Bed Changes

This page is designed to assist with requests to change a nursing home’s licensed bed capacity or bed designations for Medicare and Medicaid participation.

IMPORTANT: A request for a Change in Medicare (Title 18) / Medicaid (Title 19) Bed Designations (see below) will be processed in accordance with Medicare / Medicaid requirements.

A Change in Licensed Bed Capacity can only modify the bed designations as follows:

• If a nursing home has Certificate of Need (CON) approval to increase its licensed bed capacity, it will be allowed to designate the newly licensed beds for Medicare / Medicaid participation. The designations will be effective as of the licensure date of the new beds provided that (i) the facility is currently certified for participation in Medicare / Medicaid; and (ii) the physical space that will house the new beds has been approved by LARA Health Facilities Evaluation Section (HFES) as meeting all physical plant and Life Safety Code requirements. Any proposed change to Medicare / Medicaid designations for existing beds will require a separate application. See Change in Medicare / Medicaid Bed Designations Section below.

• A decrease will be allowed to modify existing bed designations to the extent of the change in bed capacity. This means that any designation changes must reduce existing designations but cannot increase any designation; such a request will require a separate application.

• This section applies to any request by a nursing home to increase or decrease the facility’s existing licensed bed capacity. An increase or decrease in the number of licensed beds is defined by a change in the total number of beds at the nursing home.

To request an increase or decrease in the number of licensed beds, the nursing home must submit a state licensure application (BCHS-HFD-100) and Appendix D. The nursing home must have an appropriate CON approval for any proposed increase in licensed bed capacity.

An increase or decrease in licensed bed capacity will have an impact on the Medicare / Medicaid bed designations (see below) unless the increase or decrease relates to state licensed-only beds not designated for Medicare / Medicaid use.

For an increase in licensed bed capacity, the Bureau will send an invoice for the licensing fee (if applicable) after receipt of the application and prior to issuance of a new or revised license.

• This section addresses requests for a change in Medicare / Medicaid bed designations. An increase or decrease in bed designations is defined by a change in the total number of beds designated as Medicare-Only, Dually Certified (Medicare / Medicaid), and Licensed-Only. This type of request will not change the total bed capacity at the nursing home.

To request an increase or decrease in the number of beds designated for Medicare / Medicaid purposes, including Dually Certified beds, the nursing home must submit:

• A state licensure application (BCHS-HFD-100), Appendix D, and the current and proposed floor plans for the changes being requested. The floor plans must clearly identify each room as either Medicare-Only, Dually Certified, or Licensed-Only.

• The bureau will process and approve all Medicare requests on behalf of CMS.

• FOR MEDICAID CHANGES – A nursing home must simultaneously submit a request to MDHHS Long-Term-Care Policy Section via email MDHHS-BEDCERTS@michigan.gov. Subject line: Medicaid Bed Designation Request. The request must include BCHS-HFD-100, Appendix D, and current and proposed floor plans. For any questions, please call 517-241-4079.

• The bureau will only update the Medicaid designations upon Medicaid approval. Medicaid will notify the provider.

For more information on Medicaid requirements, see the Survey, Certification & Enforcement Appendix of the Nursing Facility Chapter in the Medicaid Provider Manual.

IMPORTANT: Bed designation changes are limited by Medicare / Medicaid requirements including, but not limited to, submitting a request 45 days prior to the start of the cost reporting year/quarter. The approval and effective date will be determined by the Medicare / Medicaid programs and cannot be approved on a retroactive basis. An effective date for the bed designation changes will be the first working day of the cost reporting year / quarter after approval.

By submission of a Medicare-Only bed designation request, the nursing home is attesting to the fact that the request meets the requirements set forth in the CMS State Operations Manual (3202a, 3202A1, and 3202A2 starting on page 97) for distinct part units. In additional guidance to the Department, CMS has provided the following clarifications on the published definition of distinct part:

• A corridor can be divided in half, lengthwise, by designating the beds at one end of the corridor.
• Corridor doors and common areas are acknowledged as a physical barrier for the separation of distinct parts.

CMS may update or modify these provisions from time to time. It is the nursing home’s responsibility to comply with the requirements for distinct part units promulgated by CMS, and any future updated requirements.

To request Medicaid approval for a non-available bed plan, please contact the Medicaid office at DARS@michigan.gov. Subject line: Medicaid Non-Available Bed Plan Request.

An approved non-available bed plan allows a nursing home to take beds out of service for purposes of Medicaid cost reporting/reimbursement rate. If approved, the nursing home agrees to not use the bed(s) for the duration of the Non-Available Bed Plan approval. Bed projects less than 12 months are not eligible under this plan.

If approved, Medicaid will notify the nursing home as well as the Bureau of Community and Health Systems. The bureau is not involved in this process and thus no documents need to be submitted to our office.

For more information on Medicaid requirements, see the Cost Reporting and Reimbursement Appendix of the Nursing Facility Chapter in the Medicaid Provider Manual.

Michigan Department of Licensing & Regulatory Affairs
Bureau of Community and Health Systems
611 W. Ottawa Street
PO Box 30664
Lansing, MI 48909

Main Line: 517-335-1980

State Licensing Section – Bed Change / Designation Request
Phone: 517-241-1970
FAX: 517-241-3354
Email: bchs-statelicensing@michigan.gov