AGING AND DISABILITY SERVICES ADMINISTRATION
June 23, 2003
ADSA: BH #2003-015
NEW BED HOLD POLICY
Dear Boarding Home Provider:
You are receiving this letter because you provide COPES or Medicaid Personal Care services (MPC) to Medicaid eligible clients. The Legislature passed SSB 5579 setting a new boarding home bed hold policy and the Governor signed it into law on May 12, 2003. Aging and Disability Services Administration Case Managers will begin using the new bed hold policy effective July 1, 2003.
What are bed holds?
When a Medicaid resident temporarily leaves an adult family home or boarding
home for a hospital or nursing home stay and is expected to return within
a certain number of days, the provider may request compensation for holding
the absent resident’s bed or unit for his/her return.
Where will the funding come from to pay for the new bed hold policy?
Effective July 1, 2003, the department will reduce all daily rates an average
of $.50. The department added this amount to all daily rates on July 1, 2002
to compensate providers for bed holds. The legislature did not appropriate
additional funds for bed holds. The department must use the funding that
was allotted within the current rate policy to pay for bed holds outside
the daily rate.
Will the bed hold policy apply to the Division of Developmental Disabilities
(DDD) clients?
Yes. To authorize bed holds, DDD will have new service codes available in July
2003. The bed hold policy does not apply to DDD group homes. DD group homes
refer to DDD Policy 6.12 for vacancy payments.
| NEW BED HOLD POLICY7/1/03 | CURENT BED HOLD POLICY7/1/02 - 6/30/03 | |
|---|---|---|
| How many days must the provider hold a bed or unit for the client discharged to a nursing home or hospital? | 20 dayswhen the client is likely to return to the facility by the 20th
day. After the 20th day the unit or bed is available to others, unless a third party agrees to pay the provider to continue to hold the bed. |
30 dayswhen the client is likely to return to the facility by the 30th
day. After the 30th day the unit or bed is available to others. |
| How does the department pay the provider for holding the bed or unit? | For each day the client is in the hospital or nursing home and the
provider holds the unit or bed for his/her return, the department will
pay:
|
The department adds an amount for bed holds to the daily rate for each resident present at the facility. No bed hold rate is paid during the clients NH/hospital stay. |
| May the provider seek third party payment? | Not during the initial 20 days. After the 20th day, the provider may seek third party payment up to 85% of the average daily rate paid to the facility. | No. |
| What is the payment status of the client during the bed hold period? | Case Manager (CM) will change the client’s payment status for days:
|
The CM must remove the client from the payment system until the client returns to the original or another residence. |
What are the bed hold rates the department will pay?
Charts showing the 70% amount of each daily rate are available on the Internet
at http://www.aasa.dshs.wa.gov/professional/default.htm. The rate for the
8th through the 20th day is $10.43 a day.
Does the provider have to report on the third party payments that he or she
may receive after the twentieth day?
For management purposes and legislative reports, ADSA would like to gather
information on bed holds that go beyond the twentieth day. In a separate mailing,
ADSA will send providers a simple to complete form and/or an e-mail form on
this subject in mid July 2003.
If you have any questions, please contact Dick Rosage @ (360) 725-2442 or
George Zimmerman @ (360) 725-2534.
Sincerely,
Kathy Marshall, Director
Management Services
Penny Black, Director
Home & Community Services
Linda Rolfe, Director
Developmental Disabilities
