Vermont presenter outlines how emergency financial relief is awarded, flags hospital-owned and very small homes

Helen Leven, executive director of the Vermont Healthcare Association, told the House Human Services Committee that extraordinary financial relief (EFR) is a regulatory mechanism to preserve Medicaid beds when temporary external factors threaten a facility’s viability. She said the relief is intended to protect Medicaid recipients from losing access if a nursing facility were to close.

Leven explained EFR’s two-part eligibility test: a facility must (1) provide Medicaid as part of its payer mix and (2) operate beds the state has designated as necessary Medicaid beds. Applications require audited financial statements and documentation addressing 13 eligibility elements in the regulation; Division of Rate Setting staff then perform desk reviews and calculations. Leven said a full EFR review and determination typically takes about 18 months.

Leven said recent award patterns show “the lion’s share of large awards are going to hospital‑owned nursing homes,” which often have higher base rates because it costs more to operate nursing homes connected to hospitals. She added that this pattern is not unique to Vermont but mirrors national trends. By contrast, she said one traditional EFR purpose is to help very small facilities (the division used roughly a 40‑bed threshold in Vermont, compared with a national benchmark near 80 beds) that carry a disproportionate share of indirect and administrative costs.

On cash‑flow urgencies, Leven said an expedited process exists: the division can advance estimated funds when closure is imminent and later true up the payment. That option helps facilities bridge temporary shortfalls (for example, delayed Medicare payments), though Leven warned the workaround adds administrative burden for the division.

Leven urged continued conversation with rate‑setting authorities about stabilizing reimbursement and reducing rate volatility, which she called another destabilizing factor that makes it difficult for facilities to plan and invest in staffing.

The committee did not take a formal vote during the session. Leven offered to share regulatory citations and the EFR-related reports and underlying analyses with members for further review.