Nursing Home Vital Access Provider Assurance Program (VAPAP)

The Department of Health will accept applications on a rolling basis throughout the year. The deadlines to submit a Nursing Home VAPAP application for financial assistance (XLS) will be:

  • For the 3rd quarter of the State Fiscal Year 2022/23 - November 1, 2022
  • For the 4th quarter of the State Fiscal Year 2022/23 - February 1, 2023

All nursing homes seeking financial assistance should submit a formal application through this process.

Purpose

Up to $100 million was made available to support New York State's nursing homes pursuant to the FY 23 Enacted Budget. Under this announcement, nursing homes in severe financial distress can apply for short-term financial relief dollars to maintain operations and vital services through March 31, 2023, while they plan for the implementation of longer-term solutions to achieve financial sustainability.

The primary purpose for this pool of funding is to provide short-term financial assistance to distressed providers while they thoughtfully plan for the future of their facility.

Successful applicants will identify and begin implementation of initiatives during the funding period that will improve the likelihood of future financial sustainability while maintaining essential services to their communities.

The following describes eligibility for financial assistance, the criteria on which the State will base awards, and the process through which facilities should apply for awards.

Eligibility

Eligibility requirements for the Nursing Home VAPAP program are listed below.

  • Be defined as an Article 28 residential health care facility that is not operated by a county or a public benefit corporation; AND
  • Have less than 20 days of cash as of 12/31/21; OR
  • Has had a negative operating margin within the last two (2) complete calendar years; AND
  • Is not currently the subject of known investigation or enforcement action by CMS, the Department of Justice, HHS-OIG, the Office of the Attorney General or the Office of the Medicaid Inspector General.

Evaluation Criteria for Awards

DOH will assess the following criteria in evaluating the facility's application for funding and related initiatives plan:

  • Quality of care, as reflected in CMS Star ratings and Nursing Home Quality Incentive pool rankings;
  • The extent to which the RHCF's application provides a specific plan for transformation and long term sustainability which addresses the service needs of the community;
  • Alternative RHCF capacity and availability of other forms of long-term care in the immediate region;
  • Special services and populations served or to be served;
  • Historical and projected financial sustainability;
  • Amount and length of assistance required compared to the number of beds at risk of loss;
  • Applicants must detail the extent to which the affected community has been engaged and consulted on potential projects of the application, as well as any outreach to stakeholders and health plans; and,
  • Applicants current and/or planned engagement in a change of ownership.

Transformation Initiatives

The primary purpose of this pool of funding is to provide short-term financial assistance to distressed providers while they thoughtfully plan for the future of their facility. As such, all applicants must complete the initiatives tab on the application to detail the activities that will be undertaken to demonstrate how the provision of VAPAP funds will help the facility reach long term sustainability. These initiatives should have a positive impact on the baseline projections (exclusive of initiatives) applicants will provide on the financial projections tab.

Providers that apply for VAPAP funds should consider whether their overall plan for long term sustainability will require funding through the Vital Access Provider (VAP) program. The VAP program provides temporary (up to three years) operating assistance to financially distressed providers for the purpose of redesigning their healthcare delivery systems to promote financial sustainability. Funding is provided for operational costs associated with transformation initiatives that address financial viability, community service needs, quality of care, and health equity.

Providers interested in filing a VAP application should direct all inquiries to NHVAP@health.ny.gov with "VAP" in the subject line. VAP is the primary funding vehicle the Department will use to support multiyear transformation initiatives. Although factors specific to individual applicants will determine the nature and scope of the transformation plan, applicants may be required to commit to significant changes in governance, affiliation relationships, and service types and levels if such changes are determined necessary to achieve long–term financial sustainability.

Applications for VAPAP may include reference to the filing of a subsequent VAP application, but VAPAP funds requested in the application should include only requests for short-term financial assistance.

VAPAP Application Process

Eligible applicants for funding under the Nursing Home VAPAP program should complete the VAPAP application. The application and any questions should be submitted to NHVAPAP@health.ny.gov.

In addition to the application, please provide the following supplemental information.

  • Supplemental financial documents should include:
    • Applicant's most recent audited financial statements, including:
      • Audited 2021 financial statements and year-to-date monthly financial statements for 2022.
      • Nursing homes that are part of health systems should provide financial information specific to the nursing home either through supplemental information included in the health system financial statements or by using the cost report schedules.
      • An organizational chart indicating beneficial ownership and corporate siblings.
    • Days of cash on hand (DCOH) calculation that demonstrates the nursing home had less than 20 days cash and equivalents on hand on December 31, 2021.Federal relief funds received to address COVID-19 pandemic financial impact may be excluded for this calculation but must be shown in the DCOH calculation provided;
    • Monthly cash flow projections beginning the month the VAPAP application is submitted through the end of the State fiscal year that is March 31, 2023;
    • Evidence that the applicant has no assets that can be monetized other than those vital to the operation;
    • Evidence that the operator has exhausted all efforts to obtain resources from corporate parents and affiliated entities to sustain operations;
    • A breakdown of payor sources for the facility's long stay population;
    • Strategic initiatives plan and multi-year financial projection that demonstrates a path to long term sustainability and improved resident satisfaction; and
    • A high-level description and dollar value of the organization's long-term debt including purpose, terms, and covenants.

Review Process

Each application will be reviewed by DOH staff with expertise in health care finance, reimbursement, and health care programs. Once the Department determines that a nursing home is an eligible applicant, the applicant's current and projected financial status, proposed use of funds to maintain critical services needed by its community, anticipated impact of the loss of such services, and transformation plan will be reviewed in determining whether the applicant will be awarded funds, and in consultation with the Division of Budget, will determine the amount of the award.

Awards

Awards will be made after the Department´s analysis of an eligible nursing home's application. Awards are made at the Department's discretion and may be an amount that is lower than the awardees' requested funding. Successful applicants will be subject to specific reporting requirements as specified by the Department. This includes monitoring of progress towards a defined sustainability plan and commitment to implement the identified transformation initiatives.

Notice of Awards

The Department will make awards on a rolling basis.

Eligible Expenses

Eligible expenses shall include costs directly related to sustainability of operations. The VAPAP statute (NY Pub Health L § 2826) excludes funding of capital expenditures, including, but not limited to: construction, renovation and acquisition of capital equipment, including major medical equipment; consultant fees; retirement of long-term debt; or bankruptcy-related costs.

Payment Process

Payments under the VAPAP program may be awarded as a temporary adjustment to rates or as temporary lump sum payments.