Purpose

To determine the extent of implementation of the three recommendations included in our initial audit report, Monitoring of Medicaid Payments for Nursing Home Bed Reserve Days (Report 2010-S-21).

Background

Our initial audit report, which was issued on December 9, 2010, examined whether nursing home claims submitted to Medicaid for hospital bed reserve days were appropriate, and if not, to what extent nursing home claims exceeded the bed reserve day limits.  During the five year audit period ended March 31, 2010, our audit determined Medicaid paid $28 million for bed reserve claims that exceeded the bed reserve day limit.  However, because reimbursement rates were the same for both standard and reserve care during our audit period, we determined no significant overpayments occurred. Although we didn’t identify overpayment, we recommended the Department of Health (Department) remind nursing homes of the correct way of coding for standard nursing home days and bed reserve days.  We also recommended the Department implement controls within eMedNY to prevent payment of claims for bed reserve days in excess of prescribed limits and that it sufficiently coordinates its monitoring activities to provide appropriate accountability over claims for bed reserve days.  

With the changes to the statutes governing reimbursement for bed reserve days in June 2012, the recommendations we made became even more significant as bed reserve days are now limited to 14 days per year for each patient and the nursing home reimbursement rate for bed reserve days are now reduced.

Key Finding

• Department and Office of the Medicaid Inspector General officials have taken significant actions in correcting the problems we identified in the initial report.  Of the three prior audit recommendations, all of them have been implemented.

Other Related Audit/Report of Interest

Department of Health: Monitoring of Medicaid Payments for Nursing Home Bed Reserve Days (2010-S-21)