Chapter 514 - Nursing Facility Services - DHHR - State of West ...
Chapter 514 - Nursing Facility Services - DHHR - State of West ...
Chapter 514 - Nursing Facility Services - DHHR - State of West ...
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statement that the requirement was not met, and the evidence to support the determination <strong>of</strong>noncompliance.Denial <strong>of</strong> Payment for New Admissions (DPNA) - the denial <strong>of</strong> Medicaid payment for newadmissions when the nursing facility no longer meets the standards <strong>of</strong> facility certification.Discharge - the termination <strong>of</strong> a resident’s affiliation with the nursing facility, achieved throughthe permanent move <strong>of</strong> a resident to another facility or setting that operates independently fromthe nursing facility.Discharge Planning - the organized process <strong>of</strong> identifying the approximate length <strong>of</strong> stay andthe criteria for exit <strong>of</strong> a resident from the current service to an appropriate setting to meet theindividual’s needs. Discharge planning begins upon the day <strong>of</strong> admission to the nursing facilityand includes provision for appropriate follow-up services.Dually Certified <strong>Facility</strong> - a facility which is certified to participate in both the Medicare andMedicaid programs.<strong>Facility</strong> Certification - the <strong>of</strong>ficial designation by BMS, based on recommendation from theOffice <strong>of</strong> Health <strong>Facility</strong> Licensure and Certification (OHFLAC), that the nursing facility meetsMedicaid standards and regulations.Governing Body - the person or group <strong>of</strong> persons with the ultimate responsibility and authorityfor the operation <strong>of</strong> the nursing facility.Health Care Authority (HCA) - an organization which administers programs that help containthe rising cost <strong>of</strong> health care and assure reasonable access to necessary health care services.HCA assures public access to the information compiled under the Rural Health SystemsProgram, the Planning Division, and Certificate <strong>of</strong> Need Program.Immediate Jeopardy (IJ) - a situation in which the nursing facility’s noncompliance with one ormore certification requirements has caused, or is likely to cause, serious injury, harm,impairment or death <strong>of</strong> a resident.Interdisciplinary Team (IDT) - a group <strong>of</strong> pr<strong>of</strong>essionals, parapr<strong>of</strong>essionals, non-pr<strong>of</strong>essionalsand the resident who possess the knowledge, skill, and expertise necessary to accuratelyidentify the comprehensive array <strong>of</strong> services required to meet the resident’s needs and whodesign specialized programs responsive to the needs <strong>of</strong> the resident which are to bedocumented in the care plan.Licensed <strong>Nursing</strong> Home - any institution, residence, place or any part or unit there<strong>of</strong>, licensedin accordance with the requirements specified in W. Va. 16-5c et al, in which an accommodation<strong>of</strong> four or more beds is maintained for the purpose <strong>of</strong> providing accommodations and care for aperiod <strong>of</strong> more than twenty-four hours, to persons who are ill or otherwise incapacitated and inneed <strong>of</strong> extensive, ongoing nursing care due to physical or mental impairment, or providesservices for the rehabilitation <strong>of</strong> persons who are convalescing from illness or incapacitation.Department <strong>of</strong> Health and Human Resources <strong>Chapter</strong> <strong>514</strong>: <strong>Nursing</strong> <strong>Facility</strong> <strong>Services</strong> Page 9January 1, 2013DISCLAIMER: This manual does not address all the complexities <strong>of</strong> Medicaid policies and procedures,and must be supplemented with all <strong>State</strong> and Federal Laws and Regulations.