Obamacare and LTC reimbursment.

[fairyluv]

So how will obamacare affect LTC reimbursements ?? I know that right now it is paid by the census of your facility. Will that continue with Obama Care ?? A resident was telling me that he was wanting to go spend a few days with his family, as he often does a couple times a month. When his daughter came to pick him up, he was told by Mngmnt that if he left, the facility would not get paid, and it was strongly discouraged for him to leave. He has done this several times before and he is pretty much independent with his care, just needs little assist here and there. No reason really why he couldn't leave for a couple days. He didn't like it that he was being discouraged because if he left for the night then the facility would not get paid. How does that work ??

[TheCommuter, BSN, RN]

This is nothing new. . .if the resident is not in the bed when the clock strikes at midnight, then the facility does not get paid for that person. It has always been this way at all facilities (hospitals, nursing homes, etc.).

[chrisrn24]

Playing devils advocate but perhaps in the case of your gentleman he needs to be in an ALF instead of LTC?

[TheCommuter, BSN, RN]

Playing devils advocate but perhaps in the case of your gentleman he needs to be in an ALF instead of LTC?

Yep. A resident who could be classified as mostly independent or 'standby assist' with ADLs would be more appropriate for an independent living center or ALF.

[fairyluv]

Probably so. I am not sure why exactly he is there. Other than he was in the rehab unit for a time (generalized weakness) and then moved to LTC.

[fairyluv]

Will Obama care still reimburse the same way ?? based on census ??

[txredheadnurse, BSN, RN]

Will Obama care still reimburse the same way ?? based on census ??

Every payor source I am aware of pays off the same premise: If the resident is not in the building at midnight so as to be counted on the census then the facility does not get paid for that resident. The reasoning is why pay for a resident to be receiving either skilled or extended care if they are not physically in the building?

If the facility is funded by Medicaid funds AND is not a skilled facility there might be a provision to allow a therapeutic pass not to exceed 48 hours out of every 7 seven days and still be reimbursed the room & board portion of the facility payment. This generally applies to group homes and not facilities staffed with on site nurses 24 hours a day.

[ktwlpn, LPN]

In this state a Medicaid resident is permitted a certain number of overnight passes per year, if they take any then that number they can loose the benefits because obviously they really don't need LTC. Our rehab folks who are on Med A must be in the facility o receive therapy or they loose the benefit. You have to be there to rehab,makes sense to me.

[NurseGuyBri]

Like ktwlpn, in Virginia, a Medicaid patient has 20 "vacation" days that are paid to the facility to use throughout the year for just this circumstance. For SNF/Medicare patients, it's the midnight rule. It makes sense, as a patient in SNF/MCR is skilled with higher needs. if they can be out for periods, they don't (and usually shouldn't) qualify for that benefit. Now, back to the original post of Obamacare, no one knows, not even the Obamacare administration. Dual eligibility and ACO's in Virginia are going to kick in October I believe, so we will know then. My guess is that there will be little visible change on the floor and on payment rules. It's the payment amounts that will change and the reimbursement that will alter. This is just an educated guess, however- anyone who knows otherwise please correct me, I'd like to know more too.