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Nursing Home Bed Hold Payment Rate Adjustments

February 19, 2013

DOH notified nursing home providers that the Medicaid billing system will reflect new amounts for bed
hold payment claims submitted on and after Feb. 18. This implements the 2012-13 state budget
provision reducing hospitalization bed reservation payments from 95 to 50 percent of a home’s
Medicaid rate. DOH will also reconcile bed hold payments made since July 1, 2012 over the course of
five payment cycles starting with checks dated March 4.

The DAL sets out three varieties of bed reservation days:

  1. Leave of absence for temporary hospitalization (reimbursed 50 percent of Medicaid rate);
  2. Leave of absence for visits to a health care professional that are expected to improve the patient’s physical condition or quality of life (95 percent of the rate); and
  3. All other leaves of absence (95 percent of the rate).

The 12-month combined limit for hospitalization and health care professional leaves (numbers 1 and 2
above) is 14 days. The 12-month limit for “other” leaves of absence is 10 days (in addition to the
combined 14 day limit). These changes do not apply to residents under the age of 21.
The DAL also provides new rate codes associated with each type of leave.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841