A. View or print contact information to obtain the DHS or designated vendor step-by-step process for requesting extension of inpatient days.

Calls for extension of days may be made at any time during the inpatient stay (except in the case of a transfer from another hospital -- refer to Section 224.320).

Providers initiating their request after the fourth day must accept the financial liability should the stay not meet the necessary medical criteria for inpatient services. If the provider delays calling for extension verification and the services are denied based on medical necessity, the beneficiary may not be held liable.

B. When a Medicaid client reaches age one (1) during an inpatient stay, the days from the admission date through the day before the patient's birthday are exempt from the Medicaid Utilization Management Program (MUMP) policy. MUMP policy becomes effective on the one-year birthday. The patient's birthday is the first day of the four (4) days not requiring MUMP certification. If the stay continues beyond the fourth day following the patient's first birthday, hospital staff must apply for MUMP certification of the additional days.

C. DHS or its designated vendor utilizes Medicaid guidelines and the medical judgment of its professional staff to determine the number of days to allow.

D. Additional extensions may be requested as needed.

E. The certification process under the MUMP is separate from prior authorization requirements. Prior authorization for medical procedures thus restricted must be obtained by the appropriate providers. Hospital stays for restricted procedures may be disallowed if required prior authorizations are not obtained.

F. Out-of-state claims (claims from providers in non-bordering states) are subject to the determination for medical necessity for out-of-state treatment. In addition, the claim and records will be reviewed retrospectively for lengths of stay beyond the four (4) days allowed.

G. Claims submitted without an approved extension request will result in automatic denials of any days billed beyond the fourth day. No exceptions will be granted except for claims reflecting third party liability.