MM Curator summary
Nursing homes will be paid more to keep COVID-positive residents at their own facilities.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
Sept. 21 Update: This article has been updated with new information about the effective date of the reimbursement for COVID-19 Ready Nursing Facilities.
On the afternoon of September 20, 2021, Indiana Medicaid released a new policy increasing reimbursement for COVID-19 Ready nursing facilities. The policy is in response to the need to ease the growing stresses on the state’s hospital capacity by helping nursing facilities offset the growing and large costs for operating COVID-19 units. The effective dates for qualifying providers are dates of services between September 20, 2021 and October 16, 2021. Facilities submitting an attestation form in the month of September will have reimbursements begin back to September 20, 2021. Facilities that submit attestations on October 1, 2021 or after will have reimbursements start the date of the submission of the attestation.
The temporary increases are 4% per patient day (all Medicaid patients in the facility) for facilities that attest to being COVID-19 Ready and an additional $230 per COVID-19 positive resident.
Qualifying as a COVID-19 Ready Facility
Each nursing facility desiring to become COVID-19 Ready must follow and attest to the below Indiana Department of Health (IDOH) COVID-19 Ready requirements. The COVID-19 Ready Attestation Statement is linked below.
- Follow IDOH COVID-19 Long-Term Care (LTC) Standard Operating Procedures and IDOH COVID-19 Infection Prevention (IP) Toolkit, located on the Professional Resources page at coronavirus.in.gov.
- Follow IDOH LTC hospital transfer guidance or have developed a mutually agreed upon plan with local hospitals for admission and readmission of COVID-19 patients.
- Follow IDOH, Centers for Medicare & 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 residents.
- Follow IDOH, CMS and CDC reporting requirements for new COVID-19 cases and deaths involving residents and staff.
- Provide daily updates of COVID-19 bed capacity and changes in admission status (for example, admissions hold) in the EMResource system at emresource.juvare.com.
- When making the first entry, enter the facility’s current admissions status and capacity.
- Facilities must complete the COVID-19 Ready Attestation Statement to Derris Harrison at Derris.Harrison@fssa.in.gov
- Update their COVID-19 Ready status in EMResource. The facility must enter “yes” in the LTC COVID Ready Facility Status Column.
COVID-19 Resident Reimbursement
To obtain the temporary $230 per resident daily add-on, up to 21 days, a facility must:
- Submit the COVID-19 Ready Attestation Statement to Derris Harrison at Derris.Harrison@fssa.in.gov; and
- Bill claims for COVID-19 positive residents with the primary diagnosis code of U07.1 – COVID-19 positive.
Nursing facilities will be paid the temporary add-on for the full 21-days when the following are true:
- The resident is in a COVID-19 Ready facility.
- The resident is COVID-19 positive between Sept. 20, 2021, and Oct. 16, 2021.
- Claims had U07.1 as the primary diagnosis.
- The resident was not discharged prior to the 21 days for any reason, including death, transfer to another facility or being sent home.