What's happening
This bill partially reinstates Medicaid payments for reserved nursing home beds for temporarily hospitalized residents, with new payment limits and requirements.
Why it matters
Limits Medicaid payments for holding nursing home beds during temporary hospitalizations to 50% of the normal rate, and restricts such payments to a maximum of 7 days per year for most residents. This means facilities will receive less money for keeping a resident’s bed available while the resident is in the hospital, potentially affecting how they manage admissions and discharges.
Provides greater support for specialized populations, such as long-term ventilator-dependent residents, by allowing up to 14 paid bed-hold days annually. This recognizes the unique needs of certain high-dependency individuals who may require more time in hospitals and ensures their specific beds are held longer.
Sets strict criteria for when Medicaid will pay for a reserved bed, including requiring at least a 30-day prior stay and a facility vacancy rate of 5% or less on the day of hospitalization or leave. This could limit eligibility and encourage nursing homes to better manage occupancy and bed availability.
Mandates written policies for readmitting residents who exceed the bed-hold period or did not get a bed hold, giving them priority for the next available semi-private room if they want to return and are eligible. This provision helps protect residents from losing access to their nursing home after a hospital stay, even if their bed was not held.
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Who cares
Medicaid nursing home residents and their families
Eligible hospitalized residents would have their same bed and room held for up to 14 days, subject to the bill’s conditions, and a path to readmission when a bed hold ends.
Nursing home operators
For residents 21 and older, the bill would pay 50 percent of the Medicaid rate for up to seven hospital bed-hold days per 12 months while requiring the same bed and room to be reserved for up to 14 days.
Nursing homes with long-term ventilator units
Hospital bed-hold payments for residents receiving services in these units could cover up to 14 days per 12 months rather than seven.
New York State Department of Health
The commissioner would have to issue regulations establishing bed-hold payments and return requirements, subject to federal matching funds, and could use emergency regulations.
Headline styles
Restore Bed Holds for Residents
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Referred to health
- Returned to senate
- Died in assembly
- Referred to health
- Delivered to assembly
- Passed senateVote 60–0
- Ordered to third reading cal.1824
- Referred to rules
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
6602
2017-2018 Regular Sessions
IN SENATE
June 6, 2017
Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Rules
AN ACT to amend the public health law, in relation to partially reinstating a Medicaid reserved bed benefit for temporarily hospitalized nursing home residents
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subdivision 25 of section 2808 of the public health law, as amended by section 2 of part E of chapter 57 of the laws of 2017, is amended to read as follows:
25. Reserved bed days. (a) For purposes of this subdivision, a "reserved bed day" is a day for which a governmental agency pays or otherwise requires a residential health care facility to reserve a bed for a person eligible for medical assistance pursuant to title eleven of article five of the social services law while he or she is temporarily hospitalized or on therapeutic leave of absence from the facility.
(b) Notwithstanding any other provisions of this section or any other law or regulation to the contrary, for reserved bed days provided on behalf of persons twenty-one years of age or older:
(i) 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; [and]
(ii) notwithstanding subparagraph (i) of this paragraph, for periods on and after July first, two thousand seventeen, payments for reserved bed days for temporary hospitalizations shall be made at fifty percent of the Medicaid rate otherwise payable to the facility for services provided on behalf of such person, and payments for reserved bed days for therapeutic leaves of absence shall be made at ninety-five percent of the Medicaid rate otherwise payable to the facility for services provided on behalf of such person;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13089-01-7
S. 6602 2
(iii) for periods on and after July first, two thousand seventeen, payment to a facility for reserved bed days provided on behalf of such person for temporary hospitalizations may not exceed seven days in any twelve month period; provided however that such payments on behalf of persons receiving services in discrete units for long-term ventilator dependent residents may not exceed fourteen days in any twelve month period; and further provided that such facility shall reserve the same bed and room the person occupied before being hospitalized for up to fourteen days in any twelve month period, notwithstanding the seven day limitation of payment established by this subparagraph; and
(iv) payment to a facility for reserved bed days provided on behalf of such person for therapeutic leaves of absence may not exceed ten days in any twelve month period.
