1. (1)(a) A member must meet the severity of illness and intensity of service for LTAC hospital level-of-care as determined through an evidence-based criteria review process.

   1. (b) The Department shall deny an LTAC request for reimbursement if the member does not meet the evidence-based criteria.

2. (2) The Department may forward LTAC preadmissions, continued stays, and retroactive stays that do not meet the evidence-based criteria for secondary medical review if:

   1. (a) the LTAC provider requests the secondary medical review; or
   2. (b) review of documentation shows that LTAC is the most appropriate level-of-care for the member.

KEY: Medicaid, long-term acute care, LTAC

Date of Last Change: November 1, 2023

Notice of Continuation: November 30, 2022

Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108