Long Term Care Medicare Part D Resources for Nebraska

Medicaid Corrective Action May Impact Facilities
IMD Nonpayment for Adults Between 21 and 65 Years Old

On May 26, 2011, NHCA, NALA, LeadingAge Nebraska, and Nebraska Medicaid and Long-Term Care partnered to bring a “Medicaid Corrective Action May Impact Facilities” webcast to Nebraska nursing homes and assisted living facilities. At the completion of the program, participants were able to:

Assess a facility’s risk related to Institutions for Mental Disease (IMDs) and Medicaid eligibility and
Identify how a facility can manage the associated risk.

Webcast speakers included representatives of the Nebraska Department of Health and Human Services. Live webcast viewers were able to participate in a Q&A.

May 26, 2011, Webcast

June 3, 2011, clarification

Issue Background
In April 2011, the Centers for Medicare and Medicaid Services (CMS) sent a letter to the Nebraska Department of Health and Human Services (DHHS) asking the State to provide assurance that adult Mental Health and Substance Abuse (MH/SA) rehabilitation services were not being provided in nursing facilities, assisted living facilities, and other types of health care facilities that meet the definition of an “Institution for Mental Disease” (IMD). DHHS believes that many Nebraska nursing facilities and assisted living facilities meet the definition of IMD and does not believe it can make such an assurance. DHHS must submit a Corrective Action Plan (CAP) to CMS asking for a short time to come into compliance.

An Institution for Mental Disease (IMD) is defined as “a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care for persons with mental diseases, including medical attention, nursing care, and related services.”

A facility will be considered to be “primarily engaged in providing diagnosis, treatment, or care for persons with mental diseases” if the current need for institutionalization for more than 50 percent of residents is a direct result of a behavioral health illness. A resident will meet this definition if (1) the resident has a current diagnosis or had a behavioral health diagnosis at the time of admission, if the resident was admitted within the past year or (2) a large portion of the residents are receiving psychopharmacological drugs.

There is no federal Medicaid match for the costs of any services provided to the resident of an IMD, including Medicaid services provided outside the IMD. The only IMDs where Medicaid match is available for children are psychiatric hospitals or PRTFs (Psychiatric Residential Treatment Facilities).

Impact on Nursing Homes and Assisted Living Facilities
There is no Medicaid funding for adults between 21 and 65 living in an IMD. Thus if a facility is deemed to meet the definition of IMD, CMS will deny payment for the facility’s Medicaid residents between 21 and 65 years old.

Impact on Hospitals, Nursing Homes and Assisted Living Facilities
DHHS is providing education and training to hospitals, nursing facilities and assisted living facilities so they can assess their risk for being categorized as an IMD and the potential loss of Medicaid reimbursement for Medicaid covered services for their residents. DHHS is identifying how many nursing homes and assisted living facilities meet the IMD definition.

Nursing homes and assisted living facilities can continue to have over 16 beds, but more than 50 percent of their population cannot have a mental health diagnosis or be taking psychotropic medications.

Plans
DHHS will continue to provide education and training to nursing homes and assisted living facilities on IMD issues. It will prepare a Corrective Action Plan for CMS. It will also conduct site visits to identify Adult IMDs and offer technical assistance on ways to alter their business plan that could change their IMD status.

View Nebraska Medicaid Adult IMD Webpage. The page contains a link to the Medicaid IMD Question and Answer document and the State Medicaid Manual on IMDs.

This CMS policy could have significant negative consequences for Nebraska nursing homes and assisted living facilities in terms of Medicaid payment and occupancy. It is critical that facility management (1) be able to identify whether their facility or facilities could be subject to nonpayment and (2) obtain ideas to minimize or eliminate the risk of nonpayment.

The webcast was made possible with the support of

3900 NW 12th St Suite 100 Lincoln NE 68521
Phone: (402) 435-3551 Fax: (402) 475-6289

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