In a press release this week, the IRS confirmed that the $1,200 pandemic stimulus payments (officially called “Economic Impact Payments” under the CARES Act) received by nursing home residents remain their property. Under long-standing Medicaid law, income tax refunds follow special rules that treat these as an asset that can be spent over the following YEAR by Medicaid recipients without any penalty to their Medicaid benefits. It is not considered income paid as “applied income” to a nursing home and it does not count against the $1,600 resource limit so long as it was spent – but not given away, normally – over the year following receipt.
March 30, 2020: This Afternoon, the CT Department of Public Health (DPH), in conjunction with the Long-Term Care Ombudsman, announced plans to temporarily designate select nursing homes within the state as COVID-positive and COVID-negative skilled nursing facilities.
This plan will allow facility residents who have tested positive to receive more concentrated skilled care, to have access to more skilled health professionals and equipment at their facility, while maximizing the change that those who have tested negative are at minimal risk of contracting COVID-19 during this wave of infection. However, accomplishing this plan means that many nursing home residents, including those who have not been tested for COVID-19, will be temporarily relocated to other facilities.
A new cog in the federal response to the Coronavirus outbreak are some changes in how individuals on traditional “straight” Medicare can qualify for nursing home rehabilitation.
Medicare rehab coverage is provided under Part A hospital insurance, with two key provisions being that (1) seniors are only eligible for rehabilitation after a 3-night stay in a hospital as an inpatient, and (2) nursing home rehab is limited to 100 days per hospitalization period.
Federal Medicare administrators recognize that hospital and nursing home beds will likely become limited commodities in the coming weeks. That means some who should have hospital care will be denied in favor of needier patients, and some who would benefit from facility-based rehab will not be able to access it, possibly becoming more infirm due to the lack of intervention. In light of this, the Medicare Administrator issued a “special finding” that waives both of these limitations, in most cases.
SNF [skilled nursing facility] care without a 3-day inpatient hospital stay will be covered for beneficiaries who experience dislocations or are otherwise affected by the emergency, such as those who are (1) evacuated from a nursing home in the emergency area, (2) discharged from a hospital (in the emergency or receiving locations) in order to provide care to more seriously ill patients, or (3) need SNF care as a result of the emergency, regardless of whether that individual was in a hospital or nursing home prior to the emergency.
In addition, we will . . . provide renewed coverage for extended care services which will not first require starting a new spell of illness for such beneficiaries, who can then receive up to an additional 100 days of SNF Part A coverage for care needed as a result of the [COVID-19] emergency.
Seema Varma, Administrator, Centers for Medicare and Medicaid Services
If you are worried about yourself or a loved one having access to services, the situation is highly in flux at the moment, but we stand ready to answer your calls and questions with the latest information at (203) 871-3830 and are available for videoconferencing and teleconferencing on several common platforms.
Over the past week, there have been conflicting reports and governmental orders regarding visitation of residents in nursing homes. This was clarified March 13, when CMS (the federal medicare/medicaid regulator) issued new guidance to nursing homes nationwide. Namely, they have ordered that all visitation of nursing home residents is prohibited, with two exceptions: outside health care professionals, and limited visitation for resident’s who are actively dying or receiving hospice/palliative care. Additionally, group activities such as recreation and communal dining have been suspended.
In furtherance of this, the Probate court has suspended all proceedings that require hand-delivered notices or hearings conducted at facilities. Mostly this means new applications for conservatorship for people presently located in nursing homes, and applications to make nursing home care permanent (change of residence). It is still unclear how these will work with respect to deadlines imposed by law.
One important thing to know, however, is that just because you cannot see your loved one does not mean that you are unable to participate in their care. These rules do not change the requirement that facilities provide quality care, or develop a plan of care on a quarterly basis, with your input. It only means that conferences and reviews need to be conducted through telephone and records exchanges, rather than talking and looking in person.
We understand this change is particularly concerning for loved ones of seniors who have recently moved to a facility for rehab purposes. It is tough not being able to see their progress in person, or to know if or how quickly they will return home. You should also expect that, because facilities will have to exclude both personal care and licensed staff as an abundance of caution, and at a minimum it will be even harder than it normally is to get the responsiveness and communication by phone you may desire. But there are certain levers you can pull to get what you need, and my office is ready and able – by phone, paper, and video conference – to answer questions and help those who feel they need an advocate on their side.
