A large hurdle has just been clarified in the 2012 Regulations.
New bed confusion?
– Regulations treat new and existing beds differently when increasing bed size. Many facilities that had operated IRF beds at some time in the past were confused about whether or not reopening beds would be considered “new.” In the 2012 regulations, a time limit of five years has been established for whether to treat beds as new. Even if operated previously by the same hospital, but kept out of circulation for more than five years, the facility must start over. However, if it is less than five years, notify the CMS Regional Office (RO) within a 30 day period, follow all other classification and coverage criteria and bed capacity can be increased.
– Bed changes can occur only one time per cost reporting period. Again, notify the RO within a 30 day period.
– Keep in mind that when bed sizes are changed, the 60% rule is in effect as a new overall percentage, based on the day of opening and applies for the rest of that fiscal year.
– States having a Certificate of Need (CON) law must follow state laws for adding beds as well as approval through the CMS RO.
– Change of ownership requires application for certification of beds
The rule states that if beds were de-licensed or de-certified it will require written RO approval and a twelve (12) month cost report lapse to add beds into service.
With today’s mergers, acquisitions and needs to adopt quickly, the regulation strangled ability to provide service in a timely manner. CMS hopes these changes improve access and reduce prolonged uncertain processes previously enforced.
“In accordance with the general principles of the President’s January 18, 2011 Executive Order entitled ‘Improving Regulation and Regulatory Review,’ we are amending existing regulatory provisions regarding ”new” facilities and changes in the bed size and square footage of IRFs and inpatient psychiatric facilities (IPFs)to improve clarity and remove obsolete material.”
Changes in square footage for IRF usage has also changed since allocation of capital costs were not relevant for individual payment methods. Square footage change requires a written RO approval with 30 day notification.
IRF unit acquisitions were not dealt with in this rule since Medicare stated payment status could not be bought, sold or transferred and therefore, requiring application for Medicare status.
It states the rule takes effect October 1st, 2011. It is very possible this opens an entirely new possibility for someone reading this post right now!