DOH Answers Questions About VAPAP for Distressed Nursing Homes

The Department of Health (DOH) has answered questions relating to Vital Access Provider Assurance Program (VAPAP) applications from nursing homes that are part of larger systems and county nursing homes. As previously reported here, VAPAP is a program that provides assistance to facilities in severe financial distress to enable them to maintain operations and vital services while they implement longer-term solutions to achieve financial sustainability. The DOH website here contains complete information and links to the application.

LeadingAge NY has posed several questions concerning the application process to DOH and received responses to the following:

Will the finances of hospital-based nursing homes be considered in isolation for determining eligibility and award, or will the sponsoring organization’s finances come into play?)

• We will be looking at the financials of the nursing home (NH) in isolation.

How should the financial component of the application be developed for nursing homes that are part of larger systems that file only consolidated financials?

• For Hospital-Based Nursing Homes that do not submit separate AFS or are not a part of a supplemental submission by a Hospital or System, we ask that they calculate operating margin using the Institutional Cost Reports (ICRs). Costs are step-downed in the ICR to the SNF and should be sufficient to address this issue. This calculation would be based on the sample calculation here. This is only an example and should be tailored to the specific Hospital-Based NH. Please make sure all services are allocated:
  • NPSR – Exhibit 46
  • Direct Costs – Exhibit 11
  • Medicaid Cost Allocations
  • Medicaid Ancillary Cost Allocations.

This will allow us to calculate the operating income or loss for eligibility related to operating margin. Please make sure to attach a copy of this calculation to the application and provide reference to all costs in the ICR. The application should still include AFS for the Hospital or System for further review of available resources.

• For Free-Standing NHs: System Financials would include a supplemental section in the AFS that breaks out the Nursing Home. There is typically an RHCF balance sheet and income statement in Part IV. We would allow this to be used for eligibility calculations when financial statements are available. We would like to see the calculation as detailed above for Hospital-Based NHs.

It appears that while they are categorically excluded from VAPAP, county nursing homes are not excluded from VAP. What should they do?

• They should complete the VAPAP application and indicate they are looking for VAP funding instead of VAPAP. We will contact them to discuss VAP as an option once the application is submitted. 

If a facility thinks that its need is more appropriate for VAP funding but they are uncertain, what application(s) should they complete? Should the old “mini-ap”/listing of VAP documents be used, or is the starting point now the VAPAP application? 

• The VAPAP application will still need to be completed. We will contact them to walk through the VAP process. We still use the same VAP mini-app.

It sounded like the available funding would be divided into multiple timeframes over the life of the program so as not to be exhausted in the first few months. Could you verify this? Is a facility at a disadvantage if it does not apply in August?

• The funding will be divided into multiple timeframes. This will allow later filers to still have the same bite at the apple. There is not an advantage to submitting in August as opposed to October.

Importantly, as previously reported, DOH indicated that homes that have been discussing financial relief with the Department should complete and submit the application by Aug. 1, 2022. Applications will be reviewed on a rolling basis and paid monthly, but DOH has established three application due dates:

• Aug. 1, 2022 (which includes homes that have discussed financial relief with DOH)
• Nov. 1, 2022
• Feb. 1, 2023

We will keep members informed as additional information becomes available. 

Contacts: Karen Lipson, klipson@leadingageny.org, and Darius Kirstein, dkirstein@leadingageny.org