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Community-based ICF/IID – Logging Extended Leave Update

Last updated on 7/4/2020

HHSC requests that all community-based ICF/IID providers input a resident’s leave due to COVID-19 concerns regardless of whether the person has returned to the facility. This information was published in a June 5, 2020 alert.

Providers should use the instructions listed below to assist them in proper entry of leave when completing the Individual Movement Tracker in the TMHP Long-Term Care Portal.

Enter the leave date and return date on separate forms, so three IMTs are needed. Codes for leave types are:

  • ATH: Therapeutic Home Visit (three-day leave)
  • AEV: Extended Leave (10 days per year)

To ensure maximum payment for extended leave, ICF/IID providers must enter two types of leave and indicate a return date for the first type of leave even if the person did not return to the facility.

Example:

  1. IMT Leave Type AEV for day one of the absence period - April 1, 2020, noon.
  2. IMT Return entered for day 12 - April 1, 2020, noon.
  3. IMT Leave Type ATH for the same date as the return. Must be at least one minute later than time of Return* - April 1, 2020, 12:01 p.m.

There is no requirement for which leave type is entered first. However, if entering the three-day leave type first, the Return date must be the fourth day after the absence. After entering the leave and return date for ATH, enter an AEV IMT for the same date as the ATH return with a different time.

*IMT’s are submitted with both date and time of the movement.

The Service Authorization System creates a hold on billing when leave types are entered. For example, entering ATH will create a hold on billing at day four if no return date is entered. Entering AEV will create a hold on billing on day 12 after the leave type begins. Therefore, providers need to enter one type of leave (ATH or AEV) and then enter a return date. Then enter the next leave type permitting the provider to bill for up to the 13 days allowed under the Medicaid State Plan.

Note: Use the ATH code for more leave if a person returns to the facility and then leaves again after a provider has used the ATH/AEV combination. A billing hold is placed if the person does not return by the fourth day. Repeated use of the ATH code requires the person to return to the facility for at least 24 hours to be able to enter a return date and time.