DOH Proposes Nursing Home Bed Hold Regulations
On Feb. 14th, the Department of Health (DOH) published proposed regulations in the New York State Register that would modify the State’s payment and other policies on reserved bed days for residents of nursing homes. Of significant concern is proposed language that would require nursing homes to reserve the same room and bed for a resident who is hospitalized, even when Medicaid does not pay the facility to hold the bed.
Specifically, the proposed regulations would modify regulations at 18 NYCRR Section 505.9(d) to: (a) provide that reserved bed payments for residents age 21 and over who are temporarily hospitalized are only available for those residents who are receiving hospice services in the facility; (b) “clarify” that nursing homes must reserve the same bed in the same room, unless medically contraindicated, for a specified number of days during a Medicaid recipient’s temporary absence even if Medicaid does not pay for the bed hold; and (c) remove language incorrectly stating that Medicaid reserved bed payments for leaves of absence are only available if the leave is for therapeutic purposes.
As members may recall, the enacted 2017-18 State Budget included a change to Public Health Law § 2808(25) effectively eliminating Medicaid reimbursement for reserved bed days due to hospitalization leaves for residents age 21 and older. The law change did not affect Medicaid reserved bed day payments for individuals under 21 or impact bed hold payments for therapeutic leave. DOH issued a Dear Administrator Letter (DAL) to all nursing homes on May 12, 2017 discussing the elimination of Medicaid reimbursement for hospitalization reserved bed days and signaling its position that this change did not eliminate the current regulatory requirement that Medicaid-enrolled nursing facilities hold the same bed in the same room for such hospitalized patients for a period of 14 days. The DAL also indicated that implementation of the law changes would be delayed until DOH adopted authorizing regulations, and that nursing homes would continue to be reimbursed for reserved bed days under the law as it existed before April 1, 2017. It is currently unclear how long this policy will continue in light of the proposed regulations published on Feb. 14th.
Subsequent to enactment of the 2017-18 budget, the Legislature passed a bill supported by LeadingAge NY, A.8338 (Gottfried)/S.6559 (Hannon), which would have undone the elimination of Medicaid reimbursement for up to 14 reserved bed days annually when residents are hospitalized. However, the Governor vetoed the legislation in December, suggesting that the budget process would be the appropriate forum for this issue.
The deadline for comments on the proposed regulations is April 16th. In the meantime, LeadingAge NY will be conferring with its legislative counsel on next steps and will keep members apprised of its plans and further developments.
Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866