This page, FAQs about Beds at Open Long-term Care Facilities – Temporarily or Permanently Out of Service, is part of
This page, FAQs about Beds at Open Long-term Care Facilities – Temporarily or Permanently Out of Service, is offered by

FAQs about Beds at Open Long-term Care Facilities – Temporarily or Permanently Out of Service

The Bureau of Health Care Safety and Quality (the “Bureau”) has updated the frequently asked questions and responses (“FAQs”) related to Circular Letter 18-12-682: Long-Term Care Facility Beds Out of Service (the “Circular Letter”). The responses to these FAQs are meant to help clarify the process, effective January 1, 2019, to determine whether beds in an open long-term care facility are temporarily or permanently out of service at that facility. These FAQs are not a rule or regulation. The Bureau may revise, change, update, or rescind these FAQs at any time.

Table of Contents

General Information

1. What are beds out of service?

Generally speaking, beds “out of service” are beds at an open long-term care facility that were in service (i.e., available for residents) at that facility but were taken out of service (i.e., no longer available for residents) at that facility. As summarized below, whether beds that are taken out of service must be treated as temporarily or permanently out of service depends on several factors. Please note that the total number of beds a facility is authorized to operate at the facility is the facility’s “bed quota”, which is stated on the facility license. Please further note that the bed quota on the facility license will include beds that are treated as temporarily out of service but will not include beds that must be treated as permanently out of service.

 

2. When and why can I take beds out of service at my facility?

Although you can take in-service beds out of service at any time for any reason, whether those beds must be treated as temporarily or permanently out of service depends on several factors as summarized below. As discussed in the responses to Questions 9, 13, and 17, prior to taking beds out of service you may need to provide written notice to the Bureau and there may be a change to the facility operating capacity reported to MassHealth and the Center for Health Information Analysis (“CHIA”) and/or the bed quota on the facility license.

 

3. What are the impacts of changing in-service beds to out-of-service beds?

In-service beds may be temporarily taken out of service for construction authorized by the Department of Public Health (the “Department”) or to implement a plan of correction for cited significant physical plant deficiencies as described in the response to Question 9. Beds taken out of service for those reasons will remain out of service for an extended period of time before they can be put back into service and made available to residents. For this reason, the operating capacity reported by the Bureau to MassHealth and CHIA will be revised to reflect the reduction in the number of ​beds available to residents during the period of time it takes to complete construction or implement the plan of correction. There is no impact to the bed quota on the facility license since those beds will be put back into service and once again made available for residents upon completion of the construction or as soon as the plan of correction is fully implemented.

In-service beds may also be taken out of service for a short period of time, such as to install new floors or to paint a resident’s room. When beds are taken out of service for a short-term project, you are not required to notify the Bureau since there is no long-term impact to the number of beds available for residents. Since available beds will be out of service for only a short period of time, the facility operating capacity reported to MassHealth and CHIA does not need to change and there is no impact to the bed quota on the facility license.

Beds can be treated as temporarily out of service only if (i) they are out of service for a short-term project or (ii) they are out of service for the long-term projects identified above and in the regulation – approved construction or to implement a plan of correction to repair cited significant physical plant deficiencies. If the beds cannot be treated as temporarily out of service, then the beds must be treated as permanently out of service. When beds are permanently out of service, the number of beds the licensee is authorized to operate under its facility license permanently decreases, the Bureau issues a revised facility license with the new number of beds the facility is authorized to operate, and it reports the new number of beds to MassHealth and CHIA as the facility’s operating capacity.

 

4. How do I know whether beds are temporarily or permanently out of service?

See response to Question 3. 

General Information about Process

5. I have approval issued before January 1, 2019 to treat beds included in the “bed quota” on my facility license as out of service. Now what?

You must determine whether the beds are temporarily or permanently out of service and then follow the regulatory requirements, which may include providing written notice to the Bureau. Keep in mind that as stated in response to Question 3, beds can be treated as temporarily out of service only if (i) they are out of service for a short-term project or (ii) they are out of service for the long-term projects identified above and in the regulation – approved construction or to implement a plan of correction to repair cited significant physical plant deficiencies. If the beds cannot be treated as temporarily out of service, then the beds must be treated as permanently out of service. The requirements are located at 105 CMR 153.028 and are summarized in the responses to Questions 3, 9, 13, and 17. Please also keep in mind that an approval expires/d on the date indicated on the approval form. In most cases, when an approval issued prior to January 1, 2019 to treat beds as temporarily rather than permanently out of service expires, the permanent reduction requirement will be applied at the time of the license renewal.

 

6. How can I increase the number of beds I am authorized to operate under my long-term care facility license?

To increase the bed capacity at an existing long-term care facility, you may request approval for a one-time increase of up to 12 beds which are exempt from the Determination of Need (“DoN”) process.  If a facility previously requested and was permitted to use the one-time 12-bed increase, then whether it can apply or request approval to add more beds at that facility will be determined by the then-in effect DoN program requirements applicable to new long-term care facility beds.

