Ask the Payment Expert about ... community structure

Share this content:
Patricia Boyer, MSN, NHA, RN
Patricia Boyer, MSN, NHA, RN

I'm concerned with the new megarule expenses and that maybe I need to rethink my need for skilled nursing beds. What are your thoughts?

Many providers are rethinking their community structure. With the growth of assisted living, providers are assessing the need for additional AL beds.

Remember: AL beds are licensed by each state so you need to know your state regulations. In some cases, you might want to convert some SNF beds to AL if they meet the AL regulations.

In other cases, providers are adding additional AL beds and/or converting a space to memory care. Secure memory care units have been very popular and most can be licensed as assisted living.

To be a provider of choice in your community, you really want to develop a robust dementia program, utilizing tools from the Alzheimer's Association and other state dementia initiatives.

Someone really needs to be trained and/or certified in dementia care.  Reimbursement for such programs will vary by state. Many have a waiver program whereby the state may reimburse the provider for care conducted in an assisted living facility. You need to research that and know those rules, as well as who might qualify and the waiting time for those benefits. 

You also need to know how the use of a state waiver program will affect your daily room rate.

This is a complex decision to make. As you consider transitioning beds, you need to understand your market, so a market study might need to be completed. You also may need to understand your present level of care of your residents and who might be eligible to transition to another level of care.  

Also assess the financial impact of any changes. Know all your information before you plan any transition. Get expert assistance in areas you do not have the ability to do fully yourself. 

Please send your payment-related questions to Patricia Boyer at ltcnews@mcknights.com.