Texas Department of Human Services BOARD MEMBERS
Jon M. Bradley
Chair, Dallas
Jerry Kane
Vice Chair, Corpus Christi
Abigail Rios Barrera, M.D.
San Antonio
John A. Cuellar
Dallas
Manson B. Johnson
Houston
Terry Durkin Wilkinson
Midland
COMMISSIONER
James R. Hine

October 29, 2001

To: All Medicaid-Certified Nursing Facility and Medicare-Certified Skilled Nursing Facility Providers

Re: Provider Letter 01-39 -- Bed Change Procedures (Replaces Provider Letter #00-26)

The purpose of this letter is to inform providers of revised bed change procedures. The Center for Medicare and Medicaid Services (CMS), formerly known as HCFA, has provided additional guidance regarding the designation of Medicaid distinct parts referenced in Section 3202 of the State Operations Manual. CMS never intended for current Medicaid residents to be relocated to merely comply with this policy.

Definitions For Terms Used In This Letter

Medicare Distinct Parts

All facilities in Texas have the option to become fully participating in Medicare, or establish a portion/distinct part of the facility that is Medicare certified. Facilities that elect not to become fully participating in Medicare will be required to adhere to the all-distinct part requirements. (Please refer to the definition of distinct parts.)

Medicaid Distinct Parts

All facilities in Texas do not have the option to become fully participating in Medicaid as they do for Medicare. The number of Medicaid-certified beds in each facility is limited or restricted, due to the Medicaid bed "Allocation, Reallocation and Decertification Requirements" mandated by state legislation in Texas. These requirements are found at 40 TAC 19.2322 of the Department of Human Services (DHS) "Nursing Facility Requirements for Licensure and Medicaid Certification." Because of the Medicaid bed allocation restrictions, many facilities have licensed nursing facility beds that cannot be Medicaid certified. Consequently, the facility cannot elect to become fully Medicaid participating. Therefore, Medicaid distinct parts in Texas nursing facilities are frequently created not based on facility choice, but on mandated bed limitations. Facilities that are not fully participating in Medicaid must comply with the following requirements:

Requests for Changes in Bed Size

A change in bed size, for the purpose of this policy, constitutes an increase or decrease in the size of a facility's Medicare and/or Medicaid distinct part. A certified nursing facility may change the size of its distinct part up to two times per cost-reporting year. Facilities may submit only one request for a change in bed size at a time. Two decreases in bed size within the same cost-reporting year will not be permitted. Facilities that undergo a change of ownership or change their cost-reporting year are not exempt from the following bed change procedures:

A request for a change in bed size cannot be approved on a retroactive basis; changes are made on a prospective basis only. The DHS state office Facility Enrollment Section is responsible for advising the intermediary and updating OSCAR/ODIE of any approved changes in bed size.

There are certain situations which warrant an exception to the policy. Therefore, even if a facility has been approved for changes in bed size in accordance with the policies articulated above, the facility may be granted an additional change in bed size on the basis of one of the following situations:

  1. Life Safety Code (LSC) Requirements -- An exception may be granted if the request is to reduce the size of its distinct part to avoid being out of compliance with LSC requirements (e.g., sprinkler installation). To meet LSC requirements, the proposed bed configuration must be separated from the rest of the facility by a two-hour fire wall, so that there is no danger of a fire spreading from other parts of the facility. In this case, the proposed reduction in size of the distinct part may be established with an effective date requested by the facility. However, the effective date may not be earlier than the date the surveyor has verified that a two-hour fire wall exists. If the reason for the request is to avoid noncompliance with LSC requirements, then the fire authority must perform a full survey.

  2. Elimination of Distinct Part -- An exception may be granted if a facility wants to become fully participating. If this is the case, the facility cannot return to distinct part certification until, at the earliest, the beginning of its next cost reporting year.

  3. Enlargement Through Construction, Purchase, or Lease of Additional Space -- An exception may be granted if the facility requests to increase the size of the distinct part to include space acquired through new construction, purchase or lease (e.g., constructing a new wing, purchasing an adjacent building or leasing a floor in a hospital).

The above bed change requests must be received in state office 45 calendar days before the first day of the facility's next cost-reporting quarter, along with current and proposed floor plans and lists that identify current and proposed bed configurations.

Requests for Changes in Designated Bed Locations

Please apply this section to Medicare distinct parts.

For the purpose of this policy, a change in designated bed locations refers to a change in the location of beds without a change in the size of a facility's distinct part. A facility may request a change in designated bed locations as long as 1) there is no change in the number of beds certified to participate in the Medicare program, and 2) the request is received in state office 30 calendar days before the actual change. In addition, the facility must submit current and proposed floor plans and lists that identify current and proposed bed configurations. This will determine whether the proposed change conforms with rules for distinct part certification or full participation, whichever applies. The request must be approved before the facility makes the change. No changes may be made on a retroactive basis.

General Procedures

A "Request for Bed Changes and Bed Relocations" form is attached for your convenience. Please use this form to list and identify current and proposed bed configurations, and submit it to DHS with all accompanying information. For any bed request to be considered complete, all accompanying information must be received with the request. Incomplete requests will not be processed.

When requesting bed changes, facilities must adhere to notification requirements in 42 CFR 483.10(b)(11)(ii)(A), and residents' rights requirements in 42 CFR 483.10(o). Furthermore, facilities must also adhere to rules on bed allocation, reallocation and decertification in 40 TAC 19.2322 of the "Nursing Facility Requirements for Licensure and Medicaid Certification."

If you have any questions concerning a bed request, please contact DHS Long Term Care-Regulatory, Facility Enrollment Section at (512) 438-2630. For questions concerning bed procedures, contact Bevo Morris in Professional Services at (512) 438-2363.

Sincerely, 

- Signature on File - 

Jim Lehrman
Deputy Commissioner
Long Term Care-Regulatory

JL:mg

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