Frequently asked questions about beds out of service at open long-term care facilities

This information was compiled to help clarify some of the most frequently asked questions about the new process for taking beds out of service or reactivating out of service beds in open long-term care facilities.

Table of Contents

Overview

The Bureau of Health Care Safety and Quality (the “Bureau”) has prepared the following responses to frequently asked questions (“FAQs”) about Circular Letter 18-12-682: Long-Term Care Facility Beds Out of Service – New Process (the “Circular Letter”).

  • These responses are meant to help clarify the new process related to taking beds out of service or reactivating out of service beds in open long-term care facilities
  • The FAQs and the responses are not a rule or regulation
  • The Bureau may, from time to time, update the responses or include additional questions and responses to such questions

This informational graphic helps illustrate the requirements and related processes for Beds out of Service: Open LTCF Beds New Process Map | (Accessible version)

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 are included in the total number of beds the facility licensee is authorized to operate at the facility under its long-term care facility license that were in service (available for residents) at that facility but were taken out of service (no longer available for residents) at that facility.  As described below, beds that are in service at a facility can be taken out of service at the facility on a temporary or permanent basis.

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

You can take in service beds out of service temporarily or permanently at any time for any reason. Please note that as discussed in the responses to Questions 9, 15, and 25, you may need to provide written notice to the Bureau and there may be impacts to the facility operating capacity reported to MassHealth and the Center for Health Information Analysis (“CHIA”) and/or the facility license.

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

When you temporarily take in service beds 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, the operating capacity reported by the Bureau to MassHealth and CHIA will be revised to deduct the number of beds that will not be available for residents during the period of time it takes to complete the construction or to implement the plan of correction.  There is no impact to the facility license. 

When you temporarily take in service beds out of service for other reasons, such as to install new floors, you are not required to notify the Bureau since there is no impact to the facility operating capacity reported to MassHealth and CHIA or to the facility license.

When in service beds are permanently taken 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 authorized beds, and reports the new number of beds to MassHealth and CHIA as the facility’s operating capacity.

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

See responses to Questions 11 and 17.  Please note that the decision may depend on your specific facts and circumstances.

General information about process

5. I have beds out of service.  Now what?

You must determine whether the beds are temporarily or permanently out of service and then follow the regulatory requirements, such as providing written notice to the Bureau.  The requirements are located at 105 CMR 153.028 and are summarized in the responses to Questions 9, 15, and 25.

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.  If a facility previously requested and was permitted to use the one time 12-bed increase, then it cannot reapply or request approval to add more beds at that facility.

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?

No, there is no longer a renewal process.  Under the new process, the renewal requests are no longer necessary and will not be processed.

8. Why did the process change?

As part of its ongoing effort to align operational practices with the regulatory framework, including 105 CMR 153.000 as revised in the fall of 2018, 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, (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 any other reason, you do not need to notify the Bureau.

10. Why do I need to notify the Bureau if I plan to temporarily take in service beds out of service for Department-authorized construction or to correct cited significant physical plan deficiencies but not for other reasons?

Because the regulation requires it and so the Bureau can accurately report the facility’s operating capacity to MassHealth and CHIA as required. 

11. What do you mean by “temporarily”?  Can you provide some examples?

In service beds are considered to be temporarily taken out of service when they are removed from service for a specific purpose for a finite period of time at the end of which the beds will be put back into service. 

Examples of “temporarily” include:

  • In service beds are temporarily taken out of service for the period of time it takes to complete construction authorized by the Department.  Once the construction project is complete, the beds are put back into service. 
  • In service beds are temporarily taken out of service to cosmetically update a room with new floors and paint. After the floors are installed and the painting is done, the beds are put back into service.
12. Does the Bureau need to approve removing beds from service on a temporary basis?

No.  However, as stated in the response to Question 25, you may need to provide notice to the Bureau.  Also, as mentioned below in the response to Question 29, there may be other federal and state requirements with which a licensee needs to comply, such as when the licensee takes an in service bed occupied by a resident out of service (for example, notice of intra-facility transfer or discharge).

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

For temporary removal of in service beds, 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.  If there are no plans to put the beds back into service, that may be considered a permanent removal of the beds from service for which notice to the Bureau would be required.  See response to Question 17.

14. 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, (ii) if the beds were taken out of service pursuant to an approval to the permanent reduction requirement, or (iii) if the beds were taken out of service prior to December 2018.  See response to Question 24.

Permanently taking beds out of service

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

If you are permanently taking in service beds out of service, you must notify the Bureau in writing.  Your written notice must include (i) the reason for permanently taking the in service beds out of service, (ii) the number of in service beds you are permanently removing from service, (iii) the location of those beds, and (iv) the classification of those beds (Level I, II, III, or IV).

16. Why do I need to notify the Bureau about a permanent reduction in the number of beds in service?

Because the regulation requires it and so the Bureau can accurately report the facility’s operating capacity to MassHealth and CHIA as required. 

17. What do you mean by “permanently”?  Can you provide some examples?

In service beds are considered to be permanently taken out of service when they are taken out of service for an indefinite period of time and there is no specific plan to put those beds back into service.