 

7. I used to submit a renewal request for beds out of service with my long-term care facility license renewal form. Do I still need to do that?

Effective January 1, 2019, there is no longer a process to request or renew previous requests to treat out-of-service beds as temporarily rather than permanently out of service. Renewal requests will not be processed.

 

8. Why did the process change?

As part of its ongoing effort to align operational practices with the regulatory framework, the Bureau determined that its operational processes related to long-term care facility beds were not consistent with the intent or wording of the long-term care facility licensure statute or the related regulation. The Bureau put the new process into place to align operational practices with the long-term care facility licensure statute and regulation.

Temporarily Taking Beds Out of Service

9. If I take in service beds out of service temporarily, what do I need to do?

To temporarily take in-service beds out of service (i) for construction authorized by the Department or (ii) to implement a plan of correction for cited significant physical plan deficiencies, you must notify the Bureau in writing. Your written notice must include (i) the reason for taking the beds out of service (approved construction or to implement the plan of correction), (ii) the number of in-service beds you will temporarily take out of service, (iii) the location of those beds, (iv) the classification of those beds (Level I, II, III, or IV), and (v) the length of time you expect that the beds will be out of service. The length of time would be the date by which you expect the construction will be complete or the date by which the plan of correction must be fully implemented.

If in-service beds are temporarily taken out of service for a short-term project, such as painting the walls or installing new floors, and will be returned to service and available to residents as soon as the short-term project is complete, you do not need to notify the Bureau. Please note that if beds are taken out of service indefinitely or for an indefinite period of time and not for a specific project, those beds cannot be treated as temporarily out of service; they must be treated as permanently out of service, which requires written notification to the Department.

 

10. Does the Bureau need to approve removing beds from service on a temporary basis?

As stated in the response to Question 3, beds are treated as temporarily out of service only if (i) they are out of service for a short term project or (ii) they are out of service for the long-term projects identified in the regulation – approved construction or to implement a plan of correction to repair significant physical plant deficiencies. If beds are taken out of service temporarily for a short-term project such as painting walls or installing new flooring, then no notice to the Department or approval from the Department is required. If beds are taken out of service for approved construction or to implement a plan of correction to repair cited physical plant deficiencies, approval, in addition to the Department’s approval of the construction plans or plan of correction, would not be required. 

 

11. For how long can I keep the beds out of service?

For in-service beds to be treated as temporarily rather than permanently out of service, the beds may be out of service only during the period of time it takes to complete the specific project necessitating the temporary removal of the beds from service. See responses to Questions 3 and 9.

 

12. I temporarily took beds out of service. Do I need to tell the Bureau that I am returning those beds to service?

Yes, (i) if you provided notice to the Bureau because the beds were being taken out of service for construction authorized by the Department or to implement a plan of correction for cited significant physical plant deficiencies or (ii) if the beds were taken out of service pursuant to an approval to the exception to the permanent reduction requirement. Keep in mind that as stated in response to Question 3, beds can be treated as temporarily out of service only if (i) they are out of service for a short term project or (ii) they are out of service for the long-term projects identified in the regulation – approved construction or to implement a plan of correction to repair cited significant physical plant deficiencies. If the beds cannot be treated as temporarily out of service, then the beds must be treated as permanently out of service.

Permanently Taking Beds Out of Service

13. If I take beds out of service permanently, what do I need to do?

As explained above, if beds are not temporarily out of service, then they must be treated as permanently out of service. When beds are permanently taken out of service, you must notify the Bureau in writing. Your written notice must include (i) the number of in-service beds you are permanently removing from service, (ii) the location of those beds, and (iii) the classification of those beds (Level I, II, III, or IV).

 

14. Does the Bureau need to approve removing beds from service on a permanent basis?

No. However, as stated in the response to Question 17 below, you need to provide written notice to the Bureau. 

 

15. What do you mean by “permanent reduction”?

When beds are permanently taken out of service, the facility’s bed quota is reduced by the number of beds no longer in operation at the facility.

 

16. Are there any exceptions to the “permanent reduction” requirement?

Ordinarily, closing an entire unit must be treated as a permanent reduction in the facility’s bed quota. However, if there are exceptional circumstances under which the beds are being taken out of service for a finite period of time with the intent to return the beds to service when those circumstances no longer exist, then prior to closing the unit, the facility licensee may request permission from the Department to treat those beds as beds temporarily out of service rather than as beds permanently out of service.

Notification to the Bureau

17. When do I need to notify the Bureau that I am taking beds out of service?

Written notice to the Bureau that you are taking beds out of service is required in the following situations:
 

  • Temporary removal due to construction authorized by the Department;
  • Temporary removal due to implementation of a plan of correction for cited significant physical plant deficiencies; or
  • Permanent removal.

See also responses to Questions 9 and 13.

 

18. Who needs to provide the written notices described in these FAQs?

The facility licensee or its duly authorized agent.

 

19. If I take beds out of service and don’t tell you, how will you know?

The number of beds in operation at a facility could be observed during an inspection or survey.

Last updated: November 9, 2020
Feedback