Applies to all Medicaid and/or Medicare-certified nursing facilities
Posted September 27, 2002
For more information contact Jerri Lynn Ward.
What you should do when the facility is at its maximum capacity of Medicaid beds, and an additional resident, who was previously in a Medicare bed, is now eligible for a Medicaid bed?
Under certain circumstances, the facility can obtain a waiver that allows the resident to remain in the facility and be covered by Medicaid. This situation is likely to occur after a resident has spent down his private funds and has become eligible for Medicaid, and therefore these beds are often referred to as “spend-down” Medicaid beds.
How does a facility obtain a spend-down bed?
The authority to request a waiver and obtain a spend-down bed can be found at TAC ยง 19.2322, and is addressed in Provider Letters 98-12 and 98-04.
To be eligible for a spend-down Medicaid bed, six conditions are essential:
- The resident must have resided at the requesting facility for 6 consecutive months. Hospitalizations or therapeutic visits do not break the six consecutive month requirement.
- The resident must not have been Medicaid-eligible at the time of admission.
- The facility must request certification of currently non-certified beds.
- A licensed-only nursing facility requesting certified beds must meet the requirements for Medicaid participation and obtain a Medicaid contract.
- The facility must have a satisfactory compliance history.
- The certification lasts only until a Medicaid bed becomes available, until the resident dies, or until the resident is otherwise permanently discharged from the facility.
The number of Medicaid certified beds obtained under these “spend-down” rules must not exceed 10% of the total number of certified beds in a Medicaid facility, or 10% of the licensed beds in a non-certified nursing facility.
To apply for a waiver to have a spend-down bed, you must contact the TDHS contract specialist responsible for your region. The attorneys at Garlo Ward are happy to assist you in this process.
For more information on this subject, contact Jerri Lynn Ward with your specific question(s).
All information in this article is informational only and is not legal advice. Should you have any questions or a situation requiring advice, please contact an attorney.
Copyright 2004 by Garlo Ward, P.C., all rights reserved
Austin, Texas 78752-3714 USA
Telephone: 512-302-1103
Facsimilie: 512-302-3256
Email: Info@Garloward.com
