Expands payments for reserved bed days in residential health care facilities; repeals provisions directing the commissioner of health to establish a prospective per diem adjustment for certain nursing homes so as to achieve a eighteen million dollar savings during each state fiscal year.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A8338
SPONSOR: Gottfried TITLE OF BILL: An act to amend the public health law, in relation to
payment for reserved bed days in residential health care facilities; and
to repeal paragraph (f) of subdivision 2-c of section 2808 of such law
relating to prospective per diem adjustments for certain nursing homes
PURPOSE:
To restore the State's Medicaid reserve bed day reimbursement methodol-
ogy that held a resident's nursing home bed, for up to 14 days annually,
during hospital stays.
SUMMARY OF PROVISIONS:
The bill would amend Public Health Law § 2808 (25) to restore long
standing provisions of law which paid for "reserve bed days" and
required nursing homes to hold a resident's bed when they are hospital-
ized, for up to 14 days in a given year. The bill also repeals PHL §
2808 (2-c) (f) which cut $18 million in payments to nursing homes
related to the reserve bed day reimbursement.
JUSTIFICATION:
Both provisions in the bill would reverse enacted state budget for SFY
2017-18 provisions that the Department of Health has since delayed
implementation of. A Dear Administrator letter, issued May 2017, advises
nursing homes that the Department will continue reserve bed day payments
pending the adoption of emergency regulations in order to "clarify the
meaning and intent of the statute".
Nursing home rooms are understood to be each resident's home. New York
State has had a long standing policy under which nursing homes with high
occupancy rates are paid a reduced Medicaid rate to hold a resident's
same bed if they end up having to be admitted to the hospital. The rate
is a percentage of the full rate and is only reimbursed for up to 14
days in any calendar year for a particular resident. This policy has
ensured that residents can come home to the same facility, room and bed.
It reduces the disruption to residents who have come to feel comfortable
in their particular room and with a possible roommate. It has also
ensured that residents are not needlessly waiting in the hospital, at a
much higher cost to the health care system, until another bed becomes
available. Delayed hospital discharges cause a ripple effect throughout
the health care system.
Since April 1, 2017 when reserve bed day payments were to cease, there
has been considerable confusion and disruption. As a result, the Depart-
ment of Health issued guidance to nursing home administrators indicating
that they would be temporarily continuing reserve bed day payments as
they existed before April 1st. This legislation restores the statute and
reserve bed day payments as they existed prior to April 1, 2017 to
ensure that nursing homes, nursing home residents and the hospitals and
health care system are not adversely affected.
LEGISLATIVE HISTORY:
New bill
FISCAL IMPLICATIONS:
To be determined
EFFECTIVE DATE:
Immediately and shall be deemed to have been in full force and effect on
and after April 1, 2017.
STATE OF NEW YORK
________________________________________________________________________
8338
2017-2018 Regular Sessions
IN ASSEMBLY
June 9, 2017
___________
Introduced by M. of A. GOTTFRIED -- read once and referred to the
Committee on Health
AN ACT to amend the public health law, in relation to payment for
reserved bed days in residential health care facilities; and to repeal
paragraph (f) of subdivision 2-c of section 2808 of such law relating
to prospective per diem adjustments for certain nursing homes
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 25 of section 2808 of the public health law, as
2 amended by section 2 of part E of chapter 57 of the laws of 2017, is
3 amended to read as follows:
4 25. Reserved bed days. (a) For purposes of this subdivision, a
5 "reserved bed day" is a day for which a governmental agency pays a resi-
6 dential health care facility to reserve a bed for a person eligible for
7 medical assistance pursuant to title eleven of article five of the
8 social services law while he or she is temporarily hospitalized or on
9 [therapeutic] leave of absence from the facility.
10 (b) Notwithstanding any other provisions of this section or any other
11 law or regulation to the contrary, for reserved bed days provided on
12 behalf of persons twenty-one years of age or older:
13 (i) payments for reserved bed days shall be made at ninety-five
14 percent of the Medicaid rate otherwise payable to the facility for
15 services provided on behalf of such person; [and]
16 (ii) payment to a facility for reserved bed days provided on behalf of
17 such person for temporary hospitalizations may not exceed fourteen days
18 in any twelve month period; and
19 (iii) payment to a facility for reserved bed days provided on behalf
20 of such person for [therapeutic] non-hospitalization leaves of absence
21 may not exceed ten days in any twelve month period.
22 (c)(i) Notwithstanding any contrary provision of this subdivision or
23 any other law and subject to the availability of federal financial
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11945-03-7
A. 8338 2
1 participation, with regard to services provided to residential health
2 care facility residents twenty-one years of age or older, the commis-
3 sioner shall promulgate regulations, and may promulgate emergency regu-
4 lations, effective for periods on and after July first, two thousand
5 twelve, establishing reimbursement rates for reserved bed days.
6 (ii) Such regulations shall, for each Medicaid patient for any twelve
7 month period, provide for reimbursement for reserved bed days for: (A)
8 up to an aggregate of fourteen days for hospitalizations and for other
9 therapeutic leave of absences consistent with a plan of care ordered by
10 such patient's treating health care professional; and (B) up to aggre-
11 gate of ten days of other leaves of absence.
12 (iii) No later than thirty days after promulgation of such regu-
13 lations, the commissioner shall advise the chair of the senate finance
14 committee, the chair of the assembly ways and means committee and the
15 chairs of the senate and assembly health committees of the projected
16 reductions expected to be achieved under the methodology set forth in
17 such regulations.
18 (iv) In the event the commissioner determines, in consultation with
19 the director of the budget, that the regulations promulgated pursuant to
20 subparagraph (i) of this paragraph shall achieve projected aggregate
21 Medicaid savings, as determined by the commissioner, of less than forty
22 million dollars for the state fiscal year beginning April first, two
23 thousand twelve, and each state fiscal year thereafter, the commissioner
24 shall establish a prospective per diem rate adjustment for all nursing
25 homes, other than nursing homes providing services primarily to children
26 under the age of twenty-one, sufficient to achieve such forty million
27 dollars in savings for each such state fiscal year.
28 § 2. Paragraph (f) of subdivision 2-c of section 2808 of the public
29 health law is REPEALED.
30 § 3. This act shall take effect immediately and shall be deemed to
31 have been in full force and effect on and after April 1, 2017.
