Hospitalization Bed Hold Elimination Effective May 29th

The Department of Health (DOH) announced last week that as of May 29, 2019 (the adoption date of revised regulations), Medicaid reimbursement will no longer be made for hospitalization bed holds other than for residents under age 21 and those on hospice. Members may recall that the legislation eliminating hospitalization bed hold payments for most Medicaid beneficiaries was enacted in 2017, but implementation was delayed pending adoption of regulations. Note that therapeutic leaves of absence will continue to be paid at 95 percent of the Medicaid rate for each resident for up to 10 days in a 12-month period.

The Dear Administrator Letter (DAL) (available here) notifies providers that the regulations were adopted on May 29, 2019, providing authority for the change in policy. A previous LeadingAge NY summary of the adopted regulations is available here. Our understanding is that the final version of the regulations does not require a nursing home to hold a bed when no Medicaid reimbursement is available but rather requires a home to offer the first available bed in a semi-private room to returning residents. We have asked DOH to confirm this, and they have promised to issue a frequently asked questions (FAQ) document addressing other questions they have received.

We remind members to make sure that their policies and resident notices are updated to reflect the change. Under DOH regulations at 10 NYCRR § 415.3(h)(3), facilities are required 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.

From a reimbursement perspective, the DAL specifies that any Medicaid claim submitted for bed hold not in accordance with the policy will be denied. While we intend to object to DOH’s failure to notify facilities in advance of this change, member facilities should assume that any hospitalization bed holds to Medicaid beneficiaries who are age 21 or older and not on hospice initiated after May 29, 2019 will not be reimbursed. This underscores the importance of updating your facility’s policies and resident notices as soon as possible.

Contacts: Dan Heim, dheim@leadingageny.org, 518-867-8383 or Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841