Questions and Answers on Reserved Bed Day Reimbursement to RHCFs for Medicaid Eligible Individuals Aged Twenty-One and Older

When are the provisions of this new law effective?

The Law was enacted on June 8, 2010, retroactive to April 1, 2010; however, the limits on reserved bed days (fourteen (14) days in a 12-month period for temporary hospitalization and ten (10) days in a 12-month period for non-hospital (therapeutic) days) will be applied prospectively starting July 19, 2010.

What provisions of current regulations are impacted under this new law?

Chapter 109 of the Laws of 2010 only impacts RHCF residents aged twenty-one and over. RHCF residents under the age of twenty-one and residents of OMH and OMRDD facilities continue to be governed by current regulations.

Changes include:

  • Reserved bed days are reimbursed at ninety-five percent (95%) of the Medicaid rate otherwise payable to the facility for services provided on behalf of the resident.
  • Reserved bed days for temporary hospitalizations are limited to fourteen (14) days in a twelve month period.
  • Reserved bed days for non-hospitalization (therapeutic) leaves of absence outlined in a recipient's medically acceptable therapeutic or rehabilitative plan of care are limited to ten (10) days in a twelve month period.

Are any other requirements for RHCFs necessitated by the new law?

In addition to the current record keeping requirements for a RHCF to conduct and to keep records of a daily census for the purpose of determining the vacancy rate for bed reservation days, each RHCF must maintain:

  • Records for each resident identifying when his or her 12-month period begins and ends; and
  • Records for each resident identifying the number of hospital days and therapeutic leave of absence days claimed for him or her in the current 12-month period.

Note: Each RHCF is responsible for claiming bed reservation reimbursement correctly and must maintain all records for review for the Department upon audit. (Please refer to Title 10 NYCRR section 415.30)

What are the criteria for receiving reserved bed day payments for a Medicaid recipient in a RHCF?

The recipient must have been a resident of the facility seeking reserved bed day reimbursement for at least 30 days, regardless of reimbursement, and the unit to which the recipient will return has a vacancy rate of no more than five percent (5%). For facilities with specialty units (distinct admission requirements and/or reimbursement rate), a separate census shall be conducted for each unit.

Must a RHCF always hold a bed for an eligible resident aged twenty-one or over?

a.) A RHCF must hold a resident's bed for any period of temporary hospitalization when the resident is expected to return, except if:

  • After hospitalization, the recipient will need a level of care the institution does not provide; or
  • The recipient does not want to return to the institution.

b.) A RHCF must hold a resident's bed for any period of non-hospital (therapeutic) leave of absence that is outlined in the resident's medically acceptable therapeutic or rehabilitative plan of care.

c.) Please note that the RHCF must comply with requirements set forth in 10 NYCRR section 415.3 and Title 42 CFR section 483.12.

Can a RHCF accept a voluntary payment from a recipient or his or her family to hold the recipient's bed, if the recipient does not qualify for a bed reservation (for example, the recipient has not met the residency requirements or the RHCF vacancy rate exceeds five percent (5%))?

Yes, an interested party or a family member may pay privately to reserve the recipient's bed. Funds may be drawn from the recipient's Personal Needs Account or Special Needs Trust for this purpose, with the consent of the recipient or the responsible party. Reimbursement arrangements are established between the family and the facility.

If a recipient's bed is not reserved, what is the Department's requirement for readmission?

The requirements for readmission, as outlined in Title 10 NYCRR section 515.3(h)(2)(v)(4)(iv) are not changed by the provisions of the new law. If a bed is not reserved, the recipient must be given priority in readmission to the institution over persons referred to the institution for their first admissions.

When does the 12 month period begin?

For all recipients who have established residency, the 12-month period is from July 19, 2010 through July 18, 2011. For new admissions, the 12-month period begins once the individual has established residency (30-day stay) in the facility seeking reserved bed day reimbursement. For recipients who transfer from one RHCF to another, the 12-month period re-starts once the individual has established residency (30-day stay) at the second RHCF, regardless of the number of Medicaid reimbursed reserved bed days claimed by the former RHCF.

Does the Department have any intention at this point of proceeding with the regulatory changes that were contemplated last year (i.e. reducing the vacancy rate)?

No.

Are there any relevant Dear Administrator Letters (DALs) on the Department's website?

Yes. Here are the links for these documents.