The NY Medicaid Bed Hold policy was changed on July 3, 2019 and was retro-active to May 29, 2019. The new reimbursement policy states:
"Effective for dates of service provided on and after May 29, 2019, the following bed hold reimbursement policy will apply:
- Patients under 21 will be reimbursed at 100% of the Medicaid rate for hospital, therapeutic and hospice leaves of absences. There are no day limits for patients under 21 years old.
- Patients 21 and over on hospice will be reimbursed at 50% of the Medicaid rate otherwise payable to the facility for services provided. Payments cannot exceed 14 days in any 12-month period.
- Patients 21 and over on therapeutic leaves of absences will be made at 95% of the Medicaid rate otherwise payable to the facility for services provided and payments cannot exceed 10 days in any 12-month period."
The new policy eliminated reimbursement for hospital leave of absences for residents 21 years and over.
Medicaid retracted Room and Board (R&B) claims that were paid between May 29th and July 3rd but did not retract the corresponding tax claims.
What should a SNF do?
Every nursing home should conduct an audit of hospital bed hold claims for residents 21+ years old with dates of service May 29th to July 3rd to verify that R&B and tax retractions were completed. Void claims should be submitted for any payments not yet retracted.
System Updates Are Needed
Considering this bed bold policy change, each facility should verify that its protocols for census management and correlated billing have been adjusted to prevent the submission of hospital leave day claims for residents 21+ years old. If accidently billed, Medicaid should deny the claims – but submission of invalid claims could be considered fraudulent billing.
Don’t hesitate to reach out to our expert to discuss the policy change and ways you can make sure you are compliant with the regulation.