Nursing Home Vital Access Provider Assurance Program (VAPAP)

The State is accepting and reviewing applications on a rolling basis.

Purpose

Up to $100 million were 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 financial relief dollars to maintain operations and vital services through March 31, 2023, while they implement longer-term solutions to achieve financial sustainability. 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.

Given the near-term cash needs of some nursing homes, and the prospect of cash needs of other facilities developing later in this fiscal year, the Department will accept applications on a rolling basis throughout the year. The deadlines to submit an application for financial assistance (XLS) will be:

  • August 1, 2022
  • November 1, 2022
  • February 1, 2023

Nursing Homes that have already reached out to the Department about financial assistance should submit a formal application on or before August 1, 2022.

This funding may be awarded under the VAPAP (State-only) funding program or, if appropriate, under the VAP funding program – Vital Access Provider (VAP) Program which includes federal financial participation. The initial application regardless of funding source is the same -- DOH will inform applicants requesting funding if their request is suitable for VAP funding, in which case the applicant will be requested to submit a VAP mini-application and/or a full VAP application.

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 to Apply

  • 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.

Application Process

In addition to the application, all applications must include the following information.

Financial Information

  • Applicants must demonstrate severe financial distress as reflected in their financial statements for the year ended December 31, 2021, and interim financials year to date.
  • Supplemental financial documents should include:
    • Applicant's most recent audited financial statements, including:
      • Unaudited 2021 annual financial statements if audited financial statements are not available for 2021, and year to date monthly financial statements for 2022.
    • Financial projections that indicate that the nursing home will have less than [20] days cash and equivalents on hand on December 31, 2021;
    • 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 your organization's long term debt including, purpose, terms, and covenants.

Strategic Initiatives Plan

  • All applications must include the requested strategic initiatives plans and multi–year financial projections that demonstrate a path to long–term sustainability and improved resident care and satisfaction.
  • Although factors specific to individual applicants will determine the nature and scope of the strategic initiatives 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.

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 and transformation plan addresses community service needs;
  • Alternative RHCF capacity, availability of other forms of long-term care in the immediate region;
  • Special services and populations served;
  • Historical and projected financial sustainability; and
  • Amount and length of assistance required compared to the number of beds at risk of loss; and,
  • 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.

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 strategic initiatives.

Notice of Awards

The Department will make awards on a rolling basis.

Eligible Expenses

Eligible expenses shall include costs directly related to the operation of a facility, and specifically exclude retirement of long-term debt, consultant fees, and bankruptcy related costs.

Payment Process

Payments to awardees under the VAPAP program will be made monthly. Monthly payments will be based on DOH analysis of awardees monthly financial and activity reports, which includes cash flow analysis to determine projected cash need for the following month and progress towards achieving agreed upon goals agreed upon by the Awardee and the Department. Payments to awardees under the VAP program will be subject to the quarterly payment terms of that program.

Applications and questions should be submitted to NHVAPAP@health.ny.gov