SD6 - Admission and Discharge Policies of Nursing Homes Providing Services Under the State Plan for Medical Assistance

  • Published: 1987
  • Author: Secretary of Human Resources
  • Enabling Authority: Senate Joint Resolution 52 (Regular Session, 1986)

Executive Summary:
STUDY OF ADMISSION AND DISCHARGE POLICIES OF NURSING HOMES PROVIDING SERVICES UNDER THE STATE PLAN FOR MEDICAL ASSISTANCE

Persistent complaints regarding the difficulty of admitting Medicaid eligible residents to nursing homes prompted the General Assembly to request the Secretary of Human Resources to study whether there is discrimination by those nursing homes which participate in the Medicaid program in their admission and discharge policies based on the source of payment. This report is, therefore, submitted to the General Assembly in response to Senate Joint Resolution 52 passed by the 1986 Virginia General Assembly.

The Study found that there are practices throughout the Commonwealth which give preferential treatment to private pay patients in the admission of patients to nursing homes. Such practices are not prohibited by law unless those practices violate the Civil Rights Act or discriminate on the basis of age or handicapping condition. The Study Group found, however, that the practice of preferential admission of private payors over Medicaid patients is occurring to such an extent that it has caused serious inconvenience to Medicaid eligible patients attempting to access nursing home care, often resulting in long delays in admission and traumatic separation from family and community.

The study's recommendations follow:

1. The Department of Health should expedite its study of the methodology by which it determines the need for nursing home bed construction, and by which it allocates those beds among the localities in order to ensure that the study is completed no later than the spring of 1987.

2. The Department of Medical Assistance Services should proceed to examine the feasibility of implementing a case mix reimbursement system which would recognize the higher costs of caring for heavy care patients or patients with special nursing care needs.

3. Nursing homes should be required to fully disclose the homes' admission policies. The numbers of persons on waiting lists should also be disclosed. However, due to the need to safeguard personal privacy, waiting lists should not be disclosed.

4. The Indigent Care Task Force should study the revision of Medicaid participation requirements to require 100% certification of Medicaid participating nursing homes or to require commitment to some minimum level of Medicaid participation as a condition of contracting to receive Medicaid payments. The Certificate of Public Need Law should be studied to determine whether such mandatory certification or participation should be a requirement for obtaining a certificate of public need.

5. A first come, first serve admission policy is not recommended at this time. However, if less stringent measures fail to assure that Medicaid patients have fair access to nursing home care, the Commonwealth should consider requiring nursing homes to admit patients on a first come, first serve basis without regard to payment source.