Nursing Facility (NF) Voluntary Withdrawal
from the Medicaid (MA) Program
BACKGROUND
A nursing facility may choose to voluntarily withdraw from the Medicaid (MA) program at any time.
However, when a facility makes this choice, they retain certain responsibilities under the law. The
Resident Protection Act of 1999 outlines the requirements for facilities choosing to voluntarily withdraw
from the Medicaid program. While the Resident Protection Act provides for some additional requirements
for facilities withdrawing from the MA program, it does not in any way nullify any existing state and federal
resident protections or facility requirements. The following is an outline of the federal and state regulatory
requirements and responsibilities, as well as the procedures required of nursing facilities that choose to
voluntarily withdraw from the MA program.
DEFINITIONS
For the purposes of this law, the following definitions apply.
An “existing resident” is defined as any resident residing in the facility the day before the effective date of
facility withdrawal from the MA program, including those residents not on MA at that time.
A “new resident” is defined as one whose admittance to the facility occurred on or after the effective date
of the facility’s withdrawal from participation in the MA program.
APPLICABILITY
The Resident Protection Act applies to any nursing facility that decides to voluntarily withdraw their
participation from the MA program, but continues to provide nursing facility services. This would include,
but is not limited to, facilities withdrawing from MA but continuing to offer nursing facility services as either
a Medicare participating facility, a private-pay only facility or any combination of payor types (excluding
MA).
RESIDENT DISCHARGE OR TRANSFER
In general, a facility may not discharge or transfer a resident, except for those reasons allowable under
the law. Resident transfers and/or discharges must be made in accordance with all applicable state and
federal regulations and notice requirements.
In addition, this Act prohibits the discharge or transfer of a MA resident from a nursing facility due to the
facility’s voluntary withdrawal from the MA program.
This applies even if the resident becomes MA eligible after the effective date of the facility withdrawal
from MA participation. If an existing resident becomes MA eligible after the effective date of the facility
withdrawal from MA participation, the resident is entitled to remain in the facility until such time as the
resident is discharged or transferred for some unrelated (and allowable) reason.
The protections related to the transfer and discharge of residents under the Resident Protection Act apply
only to those residents defined as existing residents, until such time as they are discharged from the
facility.
The resident protections related to transfer and discharge provided under the Resident Protection Act do
not apply to new residents. However, other state and federal regulations related to the transfer and
discharge of residents are still applicable.
NOTICE TO RESIDENTS - REQUIREMENTS
New Residents: The facility must provide new residents, their family and/or legal guardian or other
responsible party notice (see Attachment A for a sample notice), both orally and in writing, that the facility:
►
►
is not participating in the MA program with respect to that resident; and
may transfer or discharge the resident from the facility at such time as the resident is
unable to pay the facility charges (even though the resident may have become eligible for
MA during the time since admission).
This written notice to new residents and their responsible parties must be provided:
►
►
at the time of admission, and
in a prominent manner on a separate page from the rest of the admission agreement.
In addition, the facility must obtain from each individual at that time, a written acknowledgement of receipt
of this notice (see Attachment A for a sample notice) signed by the individual, and separate from other
documents signed by the individual.
Existing Residents: The facility must provide existing residents, their family and/or legal guardian or other
responsible party, with a minimum 30 days prior written notice of the facility withdrawal from the MA
program and the effective date, and outline their resident rights under the law (see Attachment B for a
sample notice).
In addition, 30 days notice must be given residents of any rate changes as a result of the facility’s
withdrawal from the MA program (the notice may be given concurrently).
OTHER FACILITY OBLIGATIONS WHEN WITHDRAWING FROM THE MA PROGRAM
NOTICE OF WITHDRAWAL
Facilities must concurrently notify the State Departments of Health and Human Services, and the Centers
for Medicare and Medicaid Services (CMS), a minimum of 30 days in advance, of their intent to voluntarily
withdraw their participation in the MA program (see Attachment C for a sample notice).
DEEMED STATUS
With respect to individuals residing in the facility on the day before its voluntary withdrawal (including
those not entitled to MA as of that date), the facility is still deemed to continue its participation in the MA
program after the voluntary withdrawal date for the purposes of:
●
●
receiving payments under the MA program;
maintaining compliance with all applicable requirements of federal Title XIX and the State MA
program, and
●
continuing to be subject to all applicable survey, certification and enforcement authority provided
under the law (including involuntary termination of a participation agreement deemed continued
after voluntary termination).
Note: These deeming provisions apply only to existing residents and are not applicable to new residents.
OTHER
A facility’s decision to voluntarily withdraw from the MA program does not in any way alter the resident
protections found under any other provision of the Social Security Act, Federal and/or State regulations.
For a checklist of procedures a facility should follow when withdrawing voluntarily from the MA program,
refer to Attachment D in this document.
