| Is the Benefit Covered? |
Copayment Requirement |
Prior Approval Requirement |
Coverage Limitations |
Reimbursement Methodology |
Populations Covered |
|
|
Alabama
|
|
Yes
|
|
|
Hosp leave days not covered, 14 therapeutic leave days/month, may be consecutive
|
Prospective cost based per diem with limits
|
CN
|
|
Alaska
|
|
Yes
|
|
Initially to determine LOC, initially and periodically for LOS
|
Hosp leave days not covered, 5 therapeutic leave days/year
|
Prospective cost based per diem with limits
|
CN
|
|
Arizona
|
|
Yes
|
|
|
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
|
CN & MN
|
|
Arkansas
|
|
Yes
|
|
|
5 hosp leave days/hospitalization, facility must have 85% occupancy rate to be paid, unlimited therapeutic leave days up to 14 consecutive days
|
Prospective cost based class rate for facilities with fewer than 16 beds, prospective cost based per diem for larger private facilities, cost based payment for public facilities
|
CN
|
|
California
|
|
Yes
|
|
Admission
|
7 hosp leave days/hospitalization, 73 therapeutic leave days/year
|
Private facilities paid standard per diem by facility size, cost based payment for public facilities
|
CN & MN
|
|
Colorado
|
|
Yes
|
|
|
Hosp leave days not covered, 42 therapeutic leave days/year
|
Cost based payment
|
CN
|
|
Connecticut
|
|
Yes
|
|
|
15 hosp leave days/hospitalization, 36 therapeutic leave days/year
|
Prospective cost based per diem with limits
|
CN & MN
|
|
Delaware
|
|
Yes
|
|
|
7 hosp leave days/month, 18 therapeutic leave days/year
|
Prospective cost based per diem with limits
|
CN
|
|
District of Columbia
|
|
Yes
|
|
|
60 hosp or therapeutic leave days/year
|
Prospective cost based per diem with limits
|
CN & MN
|
|
Florida
|
|
Yes
|
|
|
15 hosp leave days/hospitalization, 45 therapeutic leave days/year, 30 infirmary leave days/year with each less than 16 days and with hosp leave not covered if immediately following infirmary leave, facility must have 95% occupancy rate to be paid
|
Prospective cost based per diem with limits
|
CN
|
|
Georgia
|
|
Yes
|
|
Yes
|
|
Prospective cost based per diem with limits, leave days paid 95% of per diem
|
CN
|
|
Hawaii
|
|
Yes
|
|
Yes
|
12 hosp or therapeutic leave days/year with up to 3 consecutive days
|
Prospective cost based per diem with limits
|
CN & MN
|
|
Idaho
|
|
Yes
|
|
|
Services limited to Enhanced Plan and Medicare/Medicaid Coordinatd Plan, hosp leave days not covered, 14 therapeutic leave days covered per home visit up to 36 days/year - See state-specific FN
|
Prospective cost based per diem with limits, leave days paid at 75% of facility's rate
|
CN
|
|
Illinois
|
|
Yes
|
|
Yes
|
Residents in private facilities limited to 45 hosp leave days/hospitalization and unlimited therapeutic leave days, facility must have 93% occupancy rate to be paid
|
Prospective cost based per diem with limits for private facilities and leave days paid at 75% of facility's rate, per diem based on certified cost for State-operated facilities
|
CN & MN
|
|
Indiana
|
|
Yes
|
|
For LOC determination upon admission
|
15 hosp leave days/hospitalization, 60 therapeutic leave days/year
|
Prospective cost based per diem, leave days paid at 50% of facility's rate
|
CN
|
|
Iowa
|
|
Yes
|
|
|
10 hosp leave days/hospitalization, 30 therapeutic leave days/year
|
Prospective cost based per diem with limits, leave days paid at 80% of facility's rate for facilities with more than 15 beds or at 95% if fewer beds
|
CN
|
|
Kansas
|
|
Yes
|
|
|
10 hosp leave days per acute care hospitalization, 21 therapeutic leave days/year
|
Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities
|
CN & MN
|
|
Kentucky
|
|
Yes
|
|
|
45 leave days of any type/quarter, 15 hosp leave days/hospitalization, combined hosp and therapeutic leave limited to 30 consecutive days
|
Prospective cost based per diem, cost based payment for ancillary services
|
C - See state-specific FN
|
|
Louisiana
|
|
Yes
|
|
For LOC determination upon admission
|
7 hosp leave days/hospitalization, 30 consecutive therapeutic leave days up to 45/year
|
Private facilities paid standard per diem with LOC and facility size adjustors, public facilities paid cost based per diem up to Medicare upper limit
|
CN & MN
|
|
Maine
|
|
Yes
|
|
|
25 hosp leave days/year, 52 therapeutic leave days/year
|
Prospective cost based per diem with limits
|
CN & MN
|
|
Maryland
|
|
Yes
|
|
|
Care rendered in state-operated institutions only
|
Cost based per diem up to Medicare limits
|
CN & MN
|
|
Massachusetts
|
|
Yes
|
|
|
Leave days covered if in plan of care, no annual limit
|
Prospective cost based per diem with limits, facilities not paid for leave days
|
CN & MN
|
|
Michigan
|
|
Yes
|
|
|
|
Prospective cost based per diem fwith limits
|
CN & MN
|
|
Minnesota
|
|
Yes
|
|
|
18 hosp leave days/hospitalization, 72 therapeutic leave days/year
|
Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities, leave day payment dependent on occupancy level
|
A - See state-specific FN
