|
|
Wisconsin Department of Health and Family Services Obsolete Medicaid Eligibility Handbook For the current MEH, see http://www.emhandbooks.wi.gov/meh-ebd/ For the current BC Plus Handbook, see http://www.emhandbooks.wi.gov/bcplus/ |
Certain nursing home contract provisions require prospective residents to be on private pay status for a period of time, usually 12 to 18 months, before applying for Medicaid ( MA ).
In essence, this requires the prospective resident waive the right to apply for MA for a period of time as a precondition to admittance. The prospective residents, who are typically on a higher private pay status at the time, would generally qualify for MA before the contract provision expires.
Nursing homes must honor residents’ rights guaranteed by HSS 132.31, Wis. Admin. Code, in order to participate in the MA program. The standards must be enforced as a condition of federal funding. They apply to all residents in an MA certified nursing home, both MA and private pay, as a condition of participation in the MA program.
A resident can be involuntarily discharged or transferred essentially only for: (1) medical reasons, (2) his/her welfare or that of other patients, or (3) nonpayment. Changing status from private pay to MA and any corresponding loss of revenue to the nursing home are not to be considered nonpayment.
Thus, contract provisions prohibiting a person from applying for MA by requiring a certain length of stay as a private pay resident can’t be enforced by threats of discharge.
DHFS has notified all Wisconsin nursing home providers that: (1) violations of private pay duration of stay contract provisions aren’t grounds for discharge, and (2) they must notify all present and prospective residents of this.
This page last updated in Release Number : 03-03
Release Date: 09/22/03
Effective Date: 09/22/03