Bed-Hold Policies: What is required of Indiana’s Long Term Care Facilities?

by Zach Cattell, J.D., IHCA General Counsel

IHCA continues to field questions from members regarding facility-level impacts of the decision by the Indiana Office of Medicaid Policy and Planning (“OMPP”) to eliminate reimbursement for bed-hold days. The elimination of reimbursement for bed-holds was effective February 1, 2011, (for a copy of this bulletin, click here) and the Indiana Medicaid State Plan will be amended in the coming months to finalize elimination of reimbursement. OMPP has also posted, and periodically updated, a news summary on IndianaMedicaid.com that discusses the impact of the reimbursement change on Indiana’s long term care facilities and their residents (Click here for the news summary).

More recently, requirements for long term care facilities to maintain updated bed-hold policies were discussed during a panel presentation at the 2011 IHCA Convention & Expo in May. In addition to the above OMPP-issued materials, the IHCA offers the following points for long term care facilities when developing bed-hold policies.

• Facilities must have a bed-hold policy that states whether or not the facility allows a resident to pay to hold a bed during a leave of absence

     o Though facilities are not required to allow a resident to pay to hold a bed, facilities must still have a policy that states whether or not payment for holding a bed is permitted by the facility

• The duration of the bed-hold period must be clearly stated in the facility policy

• Bed-hold policies should state that Indiana Medicaid does not reimburse for bed-holds

• Payment by residents for bed-holds must follow applicable Medicare and Medicaid guidelines regarding billing for non-covered services

• Charges for bed-holds should be set at fair market value and must be equally applied to all residents regardless of payor source

     o Facilities may be at risk for Anti-Kickback violations related to improper inducements to government program beneficiaries if charges for bed-holds are not fair market value and equal application of those charges are not maintained. However, an exception to the Anti-Kickback statute may apply in certain circumstances for bed-hold charges that are unable to be collected. This exception depends on certain elements regarding facility advertisements, other relevant services and financial need of the resident.

• If a resident on leave is expected to return to the facility, regardless of whether they have paid to hold a bed, the facility is not required to discharge the resident

• If a resident is discharged from a facility, however, the facility must permit the resident to return to the first available semi-private bed when (i) the resident continues to qualify for Medicaid, (ii) the resident requires nursing-level care and (iii) the facility is able to provide appropriate care for the resident.

     o A resident may be discharged from the facility for many reasons including, but not limited to, the resident’s failure to pay for a bed-hold or when the bed-hold period expires. Facilities must follow applicable regulations and procedures when discharging a resident.

The IHCA encourages facilities to carefully review their bed-hold policies to ensure compliance with current law and regulation. The above guidance is not intended to be specific legal advice and facilities should seek independent legal counsel when developing facility-specific policies. The IHCA is able to assist facilities find legal counsel. Please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.
IHCA thanks Randy Fearnow and Susan Ziel of Krieg DeVault, LLP for contributions to this article.