Bed Changes

The State Medicaid Agency (MDHHS) collaborates with the State Survey Agency, the Department of Licensing and Regulatory Affairs (LARA), when making determinations regarding the approval or denial of application for bed certification changes.  Providers must submit the application to both MDHHS and LARA concurrently.  LARA’s bed certification information can be found at LARA-Bed Changes. A facility may make bed changes up to two times per cost reporting year.

The State survey agency performs surveys of nursing facility providers on behalf of the State Medicaid agency to ascertain whether a provider meets applicable requirements for participation in the Medicaid program, and to evaluate performance and effectiveness in rendering a safe and acceptable quality of care.  These requirements are found in the 42 Code of Federal Regulations.


Resources:

Medicaid Provider Manual 
The Medicaid Provider Manual is updated on a quarterly basis.  You may sign up for email updates.

Providers should review the following chapters:

  • General Information for Providers
  • Nursing Facility Coverages
  • Nursing Facility Certification, Survey and Enforcement Appendix
  • Nursing Facility Cost Reporting and Reimbursement Appendix
  • Nursing Facility Lefel of Care Determination 

Centers for Medicare and Medicaid (CMS) Survey & Certification's Quality, Certification and Oversight Reports (QCOR)

  • For assistance in determining a facility's survey history.

 

Bed Certification – changes in bed designations:

On March 25, 2020, MDHHS issued Medical Services Administration (MSA) Bulletin MSA 20-16, COVID-19 Response: Options for the Use of Nursing Facility Beds.

On August 4, 2020, MDHHS issued L Letter 20-44 to provide additional guidance for nursing facilities using the options indicated; including the requried Medicare or Licensed-Only Bed Use Report (COVID-19)  -Excel format.
 

Steps for individual facilities wishing to change its Medicare/Medicaid bed certification designations, (increase, decrease, or relocation).An increase or decrease in bed designations is defined as a change in the total number of beds designated as Medicare-only, dually certified, or licensed only.This change will not change the total bed capacity at the nursing facility.

Providers must apply as outlined below and must receive approval for the change from MDHHS before the change is effective.

  • Submit a written request in the form of an application  Application (BCHS-HFD-100) and Appendix D designating the number of beds you want certified, decertified, or relocated. Include a brief narrative summary of the changes you are requesting to be made.
  • All applications must be submitted 45 days in advance of the proposed effective date. The effective date will be the first of the month beginning the next quarter of the provider’s cost reporting year.

Example: if your cost reporting year ends on December 31st, your 1st quarter or year begins on January 1st. That means applications would be due:

November 15th                      for an effective date of January 1st, 2020

February 14th                        for an effective date of April 1st, 2020

May 15th                                for an effective date of July 1st, 2020

August 14th                           for an effective date of October 1st, 2020

**Applications received after the due date, will not be reviewed for that quarter and will receive a technical denial.  Changes in bed certifications will not be approved on a retroactive basis.

In addition to the application, the following information must be submitted as part of your written request:

  • Two floor plans that are printable and readable – a current floor plan and a proposed floor plan with the requested number and proposed number of Medicaid beds identified.  Floor plans must include:
  1. Room numbers and number of beds in each room.
  2. Location of all facility beds – must include all office spaces, dining, and other non-resident rooms by wing or units.
  3. Total number of beds by wing or unit
  • The current bed designation of all facility beds by wing or unit. For example, Medicare only, dually certified, or licensed only. Include Medicaid non-available bed plan beds and building program agreement beds as well if applicable.
  • The current resident census in addition to the current Medicaid resident census.
  • Certificate of need approval if applicable

    This information should be sent by email to both Medicaid – Michigan Department of Health & Human Services (MDHHS) bed certification MDHHS-bedcerts@michigan.gov and to the Department of Licensing and Regulatory Affairs (LARA) mailbox at BCHS-statelicensing@michigan.gov.  

More details can be located in the Medicaid Provider Manual, Nursing Facility Certification, Survey and Enforcement Appendix and the Federal State Operations Manual Sections 3202B - 3202E.

Questions regarding this bed certification process can be directed to the Long-Term Care Policy Section at (517) 241-4079 or the directory appendix of the Medicaid Provider Manual.

 

Change of Ownership (CHOW)

  • After all the necessary steps are completed with the Centers for Medicare & Medicaid Services (CMS), a letter will be sent to the Department of Health and Human Services – Medicaid of the effective date of the CHOW.
  • If the facility wants to change the bed composition at the time of the CHOW, an application needs to be sent to LARA and MDHHS stating such, using the same application identified above.
  • Download the Medicaid Enrollment Checklist for Nursing Facilities which will assist in the process for participating in the Medicaid program.

 

New Facility

  • Once facility has had occupancy granted by the Health Facilities Licensing Section, and a license has been issued, the facility needs to have at least 8 residents receiving care, the facility must notify the State LARA that they are ready for the initial federal certification survey.  After the written notification, the facility will have an unannounced survey conducted.
  • If the facility is planning to be certified for Medicaid, an application should be sent to DHHS and LARA requesting the number of beds desired for certification using the process identified above under bed certification. 
  • Once the facility has been notified by Medicare that they have been approved for Medicare participation, the application for Medicaid can also be considered.  Medicare participation must be verified before Medicaid certification can occur.
  • The facility should then refer to the Medicaid Enrollment Checklist for Nursing Facilities for other steps required to participate in Medicaid.