NYS Medicaid bed hold reimbursement changes

There have been changes to Medicaid bed hold reimbursement as part of the new NYS budget approved in April. This clarifies the current situation. http://update.nyshfa.org/en/1611953/1/6226/Alert-2017-18-Budget-has-Changed-the-SNF-Bed-Hold-Rules.htm

Alert: 2017-18 Budget has Changed the SNF Bed-Hold Rules

Carl J. Pucci and Nancy Leveille and Lisa Volk in Clinical & Quality

Effective April 1, 2017, the New York State budget has eliminated the 50% Medicaid payment for bed-hold for residents’ stay in hospitals. Therefore, DOH will no longer reimburse bed-hold days for facilities with a 95% or greater census upon such hospitalization a maximum of 14 days in a calendar year. The DOH will maintain the 2012 enacted bed-hold rate cut necessary to achieve $18M in annual savings (line 14 of the Medicaid rate sheets).  This change does not affect Therapeutic leaves and therefore facilities must continue to follow those rules for implementation. As such, Therapeutic leaves of absence (paid at 95% of Medicaid rate) remain intact, not to exceed 10 days per 12-month period.

With this change, facilities will no longer be required to hold the resident’s specific bed, but must offer the first available, appropriate bed.

With the 14-day paid bed-hold eliminated, skilled nursing facilities must continue to follow both New York State (415.3 resident rights) https://regs.health.ny.gov/content/section-4153-residents-rights and Federal requirements (483.15 (d).  CMS has updated this section based on the new requirements of participation.  https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R168SOMA.pdf  Scroll down to page 63-64 to locate the specific bed-hold information.

NYSHFA recommends that each SNF take the following actions to enact this change to bed-hold:

  1. Update your facility policy for bed-hold specific to NYS code 415.3 and CMS code 483.15(d).
  2. Notify all current residents or their representative of this change in policy due to the 2017/2018 NYS Executive Budget.
  3. Update your notice to new admissions instructing them on the current policy for bed-hold.
  4. Update the facility’s bed-hold letter templates to reflect these changes.
  5. Note that the hospital is still not a discharge location, therefore the SNF is still required to transfer these residents back to the SNF upon discharge from the hospital.
  6. Review the sections of code related to holding the residents’ original bed or offering them the next available bed.
  7. Utilize the NYS regulations 415.3 and CMS 483.15 (e)(1) permitting residents to return to facility codes as your reference for policy and letter changes. This section specifies what the residents and SNF rights are related to when a resident transfers to the hospital and when a resident returns to the facility.

 

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