DAL/DRS: 10-08: Reserved Bed Day Reimbursement to RHCFs for Medicaid Eligible Individuals Aged Twenty-One and Older

July 19, 2010

DAL/DRS: 10-08

RE: Reserved Bed Day Reimbursement to RHCFs for Medicaid Eligible Individuals Aged Twenty-One and Older

Dear Administrator:

Chapter 109 of the Laws of 2010, enacted on June 8, 2010, contains changes regarding reserved bed day reimbursement to residential health care facilities (RHCFs) for Medicaid eligible individuals aged twenty-one and older. Residents of RHCFs under the age of twenty-one and residents of OMH and OMRDD facilities are not affected by these changes.

Effective July 19, 2010, the Department will reimburse a RHCF to reserve the bed for a Medicaid recipient aged twenty-one or over, for fourteen (14) days in a 12-month period for temporary hospitalizations and for ten (10) days in a 12-month period for non-hospital (therapeutic) leaves of absence. The RHCF reimbursement for such days will be made at ninety-five percent (95%) of the Medicaid rate otherwise payable to the facility for services provided on behalf of such person. The procedures a facility must follow when determining patient census and vacancy rate for these recipients remain in effect (see DAL/DQS #05-13). Transfer and discharge rights (see DAL/DQS #06-23) are also unaffected by this statutory change. Please see the attached Questions and Answers (Q&A) for a link to these documents.

When a resident aged twenty-one or over is hospitalized, the facility must hold the bed for the resident's return for the entire length of the hospitalization. If a resident aged twenty-one or over has non-hospital (therapeutic) leaves of absence in his or her plan of care, the facility must hold the bed for the resident's return for the entire length of each leave of absence.

RHCFs are encouraged to review their bed reservation policies (including notification procedures) for residents both under and over the age of twenty-one with all appropriate staff to ensure that the above-mentioned changes do not result in confusion about each resident's right to return to the facility after a hospitalization or therapeutic leave. Requirements to notify each resident and/or designated representatives about the resident's right to return to the facility after hospitalization or therapeutic leave are unchanged.

Thank you in advance for your efforts to assure compliance with all relevant State and federal requirements. Should you have any additional questions, please contact Christopher Phillips at (518) 486-6562.

Sincerely,

Jacqueline O. Pappalardi
Director, Division of Residential Services
Offic of Long Term Care

John E. Ulberg
Director, Division of Division of Health Care Financing
Office of Long Term Care Office of Health Insurance Programs