Revised Medicaid Bed Hold Regulations Adopted

The May 29, 2019 issue of the State Register (page 15 under “Rule Making Activities”) included a notice of adoption of the Department of Health’s (DOH) proposed regulations governing Medicaid reserved bed day payment and policy. The regulations end Medicaid coverage of hospitalization bed holds for most residents but, in response to LeadingAge NY’s advocacy, will not require nursing homes to reserve beds for days when no Medicaid payment is available. While the effective date of the regulatory change is identified as May 29, 2019 in the State Register notice, we do not yet have definitive guidance on when or how it is to be implemented.

The final 2017-18 State Budget revised Public Health Law § 2808(25), effectively eliminating Medicaid coverage of hospitalization bed holds for residents 21 years of age or older who are not on hospice. DOH issued a Dear Administrator Letter (DAL) in May 2017 discussing the law change and indicating that implementation of the new law would be delayed until DOH adopted regulations, and that nursing homes would continue to be reimbursed for reserved bed days under the law as it existed before April 1, 2017.

The adopted regulations reflect the following:

Medicaid will no longer pay to reserve a bed for a recipient in a nursing home who is 21 years of age or older and is temporarily hospitalized, unless the recipient is receiving hospice services in the facility;
DOH pays 50 percent of each nursing home’s rate for a temporary hospitalization of a recipient who is receiving hospice services in the facility, for up to 14 days for any 12-month period;
Reserved bed day payments for Medicaid recipients 21 years of age or older in nursing homes during a leave of absence from the facility are to be made at 95 percent of the facility’s Medicaid rate, for up to 10 days per recipient for any 12-month period;
Nursing homes are not required to hold a bed for days when no Medicaid payment is available; and
Reserved bed days are to be included in the methodology used to calculate rates for specialty nursing homes/units.

DOH submitted a proposed Medicaid State Plan Amendment (SPA #18-0042) on Dec. 31, 2018 seeking Centers for Medicare and Medicaid Services (CMS) approval of this change with an effective date of Jan. 1, 2019. At this time, there is no indication that CMS has yet approved SPA #18-0042, and it is unclear what bearing, if any, action on the SPA will have on when and how this change is to be implemented.

We have reached out to DOH asking for clarification on the effective date of these changes as well as for definitive guidance to facilities in a DAL on implementing the revisions. Specifically, facilities are required under the regulations at 10 NYCRR § 415.3(h)(3) to establish and implement a bed hold policy that provides residents who are transferred and their designated representatives with notice of the facility’s bed hold policies. Facilities may also need to revise their written policies under which a resident whose hospitalization or therapeutic leave exceeds the bed hold period is readmitted to the facility immediately upon the first availability of a bed in a semi-private room if the resident requires the services provided by the facility and is eligible for Medicaid nursing home services.

DOH staff have advised us that written guidance will be forthcoming soon. We will keep members posted with the latest information on this subject.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866