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New nursing home regs could help LTCI users

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New federal long-term care facility requirements could make the cost of nursing home care more predictable, sharply reduce the number of nursing homes that take Medicaid, or both.

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The Centers for Medicare & Medicaid Services (CMS) says in new final regulations that a long-term care facility that takes Medicare or Medicaid must meet federal transfer and discharge requirements. 

A facility can transfer a resident for non-payment, but, “for a resident who becomes eligible for Medicaid after admissions to a facility, the facility may charge a resident only allowable charges under Medicaid,” according to the regulation text.

The regulation does not appear to require a resident to have paid for a private care in an affected facility for a minimum number of days for qualifying to stay in the facility at Medicaid rates.

The final rule appeared in the Federal Register today. The CMS intends to implement the requirements in the rule over several years. The discharge rights requirements appear to be part of the Phase 1 requirements. The CMS says facilities should implement the Phase 1 requirements by Nov. 28.

Industries often use administrative processes and lawsuits to change regulations.

If the new regulations take effect as written, they could require nursing homes that take in people who have modest amounts of private long-term care insurance, or short-term care insurance, to limit charges for those residents to Medicaid rates once the residents exhaust private savings and insurance and become eligible for Medicaid.

In Connecticut, for example, a year in a nursing home can cost a private-pay patient more than $100,000 per year.

Medicaid pays nursing homes in the state only about $25 per day, or about $9,100 per year.

The new CMS rule could reduce costs and cost uncertainty for private-pay patients who exhaust private resources and are able to stay in the same facility while paying Medicaid rates, but it could make facilities look harder at the financial resources of incoming private-pay patients.


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