Examples of “permanently” include:

  • In most situations, the closing of an entire wing or unit in the facility is treated as a permanent removal of those beds from service.
  • In many situations, when rooms are reconfigured to be private rather than semi-private, that is treated as permanently taking beds out of service.  For example, there are 4 rooms in a facility with 2 in service beds in each room (for a total of 8 in service beds).  The 4 rooms are turned into private rooms with one bed in each room (for a total of 4 in service beds and 4 beds permanently removed from service).
18. Does the Bureau need to approve removing beds from service on a permanent basis?

No.  However, as stated in the response to Question 25, you may need to provide notice to the Bureau.  Also, as mentioned below in the response to Question 29, there may be other federal and state requirements with which a licensee needs to comply, such as when the licensee takes an in service bed occupied by a resident out of service (for example, notice of intra-facility transfer or discharge).

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

When in service beds are permanently taken out of service, the number of beds the licensee is authorized to operate at the facility permanently decreases on its facility license.

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

Yes, there is a narrow exception for a facility that closes an entire unit.  Ordinarily, closing an entire unit must be treated as a permanent reduction in the number of authorized beds on the facility license.  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. 

21. I am closing a unit in my facility.  What do I need to do to request permission to not have the beds in that unit permanently taken off of my facility license?

To request approval for an exception to the “permanent reduction” requirement, the licensee must notify the Bureau in writing in advance of closing the unit and include in its written notice (i) the number of beds in the unit that the licensee plans to close, (ii) the location in the facility of the unit, (iii) the classification of the beds being taken out of service (Level I, II, III, or IV), (iv) an explanation of the exceptional circumstances underlying the request for the exception, and (v) the finite period of time for which the beds would be out of service.  If the Department approves the request to treat the beds as temporarily, rather than permanently, out of service under this exception, the approval would expire on the date specified in the approval.

22. Can you give an example of a potential exception to the permanent reduction requirement?

An example of this could be under recently revised 105 CMR 153.030, which permits a licensee to use part of licensed long-term care facility space for other business purposes.  Prior to converting the long-term care facility unit to another business, the licensee could submit a written request to the Bureau in which it asked for approval to take the beds in service in that unit out of service temporarily so that it could open a secondary business in that space.  In its written request to the Bureau, the licensee would need to include the finite period of time (for example, 3 years) required to see whether the secondary business would be profitable.  If the licensee received approval of its request to treat the beds from that unit as temporarily, rather than permanently, out of service for the requested period of time, the Bureau would report the revised operating capacity to MassHealth and CHIA for that period; there would be no impact to the facility license during that time.  Prior to the end of the approved time period, the licensee would need to make a decision about whether to keep the secondary business or convert the space back to long-term care facility space and put the out of service beds back into service. 

*If, prior to the end of the approved time period, the licensee decides to continue with the secondary business, it must notify the Bureau in writing.  The Bureau must then permanently decrease the number of beds the licensee is authorized to operate on its facility license by the number of out of service beds from the closed unit.  If the licensee decides that it wants to convert the secondary business space back to long-term care facility space, the licensee would need to submit to the Bureau written notice of its intent to put the out of service beds back into service.  As mentioned below in the response to Question 29, you need to make sure that you are in compliance with all applicable requirements prior to putting the beds back into service (for example, size of room, sufficient staffing, and equipment).

23. I took beds out of service in some of the rooms in my facility years ago to make those rooms private rooms.  Do I need to do anything?

Yes.  See responses to Questions 4 and 5.

Reactivating previously approved out of service beds

24.I want to put out of service beds back into service.  What do I need to do?

You need to submit written notice to the Bureau.  In your notice, you must include (i) the number of out of service beds you are returning to service, (ii) the classification of the beds being returned to service (Level I, II, III, or IV), (iii) the location in the facility of the beds that are being returned to service, (iv) the date on which the beds will be back in service, and (v) the reason you are reactivating the out of service beds.  As mentioned below in the response to Question 29, you will need to make sure that you are in compliance with all applicable requirements prior to putting the beds back into service (for example, size of room, sufficient staffing, and equipment).

Notification to the Bureau

25. 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
  • Permanent removal
  • See responses to Questions 9 and 15.
26. I need to take beds out of service or reactivate out of service beds.  What do I need to put in my written notice?

See responses to Questions 9, 14, 15, and 24 for information on when written notice is required and what information a written notice must include.

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

The facility licensee or its duly authorized agent.

Enforcement

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

This would be observed during an inspection or survey.  If a required notice was not provided to the Bureau, that could be noted as a deficiency on a statement of deficiency.

Other legal requirements

29. Is there anything else I should know?

Please keep in mind that these FAQs and responses are about the legal requirements related to taking beds out of service or reactivating out of services beds in open long-term care facilities; there may be other federal and state requirements related to in service or out of service beds with which a licensee would need to comply, such as when the licensee reactivates out of service beds (for example, size of room, sufficient staffing, equipment) or takes an in service bed occupied by a resident out of service (for example, notice of intra-facility transfer or discharge).

Date published: April 1, 2019
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