DMAS Manual Update Source of Confusion

Late last week, the Virginia Department of Medical Assistance Services (DMAS) issued a memo announcing a nursing facility Provider Manual update addressing readmission of residents subsequent to hospitalization or therapeutic leave. 

As stated in the November 3rd memo from Director Patrick Finnerty, DMAS does not make payments to a nursing facility for days that a nursing facility resident is hospitalized or on therapeutic leave.  A resident or his family may choose to hold a bed, but cannot be required to do so.  A nursing facility must allow a resident to return to the next available bed at the time he is ready for discharge from the hospital or return from therapeutic leave. 

The memo further addresses readmission and states that the nursing facility may not refuse to readmit a resident whose hospitalization or therapeutic leave exceeds the bed-hold period under the State Plan for the following reasons:

• The resident has medical and/or behavioral needs that cannot be met by the nursing facility;
• The resident is judged by a physician to be a danger to self or others; or
• The resident (at the time of re-admission) has an outstanding payment to the nursing facility for which he/she is responsible in accordance with Medicaid regulations.

The updated Provider Manual (Chapter IV) echoes this language which represents a significant departure from our understanding of the Department’s previous policy related to readmission.  Specifically, to require a nursing facility to readmit a resident with care needs beyond the facility’s capability to provide care fails all logic and reasonableness standards and establishes a potential situation where the likelihood for inadequate resident care is high.  Additional confusion arises from the wording of Exhibit 1 in Chapter IV.  The Exhibit states that the three situations described above constitute valid exceptions for a nursing facility to refuse readmission.

VHCA has held multiple discussions with DMAS staff this week in an effort to resolve any potential misunderstanding resulting from the Provider Manual update.  We expect to meet with senior DMAS staff early next week and will pass along any new guidance resulting from our discussions with the Department.