|
|
Mississippi
|
|
Yes
|
|
|
15 hosp leave days/year, 84 therapeutic leave days/year
|
Prospective cost based per diem with limits
|
CN
|
|
Missouri
|
|
Yes
|
|
|
12 therapeutic leave days/6 months
|
Prospective cost based per diem with limits for private facilities, cost based payment for public facilities
|
CN & MN
|
|
Montana
|
|
Yes
|
|
Therapeutic leave exceeding 3 days
|
Hosp leave days not covered, 24 therapeutic leave days/year
|
Prospective cost based per diem with limits
|
A - See state-specific FN
|
|
Nebraska
|
|
Yes
|
|
Yes
|
15 hosp leave days/hospitalization, 36 therapeutic leave days/year
|
Private facilities paid prospective cost based per diem with limits, cost based payment for state-operated facility
|
CN & MN
|
|
Nevada
|
|
Yes
|
|
|
Hosp leave days not covered, therapeutic leave limited to rehabilitative and pre-discharge transitional home and community visits up to 24 days/year
|
Prospective cost based per diem with limits
|
CN
|
|
New Hampshire
|
|
No
|
|
|
|
|
|
|
New Jersey
|
|
Yes
|
|
|
10 hosp leave days/hospitalization, 24 therapeutic leave days/year
|
Cost based payment
|
CN
|
|
New Mexico
|
|
Yes
|
|
|
65 leave days/year of any type with additional 6 days allowed if approved plus 6 leave days for discharge planning
|
Prospective cost based per diem with limits
|
CN
|
|
New York
|
|
Yes
|
|
|
|
Prospective cost based per diem with limits
|
CN & MN
|
|
North Carolina
|
|
Yes
|
|
Admission
|
Hosp leave days not covered, 15 consecutive therapeutic leave days up to 60 days/year
|
Prospective cost based per diem with limits for private facilities, cost based payment for public facilities
|
CN & MN
|
|
North Dakota
|
|
Yes
|
|
|
15 hosp leave days/hospitalization, 28 therapeutic leave days/year
|
Cost based payment
|
CN & MN
|
|
Ohio
|
|
Yes
|
|
|
30 hosp or therapeutic leave days/year
|
Prospective cost based per diem with limits, leave days paid full per diem rate
|
CN
|
|
Oklahoma
|
|
Yes
|
|
|
14 consecutive therapeutic leave days up to 60/year
|
Prospective cost based per diem with limits, leave days paid 75% of facility's rate
|
CN
|
|
Oregon
|
|
Yes
|
|
|
14 leave days/month of any type
|
Cost based payment
|
A - See state-specific FN
|
|
Pennsylvania
|
|
Yes
|
|
|
15 hosp leave days/hospitalization, 75 therapeutic leave days/year
|
Prospective cost based per diem with limits
|
CN & MN
|
|
Rhode Island
|
|
Yes
|
|
|
|
Prospective cost based per diem
|
CN & MN - see state-specific FN
|
|
South Carolina
|
|
Yes
|
|
|
10 hosp leave days/hospitalization, 9 consecutive therapeutic leave days up to 18 days/year, additional days allowed for approved rehab programs or transition to community placement
|
Cost based payment
|
CN
|
|
South Dakota
|
|
Yes
|
|
|
5 hosp leave days/hospitalization, 15 consecutive therapeutic leave days if in plan of care
|
Prospective cost based per diem with limits
|
CN
|
|
Tennessee
|
|
Yes
|
|
|
15 hosp leave days/admission if return to facility intended, 60 therapeutic leave days/year with no more than 14 days/occurrencefor home visit or other therapeutic absence
|
Lower of reasonable cost or charge, reimbursement for hospital leave days only if 85% occupancy requirement met
|
A - See state-specific FN
|
|
Texas
|
|
Yes
|
|
|
Unlimited therapeutic leave episodes up to 3 days and one therapeutic leave episode up to 10 days/year
|
Private facilities paid acuity adjusted cost based per diem that varies by facility size, cost based per diem for public facilities
|
CN & MN
|
|
Utah
|
|
Yes
|
|
|
Hosp leave days not covered, 25 therapeutic leave days/quarter
|
Private facilities paid negotiated cost based per diem, cost based payment for public facilities
|
A - See state-specific FN
|
|
Vermont
|
|
Yes
|
|
|
6 hosp leave days per acute care hospitalization, 15 therapeutic leave days/quarter up to 60 days/year
|
Prospective per diem
|
A & B - See state-specific FN
|
|
Virginia
|
|
Yes
|
|
Admission
|
Hosp leave days not covered, 7 consecutive therapeutic leave days up to 18 days/year
|
Cost based payment
|
CN
|
|
Washington
|
|
Yes
|
|
More than 7 consecutive therapeutic leave days
|
Hosp leave days not covered, 18 therapeutic leave days/year
|
Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities
|
CN & MN
|
|
West Virginia
|
|
Yes
|
|
|
14 hosp leave days/hospitalization, 21 therapeutic leave days/year
|
Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities
|
A & B
|
|
Wisconsin
|
|
Yes
|
|
|
15 hosp leave days/hospitalization, unlimited therapeutic leave days, facility must have 95% occupancy or fewer than 9 vacant beds to be paid
|
Prospective cost based per diem with some settlement, leave days paid at 85% of facility's rate
|
CN & MN
|
|
Wyoming
|
|
Yes
|
|
|
14 leave days of any type/year
|
Prospective cost based per diem with limits
|
CN
|
|
American Samoa
|
|
No
|
|
|
|
|
|
|
Guam
|
|
No
|
|
|
|
|
|
|
Northern Mariana Islands
|
|
No
|
|
|
|
|
|
|
Puerto Rico
|
|
No
|
|
|
|
|
|
|
Virgin Islands
|
|
No
|
|
|
|
|
|
