Nursing Home Vital Access Provider Assurance Program (VAPAP)
The Department of Health will be accepting VAPAP applications for the Fiscal Year 2025. The deadlines to submit a Nursing Home VAPAP application for financial assistance will be:
- For the 1st half of the State Fiscal Year 2024/2025 - August 15, 2024
- For the 2nd half of the State Fiscal Year 2024/2025 - December 15, 2024
All nursing homes seeking financial assistance should submit a formal application through this process.
Purpose
Up to $25 million was made available to support New York State's nursing homes pursuant to the Fiscal Year 2025 Enacted Budget. Under this announcement, nursing homes in severe financial distress can apply for short-term financial relief dollars to maintain operations and vital services while they plan for the implementation of longer-term solutions to achieve financial sustainability.
The primary purpose of this pool of funding is to provide one-time, non-reoccurring, short-term financial assistance to distressed providers while they thoughtfully plan for the future of their facility. Applications for Nursing Home VAPAP funds should include only requests for short-term financial assistance.
Successful applicants will identify and begin implementation of initiatives during the funding period that will improve the likelihood of future financial sustainability while maintaining essential services to their communities.
Nursing Home VAPAP is not intended for emergency situations or immediate payroll concerns. If a nursing home is not able to provide adequate care to a resident at any time during that resident's stay, the nursing home is required to contact their respective regional office of the Department of Health and must provide the necessary information to assist with any relocation needs, including but not limited to assistance with arranging transportation to an alternate facility that can provide the necessary care and services for the resident.
The following describes eligibility for financial assistance, the criteria on which the State will base awards, and the process through which facilities should apply for awards.
Eligibility Criteria
Eligibility requirements for the Nursing Home VAPAP program are listed below.
- Be defined as an Article 28 residential health care facility; AND
- Have less than 15 days of cash and equivalents on hand; AND
- Has had a negative operating margin within the last two (2) complete calendar years; AND
- Has no outstanding payments due to the Department; AND
- The applicant must have submitted the facility-appropriate cost report to the Department; AND
- The applicant, along with any related or affiliated entities, is not currently the subject of known investigation or enforcement action by CMS, the Department of Justice, HHS-OIG, the Office of the Attorney General, or the Office of the Medicaid Inspector General.
Evaluation Criteria for Awards
DOH will assess the following criteria in evaluating the facility's application for funding and related initiatives plan:
- Quality of care, as reflected in CMS Star ratings and Nursing Home Quality Incentive pool rankings;
- The extent to which the RHCF's application provides a specific plan for transformation and long-term sustainability, which addresses the service needs of the community;
- Alternative residential health care facility (RHCF) capacity and availability of other forms of long-term care in the immediate region;
- Special services and populations served or to be served;
- Historical and projected financial sustainability;
- Amount and length of assistance required compared to the number of beds at risk of loss;
- Applicants must detail the extent to which the affected community has been engaged and consulted on potential projects of the application, as well as any outreach to stakeholders and health plans; and,
- Applicants current and/or planned engagement in a change of ownership, including adherence to all State and Federal requirements governing the facility's operating certificate,
- Additional factors subject to the Department's discretion.
Sustainability Plan
The primary purpose of the VAPAP pool of funding is to provide one-time, non-reoccurring, short-term financial assistance to distressed providers while they thoughtfully plan for the future of their facility. As such, all applicants must complete the initiatives tab on the VAPAP Financial Assistance Template Attachment to detail the activities that will be undertaken to demonstrate how the provision of VAPAP funds will help the facility reach long-term sustainability. The presented initiatives should have a positive impact on the baseline projections provided on the financial projections tab.
Providers that apply for VAPAP funds should consider whether their overall plan for long-term sustainability will instead require funding through the Vital Access Provider (VAP) program. The VAP program provides temporary (up to three years) operating assistance to financially distressed providers for the purpose of redesigning their healthcare delivery systems to promote financial sustainability. Funding is provided for operational costs associated with transformation initiatives that address financial viability, community service needs, quality of care, and health equity.
Providers interested in filing a VAP should direct all inquiries to NHVAP@health.ny.gov with "VAP" in the subject line. VAP is the primary funding vehicle the Department will use to support multiyear transformation initiatives. Although factors specific to individual applicants will determine the nature and scope of the transformation plan, applicants may be required to commit to significant changes in governance, affiliation relationships, and service types and levels if such changes are determined necessary to achieve long-term financial sustainability.
VAPAP Application Process
Eligible applicants for funding under the Nursing Home VAPAP program should complete an application online via Nursing Home VAPAP. The application must include the VAPAP Financial Assistance Template Attachment and the following supplemental information:
Supplemental documents must include (the applications will not be reviewed if all the documents are not submitted with the application):
- Copy of the applicant's organization chart, including all affiliates.
- Copy of audited financial statements for the applicant for the years ended December 31, 2022, and 2023 and the latest 2024 internal financials year to date. If applicable, copies of audited financial statements for each affiliated entity in addition to an audited consolidated financial statement must be included.
- Financial projections that demonstrate that the nursing home will have less than 15 days cash and equivalent on hand.
- Evidence that no assets can be monetized other than those vital to operations.
- Evidence that the operator has exhausted all efforts to obtain resources from corporate parents and affiliated entities to sustain operations.
- A breakdown of payor sources for your resident population.
- A report of executive management salaries.
- Strategic initiatives plan and multi-year financial projections that demonstrates a path to long-term sustainability and improved resident satisfaction.
- High-level description and dollar value of your organization's long-term debt including purpose, terms, and covenants.
- A statement from the lender of the long-term debt providing details on compliance related to debt covenants, the total amount of debt with the due date, and the amount outstanding as of the date of the VAPAP application.
Review Process
Each application will be reviewed by DOH staff with expertise in health care finance, reimbursement, and health care programs. Once the Department determines that a nursing home is an eligible applicant, the applicant's current and projected financial status, the proposed use of funds to maintain critical services needed by its community, the anticipated impact of the loss of such services, and the transformation plan will be reviewed in determining whether the applicant will be awarded funds, and in consultation with the Division of the Budget, will determine the amount of the award.
The Department's request for clarifying information in the course of evaluation will be conducted exclusively with the authorized contacts listed on the application. Any inquiries regarding the application must be made only by these contacts . Any changes in the contacts after application submission require a change request to be forwarded to NHVAPAP@health.ny.gov.
Awards
Awards will be made after the Department's analysis of an eligible nursing home's application. Awards are made at the Department's discretion and may be an amount that is lower than the awardees' requested funding.
Successful applicants will be subject to specific reporting requirements as specified by the Department. This includes monitoring of progress towards a defined sustainability plan and commitment to implement the identified transformation initiatives.
Notice of Awards
The Department will communicate the award determination notice by email to the operator/authorized officer. Any changes in the operator/authorized officer after application submission require a change request to be forwarded to NHVAPAP@health.ny.gov.
Eligible Expenses
Eligible expenses shall include costs directly related to the sustainability of operations. The VAPAP statute (NY Public Health Law §2826) excludes funding of capital expenditures, including, but not limited to: construction, renovation and acquisition of capital equipment, including major medical equipment; or bankruptcy-related costs.
Payment Process
Payments under the VAPAP program may be awarded as a temporary adjustment to rates or as temporary lump sum payments.
