Bed Hold Regulations Adopted

Allison Gold and Carl Pucci in Clinical & Quality, Finance & Reimbursement

The Department of Health recently adopted regulations pertaining to the Medicaid Reimbursement of Nursing Facility Reserved Bed Days for Hospitalizations as published in its May 29, 2019 Rule Making Activities. The regulations set forth the general rule that Medicaid will not pay to reserve a bed for a recipient in a nursing facility who is 21 years of age or older and temporarily hospitalized unless the recipient is receiving hospice services in the facility. Other aspects of the regulations are:

  • No requirement to reserve a bed for days where no Medicaid payment is available;
  • The requirement to accept individuals from the hospital has not changed, but there is no requirement to hold the same bed;
  • Clarification that reserved bed days are included in the methodology utilized to calculate residential health care rates for specialty facilities and set forth payment amounts for Medicaid recipients over age 21;
  • Reserved bed day payments will be made at 50 percent of the Medicaid rate recipients age 21 or over who are temporarily hospitalized and receiving hospice services at the facility, for up to 14 days for any 12-month period.  The institution must reserve the same bed and room occupied before the leave of absence in this situation;
  • Reserved bed day payments for Medicaid recipients age 21 or over in nursing facilities during a therapeutic leave of absence from the facility will be made at 95 percent of the Medicaid rate, for up to 10 days per recipient for any 12-month period.  The institution must reserve the same bed and room occupied before the leave of absence in this situation.

The SFY 2017-18 enacted State Budget included a provision that eliminated the Medicaid reimbursement for reserved beds during hospitalization for residents age 21 or over that are not receiving hospice services. Pursuant to this change in law, DOH issued a Dear Administrator Letter (DAL) in May 2017 detailing that the implementation of the law would be delayed until regulations were adopted and that facilities would continue to be reimbursed as required by the law prior to the enacted 2017-18 Budget. This DAL also indicated that the intent was to require facilities to hold a bed even though there would no longer be payment, but DOH reversed this position in the final regulations published in the May 29, 2019 Register. The DAL can be found in the Regulatory section of the webpage. Ending the reserved bed payments and reservation requirement is expected to yield $14 million annually in savings.

The May 29 Rule Making Activities provide an effective date of January 1, 2019, however a State Plan Amendment (SPA) must still be approved by Centers for Medicare and Medicaid Services (CMS). The SPA was submitted by DOH to CMS on December 31, 2018. Because there has been no federal SPA approval to date and no guidance issued by DOH, it is unclear when and how the regulations will be implemented. It is recommended that facilities review and update bed hold policies accordingly in anticipation of CMS approval.

NYSHFA-NYSCAL is following up with DOH and will update members accordingly. Please reach out with any questions or concerns.

NYSHFA/NYSCAL CONTACTS:

Allison Gold, Esq.
Director of Policy & Reimbursement
518-462-4800 x25

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36