----------------------------------------------------------------------------------------------------------------------------- -----------ATTACHMENT A
NOTICE OF NON-PARTICIPATING FACILITY
(Sample Notice for Residents Admitted On/After the Effective Date of
Facility Withdrawal from MA).
(Note: Facility keeps a signed copy of this in the resident records.)
January 7, 2010
John Q. Public
Mainstreet Care Home
123 Mainstreet
Main, MN 55100
Dear John Q. Public and Family,
This letter is to inform you that with respect to your admission, Mainstreet Home does not participate in
the Minnesota Medicaid (MA) program. This may effect your stay in Mainstreet Home.
This means that Mainstreet Home may discharge or transfer you if you are unable to pay your facility
charges, even if you become eligible for MA at some time during your stay in this facility.
Please contact Mainstreet Home and/or the Office of Ombudsman for Older Minnesotans if you have
questions about this policy or your rights.
Sincerely,
Mary Smith, Administrator
(612) 555-5555
Deb Johnson,
Office of Ombudsman for Older Minnesotans
(651) 431-0000
I, the undersigned, acknowledge that I have received both orally and in writing, notice of these policies
under the Resident Rights Act - at the time of admission to the facility.
Name __________________________________
Date_____________ Phone_____________
Name _________________________________
Date_____________ Phone_____________
----------------------------------------------------------------------------------------------------------------------------- -------------
ATTACHMENT B
NOTICE OF NON-PARTICIPATING FACILITY
(Sample Notice for Existing Facility Residents)
January 7, 2010
John Q. Public
Mainstreet Care Home
123 Mainstreet
Main, MN 55100
Dear John Q. Public and Family,
This letter serves as a 30 day notice to inform you that effective March 1, 2010, Mainstreet Home will no
longer participate in the Minnesota Medicaid (MA) program.
This does not effect your stay in Mainstreet Home, if you are currently receiving Medical Assistance (MA)
or if you become eligible for MA at some time during your stay at Mainstreet. Mainstreet Home will
continue to accept MA as a form of payment for facility charges, for any resident residing in Mainstreet
before March 1st, 2010.
For residents admitted on or after March 1st, 2010, Mainstreet Home will not accept MA as a form of
payment. If you are discharged or transferred from Mainstreet on or after March 1, 2010 and re-admitted
to the facility at a later date, you will be considered a “new” resident and must use some other form of
payment (other than MA) for your facility charges.
(Insert 30 day notice of impending rate changes for private-pay residents here, if applicable – or outline in
a separate notice).
Please contact Mainstreet Home and/or the Office of Ombudsman for Older Minnesotans if you have
questions about this policy or your rights.
Sincerely,
Mary Smith, Administrator
(612) 555-5555
Deb Johnson,
Office of Ombudsman for Older Minnesotans
(651) 431-0000
----------------------------------------------------------------------------------------------------------------------------- -------------
ATTACHMENT C
(Sample Notice of Voluntary Withdrawal from the Medicaid Program)
Date: January 1, 2010
To Whom it May Concern:
Regarding:
Mainstreet Home
123 Mainstreet
Main, MN 55100
Medicare Provider # 12345678
Medicaid Provider # 4120323
This serves as our 30 day notice that Mainstreet Home intends to voluntarily withdraw from the Medicaid
program effective March 1st, 2010.
We are aware of the provisions of the Resident Protection Act of 1999, Section 1919 of the Social
Security Act and understand we must comply with these requirements with regards to our deemed status,
and resident notice and resident rights procedures.
Should you have any questions, feel free to contact me at, (612) XXX-XXXX.
Sincerely,
Mary Smith, Administrator
cc:
MN Department of Human Services – ATTN: Munna Yasiri
MN Department of Health – ATTN: Facility and Provider Compliance Division
Centers for Medicare and Medicaid Services (CMS) – ATTN: MN Region State Representative
Office of Ombudsman for Older Minnesotans – ATTN: Deb Holtz
----------------------------------------------------------------------------------------------------------------------------- -------------
ATTACHMENT D
(Facility Checklist for Voluntary Withdrawal from the MA Program)
1) Concurrently notify DHS, MDH and the CMS in writing, a minimum of 30 days in
advance, of the facility’s intent to withdraw from the MA program, and the effective date (see sample
notice in Attachment C).
2) Give existing residents and their family or responsible party, a minimum of 30 days prior
written notice of the facility’s intent to withdraw from the MA program (see sample notice in
Attachment B).
3) If the facility intends to increase room rates for private pay residents as a result of their
withdrawal from the MA program, provide residents with a minimum of 30 days advance written notice
of rate changes.
4) Provide all new residents and their family or responsible party, oral and written notice
(see sample notice in Attachment A) at the time of admission – of the facility’s non-participation in the
MA program. In addition, get written acknowledgement/receipt of such notice and place a copy in the
resident’s record.