(c) Subject to the provisions of this subdivision and to the availability of federal financial participation, the commissioner shall promulgate regulations, and may promulgate emergency regulations, effective for periods on and after July first, two thousand seventeen, establishing payments for reserved bed days and applicable requirements permitting residents to return to a facility after they are hospitalized or placed on therapeutic leave of absence. Such regulations shall provide as follows:
(i) the limitations on payment established by this subdivision shall not apply to reserved bed days provided on behalf of persons less than twenty-one years of age, or to reserved bed days payments to hospices for persons residing in residential health care facilities who are in receipt of hospice services;
(ii) in order to qualify for coverage of reserved bed days, the person must have resided in the residential health care facility for at least thirty days since the date of his or her initial admission; and the part of the facility to which the person will return must have a vacancy rate of no more than five percent on the first day the person is hospitalized or on a therapeutic leave of absence;
(iii) unless medically contraindicated, the residential health care facility shall reserve the same bed and room the person occupied before being hospitalized or placed on therapeutic leave of absence;
(iv) a residential health care facility shall not reserve a person's bed when:
(A) it is clear when the person is hospitalized that he or she will not return to the facility within fourteen days or fewer;
(B) after hospitalization, the person will need a level of care the facility does not provide; or
(C) the recipient does not want to return to the facility; and
(v) a residential health care facility shall establish and follow a written policy under which a person whose hospitalization or therapeutic leave exceeds the bed hold period established under this subdivision, or who has resided in the nursing home for thirty days or more and who has been hospitalized or who has been placed on therapeutic leave without being given a bed hold, is readmitted to the facility immediately upon the first availability of a bed in a semi-private room if the resident wants to return to the facility; requires the services provided by the facility; and is eligible for Medicaid covered residential health care facility services.
§ 2. This act shall take effect immediately and shall be deemed to have been in full force and effect on and after April 1, 2017.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the public health law, in relation to partially reinstating a Medicaid reserved bed benefit for temporarily hospitalized nursing home residents
Purpose
This legislation would partially reinstate payment to nursing homes for the hospitalization bed hold benefit, for Medicaid patients who are at least 21 years of age.
Summary of provisions
Section one of the bill amends subdivision 25 of section 2808 of the Public Health Law to add references to temporary hospitalizations. It also specifies that, effective July 1, 2017, Medicaid payments to a nursing home for hospitalization bed hold would be limited to 7 days per year for each resident, but requires facilities to offer up to 14 days per year per resident. Residents in nursing home ventilator-dependent units, which are medically fragile, would retain paid coverage of up to 14 days per year. Section one also clarifies that residents who are receiving hospice benefits in a nursing home and residents under age 21 are unaffected by the reductions in hospitalization bed hold paid coverage. The Commissioner of Health is required to promulgate regulations consistent with these statutory changes, as well as prior regulatory standards pertaining to bed hold coverage and requirements relating to priority readmission to the first available semi-private room if a bed hold expires or is not offered, consistent with federal regulations.
Read the full memo (651 words)
Section two of the bill provides for an immediate effective date, with the statutory revisions taking effect April 1, 2017.
Justification
The enacted SFY 2017-18 state budget eliminated hospitalization bed hold payments for Medicaid beneficiaries aged 21+, while maintaining 10 days of therapeutic leave per 12-month period reimbursable at 95 percent of the Medicaid rate. Prior to its elimination, the hospitalization bed hold benefit had been limited to up to 14 days per year per resident, and payable to the facility at 50 percent of the Medicaid rate. The effective date of these changes is April 1, 2017, but implementation has been suspended contingent on promulgation of emergency regulations.
A nursing home is a resident's home, and the Medicaid bed hold benefit has ensured that a resident would be able to return to his or her same room following a temporary hospitalization. Hospitalizations can be very disorienting and confusing to frail elders, and not being able to return to the same room or even the same nursing home following discharge could cause significant psychological distress and have other adverse health and social effects on them. The bed hold benefit helps to ensure that the resident can return to familiar surroundings, the same caregivers and perhaps the same roommate.
By eliminating payment for this service, the current statute does not provide for bed hold coverage for residents who are temporarily hospitalized. With nursing homes under considerable financial pressure, they cannot afford to hold beds open that could otherwise be occupied by other residents/patients without payment for doing so. Medicaid regulations already provide that bed hold days are not reimbursable unless the facility has no greater than a 5 percent vacancy rate. Elimination of the hospitalization bed hold benefit can also have a major financial impact on veterans who reside in State Veterans Homes. If these individuals are temporarily hospitalized and need to be placed in a non-State Veterans nursing home due to unavailability of beds, they and their families can see a nearly 90 percent reduction in their monthly stipend from the Veterans Administration.
Hospitals are also likely to be adversely affected by the lack of a hospitalization bed hold benefit, since they will experience delays in being able to discharge individuals who continue to need nursing home care but for whom appropriate beds are not available.
Legislative history
New Bill
Fiscal implications
None to the State
Effective date
Immediately, provided that the provisions of this legislation shall be in full force and effect as of April 1, 2017.
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