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

August 13, 2010

Dear Administrator:

On July 19, 2010 the Department of Health issued a Dear Administrator Letter (DAL/DRS: 10-08) regarding Chapter 109 of the Laws of 2010 and the impact of this new law on the reserved bed day policy for residential health care facilities (RHCFs). This letter supplements and does not replace the information previously distributed in the July 19th DAL, and provides additional clarification.

Part B, Section 31 of Chapter 109 is applicable only to Medicaid eligible persons twenty-one years of age and older, and contains the following provisions:

  • Payments for reserved bed days shall be made at ninety-five percent of the Medicaid rate otherwise payable to the facility for services provided on behalf of such person.
  • Payment to a facility for reserved bed days provided on behalf of such person for temporary hospitalizations may not exceed fourteen days in any twelve month period.
  • Payment to a facility for reserved bed days provided on behalf of such person for non-hospitalization leaves of absence may not exceed ten days in any twelve month period.

While the statute changes the Medicaid reimbursement rate for reserved bed days and limits the number of reserved bed days for which a facility will be reimbursed, it does not change the existing regulations regarding reserved bed days (Title 18 NYCRR Section 505.9(d)) or a resident's transfer and discharge rights (Title 10 NYCRR Section 41 5.3(h)). That is, after the fourteen day cap is reached (for hospitalization) or the ten day cap is reached (for therapeutic leave), and a resident has not returned to the RHCF, the RHCF need not continue to hold the resident's bed, but would be required to offer priority readmission to the individual. Further, residents of RHCFs under the age of twenty-one, residents of OMH and OMRDD facilities, and RHCF residents who are in receipt of hospice services are not affected by these changes.

Effective July 19, 2010, a reserved bed for a Medicaid recipient aged twenty-one or over, is limited to fourteen days in a 12-month period for temporary hospitalizations and to ten days in a 12-month period for non-hospitalization (therapeutic) leaves of absence. Effective April 1, 2010, the RHCF reimbursement for such days will be made at ninety-five percent 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 DQS/DAL #06-23) are also unaffected by this statutory change.

RHCFs are encouraged to review their bed reservation policies (including notification procedures) for all residents 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. Attached, please find additional Q & A's addressing specific issues and questions. Should you have any additional questions, comments or concerns, please submit them in writing to the following e-mail address: bedres@health.state.ny.us. Responses will be posted as an addendum to the Q and A's attached to DAL/DRS: 10-08. Please check the HPN for periodic updates.

Sincerely,

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

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