Care Wisconsin believes that our members’ lives are enriched through social opportunities that many of us enjoy without much thought or effort—like visiting friends and family for the weekend or taking a fun trip each year. Social, meaningful activities can keep our members healthier and happier over time.
We ask that residential providers inform care teams and request a bed hold authorization when our members have planned time away. Our updated policy is to pay 50% of your Care and Supervision rate for these brief absences. Please be aware that bed holds do NOT apply to the following circumstances:
• The member is in a respite, hospital or in a skilled nursing facility
• The member is in a rehabilitation or behavioral treatment facility
If any of the above circumstances occur, you are required to notify the care team to stop the Care and Supervision authorization. The authorization will be restarted upon their return. Please note this is required to comply with Medicare and Medicaid regulations regarding alternate facility stays.
*If a member is frequently gone from the residential setting, your IDT may discuss the appropriateness of the residential placement. If prolonged absences are possible, the member may be ready for a more independent residential setting. Absences of more than 60 days in a calendar year may not be eligible for the 50% Care and Supervision bed hold reimbursement. Please contact your Contracting Specialist at Care Wisconsin if you have questions.
Disclaimer: Care Wisconsin helps manage member health and safety under the guidelines and staffing patterns defined in provider contracts. If the member’s absence does not include contracted supervisory staff, the member, family, guardian, or the provider assume responsibility for supervision
Not all providers have bed hold in their contract. Pre-authorization is required from the care teams. Claims will not be paid for unauthorized or non-contracted services.