bed hold was requested, you may also report the client's return by calling the Bed Hold Toll Free number 866 -257-5066. Upon the resident's return, you still must notify the client's case manager if there is a significant change in the client's condition, for better or worse, and the plan of care no longer meets their needs.

Facilities must be careful not to claim for regular service payment during periods of absence for medical leave. Such claims may duplicate days authorized for payment through bed hold SSPS Codes 4125 and 4150 and lead to overpayments. To knowingly submit duplicate claims or regular service claims for periods of such absence may also constitute Medicaid fraud resulting in a referral for investigation to the Medicaid Fraud Unit.

If you have any questions regarding the processing of bed hold requests, please contact:

David Yarbrough, Bed Hold Program Manager
(360) 725-2449 or
(866) 257-5066 Toll Free
bedhold@dshs.wa.gov .

For questions on the bed hold policy, please contact:

George Zimmerman, Residential Policy Manager
(360) 725-2534
zimmegm@dshs.wa.gov

Sincerely,

Penny Black, Director
Home and Community Services