For some families, the golden years are turning nightmarish, thanks to state laws that some nursing homes are using to try to gain guardianship – and financial control – of their older patients. For more details, go to my blog: Nursing Homes Use Gardianship as Tool to Profit.
Thank you to the Manhattan program committee and Sonya Mittleman for the opportunity to be part of the panel along with Paul Tramontozzi, Mike LaMagna and Joe Lawliss.
For those not in attendance, much of the information presented can be gotten from the 2018 Consumer Guide; 6 Ways to Finance Chronic Healthcare. All the contributors are Orion members.
The Guide can be downloaded from my website: www.GuideINS.com
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:
- Update your facility policy for bed-hold specific to NYS code 415.3 and CMS code 483.15(d).
- Notify all current residents or their representative of this change in policy due to the 2017/2018 NYS Executive Budget.
- Update your notice to new admissions instructing them on the current policy for bed-hold.
- Update the facility’s bed-hold letter templates to reflect these changes.
- 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.
- Review the sections of code related to holding the residents’ original bed or offering them the next available bed.
- 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.
NY Managed Long Term Care Companies (MLTC) Are Killing Elders By Refusing Mandated Services. – My Elder Advocate, LLC
The New York Legal Assistance Group has filed a federal class action lawsuit in the Eastern District of New York to challenge threatened and actual reductions in Medicaid-funded home care services. Named Plaintiffs and the class they seek to represent are people with disabling conditions who need home care services to remain safely in their homes and communities.
Few people are aware that a nursing home can take such a step. Guardianship cases are difficult to gain access to and poorly tracked by New York State courts; cases are often closed from public view for confidentiality. But the Palermo case is no aberration.