Policies & Guidelines
- Compliance
- Definitions
- Ambulatory Surgical Services
- Billing Policy
- Children's Services
- Chiropractic Services
- Clinic Services
- Dental
- HCBS Elderly Waiver
- Home Care
- Hospice
- Hospital Services
- Inpatient Hospital Notification and Authorization
- Laboratory/Pathology, Radiology and Diagnostic Services
- Long-Term Care
- Mental Health Services
- Optical Services
- Pharmacy Services
- Physician and Professional Services
- Rehabilitative Services
- Requirements for Providers
- Service Authorization
- Substance Use Disorder Services
- Transportation
- Tribal and Indian Health Services
- Legal References
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- Ambulatory Surgical Services
- Billing Policy
- CFSS
- Children's Services
- Chiropractic Services
- Clinic Services
- Dental
- Equipment and Supplies
- HCBS Elderly Waiver
- Home Care
- Hospice
- Hospital Services
- Housing Stabilization Services
- Immunizations and Vaccinations
- Inpatient Hospital Notification and Authorization
- Laboratory/Pathology, Radiology and Diagnostic Services
- Long-Term Care
- Member Eligibility
- Mental Health Services
- Optical Services
- Pharmacy Services
- Physician and Professional Services
- Recuperative Care
- Rehabilitative Services
- Requirements for Providers
- Service Authorization
- Substance Use Disorder Services
- Transportation
- Tribal and Indian Health Services
- Quality: HEDIS
- Policies & Procedures
Long-Term Care
Definitions
Certified Bed: A bed certified under Title XIX of the Social Security Act.
Certified Nursing Facility: A facility or part of a facility that is licensed to provide nursing care for people who are unable to care for themselves properly.
Discharge: Termination of placement in the nursing facility that is documented in the discharge summary and signed by the physician.
Facility with Distinct Part Certification: Sections of the facility certified as psychiatric, nursing facility, or Intermediate Care Facility for the Developmentally Disabled (ICF/DD) must admit and care for those Medical Assistance (Medicaid) members certified as requiring the same level of care as the bed certification.
Long-Term Care Facility (LTCF): A residential facility certified by the Minnesota Department of Health (MDH) as a Skilled Nursing Facility (SNF) or as an Intermediate Care Facility (ICF), including an ICF/DD.
Leave Day: An overnight absence of more than 23 hours. After the first 23 hours, additional leave days are accumulated each time the clock passes midnight. Absence must be for hospital or therapeutic cause.
Reserved Bed: The same bed that a member occupied before leaving the facility for hospital leave or therapeutic leave, or an appropriately certified bed if the member’s physical condition upon returning to the facility prohibits access to the bed he/she occupied before the leave. Commonly referred to as “bed hold.”
Residential Facility: Facility in which residents live in a group setting at a location that is not a single-family home or medical institution.
Skilled Nursing Facility (SNF): A licensed facility that provides skilled nursing care for acute and chronic conditions as well as additional help for activities of daily living (ADL).
Swing Bed: A hospital bed that has been granted a license under MN Stat. sec. 144.562 and which has been certified to participate in the Federal Medicare program under Title 42 United States Code (USC) Section 1395. Refer to the Swing Bed section of this chapter.
Transfer: The movement of a member after admission from one facility directly to another facility with a different provider number, or to or from a unit of a hospital to another unit recognized as a rehabilitation-distinct part by Medicare. Transfer also includes members who move to or from extended inpatient psychiatric services capacity under contract with the Minnesota Department of Human Services (DHS). Moving a member from a medical or surgical service to the acute psychiatric unit within the same hospital is not considered a transfer and must be billed as one continuous hospitalization.
PW_03-19_138
Updated_03/14/2019
