To assist in easing the burden on Indiana hospitals, the Indiana Family and Social Services Administration (FSSA) announced recently that Indiana Medicaid certified nursing facilities can receive additional Medicaid reimbursement to help address the additional costs the nursing facilities incurred and continue to incur to address COVID-19 in light of the highly contagious delta variant. The additional reimbursement is intended to assist hospitals which are or are becoming overwhelmed with COIVD-19 positive patients by housing COVID-19 patients in long-term care nursing facilities rather than hospitals. In other words, nursing facilities are being offered an incentive to admit COVID-19 patients who otherwise would be hospitalized to ease the burden on Indiana hospitals. To qualify for the additional reimbursement, the nursing facility must be equipped to and its staff trained to provide safe and adequate care for COVID-19 positive individuals.
In a bulletin released September 20, 2021 the Indiana Health Coverage Program announced a temporary 4% Medicaid reimbursement increase for COVID-19 Ready nursing facilities. To qualify for the additional reimbursement, nursing facilities will have to attest to being COVID-19 Ready. The temporary 4% reimbursement rate increase will be calculated based on each facility’s standard Medicaid reimbursement rate.
In addition, COVID-19 Ready Medicaid certified nursing facilities are eligible for a temporary $230 per day add on additional reimbursement for each resident diagnosed with COVID-19. The 4% reimbursement rate increase is available for dates of service between September 20, 2021 and October 16 2021, and the add on is available for up to 21 days per COIVD-19 positive resident between September 20, 2021 and October 16, 2021.
COVID-19 Ready nursing facilities seeking the temporary 4 % rate increase are those facilities that attest to:
- Following the Indiana Department of Health COVID-19 Long-Term Care Standard Operating Procedures and IDOH COVID-19 Infection Prevention Tool Kit, which are found on the Professional Resources page at coronavirous.in.gov;
- Following the IDOH Long-Term Care hospital transfer guidelines or have developed a mutually agreed upon plan with local hospitals for admission and readmission of COVID-19 patients;
- Following IDOH, Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) communication guidelines;
- Accept COVID-19 new admissions, readmissions, and transfers;
- Share complete COVID-19 status information with transportation providers serving long-term care nursing facility residents;
- Following IDOH, CMS, and CDC reporting requirements for new COVID-19 cases and deaths involving residents and staff; and
- Providing daily updates of COVID-19 bed capacity and changes in admission status such as admissions hold in the EMResource system at emresource.juvare.com.
COVID-19 Ready nursing facilities must complete and sign the Attestation Statement-COVID-19 Ready Providers located on the Myers and Stauffer website and email it to Dennis.Harrison@fssa.in.gov. Nursing facilities must also be enrolled in the EMResource system and update their COVID-19 Ready status in EMResource and attest to being COVID-19 Ready by entering “yes” in the LTC COVID Ready Facility Status column.
To qualify for the $230 per resident per day add on the nursing facility must:
- Submit an attestation and comply with the IDOH requirements for COVID-19 Ready facilities described above; and
- Bill claims for COVID-19 positive residents with the primary diagnosis code of U07.1-COVID-19 positive.
- Medicaid certified nursing facilities will be paid the temporary $230 per resident per day add-on for 21 days from a resident’s initial positive COVID-19 diagnosis only if
- The nursing facility is a COVID-19 Ready facility;
- The resident is COVID-19 positive between September 20, 2021and October 16, 2021;
- Claims had a U07.1 as the primary diagnosis; and
- The resident was not discharged for any reason including death, transfer to another facility, or going home prior to the 21 days.
Indiana Medicaid certified nursing facilities should seek this additional reimbursement in accordance with the guidelines described above as quickly as possible to ensure timely reimbursement for nursing facilities housing COVID-19 positive residents.
If you questions regarding health care or COVID-19 guidelines, contact Janet McSharar at jmcsharar@dsvlaw.com or your DSV attorney.
**The information contained on this website is for informational purposes and is not intended as formal legal advice and cannot be relied upon as such. No attorney client relationship is established or intended as a result of the information contained on this website.**