Nursing home residents often require temporary admission to a hospital to treat a chronic condition, an illness or medicine readjustment. A recent study estimates that a quarter of all nursing home residents will require hospital care every year. Yet most residents and their families are not aware of the nursing home readmission policy. Many assume the resident will be readmitted and return to the same bed. This is not always the case.
Federal regulations require all skilled nursing facilities (SNIFs) receiving Medicare and Medicaid to provide a returning resident the next available bed in a semi private room, not necessarily the original bed. States may modify these regulations as long as they do not offer lesser services.
New York Bed Hold Day Policy
New York State had one of the more generous states regarding bed holds. The state guaranteed a resident cold return to her original bed as long as she was not hospitalized more than 14 days in any 12-month period. This applied to all residents receiving Medicaid and occupying a bed in a semi private room. After this time period the nursing facility would still provide her with the next available bed, but not the necessarily the original bed.
Hospital Leave Bed Hold Days Reduced in 2017
Effective April 1, 2017 New York’s liberal bed hold policy has changed. New York State SNIFs must still guarantee the first available bed in a semi private room but not necessarily in the same room or on the same floor. The state affirms that by eliminating this policy it can significantly reduce Medicaid costs. A family may still reserve a bed but only if they pay privately.
Prior to April 2017, New York nursing homes were reimbursed 50% of the Medicaid daily rate for 14 days as long as the nursing facility maintained a 95% occupancy rate. This change is due to a New York State amendment to the Public Health Law that eliminates Medicaid’s bed hold reimbursement. New York’s Department of Health maintains this amendment will reduce Medicaid expenses by $22 million per year.
Some states still retain policies that reserve nursing home beds for a designated number of days. Minnesota has a bed hold policy of 18 days, Washington State will reserve a bed for 20 days, and Connecticut for 15 days. Other states have determined the expense for a bed hold is too costly. Maryland, Alabama, Indiana, and Oklahoma have no bed hold days. These states will still hold a bed if a family or friend privately pay for it. The average bed hold cost is between $300-$350/day.
Therapeutic Leave Bed Hold Days Maintained
New York still offers generous bed-holds for “therapeutic leave”; this is non-medical a overnight visit to a friend or family. Medicaid pays the nursing facility 95% of the Medicaid rate provided to that resident for up to 10 days within any 12-month period.
The average length of time for therapeutic leave among state programs is about 18 days per year. North Carolina offers the most permissive policy, paying for 60 days of therapeutic leave per year. Some states have different rules with regards to leaving the facility for consecutive days. For instance, in Hawaii allows Medicaid eligible resident a total of 12 days for therapeutic leave per year, but the leave cannot be for more than three consecutive days.
Nursing homes are obliged to inform every resident of their bed hold policy when a person is first admitted. The facility is also obliged to restate this policy if and when a resident is sent to a hospital for an extended time. Families should be aware of these policies to insure their rights. By knowing state nursing home bed hold policies, residents and families can insure a nursing home bed is available when they leave a hospital.