TOTAL NUMBER OF MEDICAID COVERED DAYS FOR THE RECIPIENT IN AN NURSING FACILITY FOR THE CALENDAR YEAR.
(SAS USERS: ZONED DECIMAL - ZD3)
Comments
USER NOTE: THIS COUNT EXCLUDE LEAVE DAYS. IF MEDICAID PAYMENTS WERE WERE MADE FOR LEAVE DAYS, PAYMENTS PER DAY (USING THESE DAY COUNTS) MAY BE OVERSTATED. CONVERSELY, IF MEDICAID DID NOT PAY FOR LEAVE DAYS AND LEAVE DAYS WERE ADDED TO COVERED DAY COUNTS, PAYMENTS PER DAY MAY BE UNDERSTATED. STATES MAY PAY LOWER AMOUNTS THAN STANDARD DAY RATES OR MAY NOT PAY AT ALL FOR LEAVE DAYS. SINCE IT IS NOT POSSIBLE TO DETERMINE WHEN TO ADD (AND WHEN NOT TO ADD) LEAVE DAYS TO COVERED DAY COUNTS. DAYS MAY BE > 365 IN SOME STATES AND FOR SOME LONG-TERM CARE FACILITIES. THIS CAN HAPPEN IF THE NUMBER OF COVERED DAYS FOR A GIVEN MONTH WAS REPORTED ON MULTIPLE CLAIMS (E.G. A CLAIM FOR PER DIEM PAYMENT AND A CLAIM FOR SUPPLEMENTAL SERVICES). IT IS NOT POSSIBLE TO SEPARATELY IDENTIFY PER DIEM CLAIMS VERSUS SUPPLEMENTAL CLAIMS. SO, IF DAYS ARE >365, THIS SHOULD ALERT A DATA USER OF THE POTENTIAL OVERREPORTING OF THE NUMBER OF COVERED DAYS. WHEN DAYS ARE > 365, USERS MAY WANT TO EXAMINE RECORDS BY MONTH TO ESTIMATE THE ACTUAL NUMBER OF DAYS. DAYS ARE SET VALUE <= 998.
SOURCE: CREATED BY SUMMING THE COVERED DAY COUNTS FROM 'RECIPIENT LONG-TERM CARE MENTAL HOSPITAL FOR THE AGED COVERED DAY COUNT' , 'RECIPIENT LONG-TERM CARE INPATIENT PSYCHIATRIC FACILITY (AGE < 21) COVERED DAY ', 'RECIPIENT INTERMEDIATE CARE CARE FACILITY FOR INDIVIDUALS WITH INTELLECTUAL DISABLITIES - ICF-IID COVERED DAY ' AND 'RECIPIENT NURSING FACILITY - NF - COVERED DAY COUNT'.
USER NOTE: THIS COUNT EXCLUDE LEAVE DAYS. IF MEDICAID PAYMENTS WERE WERE MADE FOR LEAVE DAYS, PAYMENTS PER DAY (USING THESE DAY COUNTS) MAY BE OVERSTATED. CONVERSELY, IF MEDICAID DID NOT PAY FOR LEAVE DAYS AND LEAVE DAYS WERE ADDED TO COVERED DAY COUNTS, PAYMENTS PER DAY MAY BE UNDERSTATED. STATES MAY PAY LOWER AMOUNTS THAN STANDARD DAY RATES OR MAY NOT PAY AT ALL FOR LEAVE DAYS. SINCE IT IS NOT POSSIBLE TO DETERMINE WHEN TO ADD (AND WHEN NOT TO ADD) LEAVE DAYS TO COVERED DAY COUNTS. DAYS MAY BE > 365 IN SOME STATES AND FOR SOME LONG-TERM CARE FACILITIES. THIS CAN HAPPEN IF THE NUMBER OF COVERED DAYS FOR A GIVEN MONTH WAS REPORTED ON MULTIPLE CLAIMS (E.G. A CLAIM FOR PER DIEM PAYMENT AND A CLAIM FOR SUPPLEMENTAL SERVICES). IT IS NOT POSSIBLE TO SEPARATELY IDENTIFY PER DIEM CLAIMS VERSUS SUPPLEMENTAL CLAIMS. SO, IF DAYS ARE >365, THIS SHOULD ALERT A DATA USER OF THE POTENTIAL OVERREPORTING OF THE NUMBER OF COVERED DAYS. WHEN DAYS ARE > 365, USERS MAY WANT TO EXAMINE RECORDS BY MONTH TO ESTIMATE THE ACTUAL NUMBER OF DAYS. DAYS ARE SET VALUE <= 998.
SOURCE: CREATED BY SUMMING THE COVERED DAY COUNTS FROM 'RECIPIENT LONG-TERM CARE MENTAL HOSPITAL FOR THE AGED COVERED DAY COUNT' , 'RECIPIENT LONG-TERM CARE INPATIENT PSYCHIATRIC FACILITY (AGE < 21) COVERED DAY ', 'RECIPIENT INTERMEDIATE CARE CARE FACILITY FOR INDIVIDUALS WITH INTELLECTUAL DISABLITIES - ICF-IID COVERED DAY ' AND 'RECIPIENT NURSING FACILITY - NF - COVERED DAY COUNT'.