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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Minimum Data Set (MDS) - a core set <strong>of</strong> screening, clinical, and functional status elementscompleted by an IDT <strong>of</strong> which the resident is the principal member. It also includes commondefinitions and coding categories that form the foundation <strong>of</strong> the comprehensive assessment forall residents <strong>of</strong> long-term care facilities certified to participate in Medicare and Medicaid.Misappropriation <strong>of</strong> Property - the deliberate misplacement, exploitation, or wrongful misuse<strong>of</strong> a resident’s belongings or money.Neglect - the failure to provide goods and services necessary to avoid physical harm, mentalanguish, or mental illness.<strong>Nursing</strong> <strong>Facility</strong> - defined as an institution (or a distinct part <strong>of</strong> an institution) which isprimarily engaged in providing skilled nursing care and related services for residents whorequire medical or nursing care, rehabilitation services for the rehabilitation <strong>of</strong> injured,disabled, or sick persons, or on a regular basis, health-related care and services toindividuals who because <strong>of</strong> their mental or physical condition require care and services(above the level <strong>of</strong> room and board) which can be made available to them only throughinstitutional facilities, and is not primarily for the care and treatment <strong>of</strong> mental diseases andhas in effect a transfer agreement (meeting the requirements <strong>of</strong> §1861(1)) with one or morehospitals having agreements in effect under §1866.Patient Resource (or Resident Resource) Amount - the amount calculated by the WV<strong>DHHR</strong>which the resident must contribute to the cost <strong>of</strong> care every month by which the monthlyMedicaid payment is reduced.Personal Needs Allowance - the amount deducted from the member’s monthly income whichallows for personal needs <strong>of</strong> the nursing facility member.Pre-Admission Screen - the preliminary screen conducted on all persons seeking admission toa nursing facility in order to identify persons with major mental illness or developmentaldisability.Representative - the spokesperson acting in the best interest <strong>of</strong> the resident. Representativesmay be designated by the residents themselves, court appointed, or physician appointed, inaccordance with state law.Resident - any individual residing in a nursing facility (NF), skilled nursing facility (SNF), ordually certified skilled nursing facility/nursing facility (SNF/NF). For the purpose <strong>of</strong> Medicaidreimbursement only, the resident may be identified as a Member <strong>of</strong> the Medicaid program.Resident Council - a group <strong>of</strong> residents residing in the nursing facility having the right to meetto express grievances in relation to the residents’ general well-being and to makerecommendations concerning nursing facility policies and procedures.Department <strong>of</strong> Health and Human Resources <strong>Chapter</strong> <strong>514</strong>: <strong>Nursing</strong> <strong>Facility</strong> <strong>Services</strong> Page 10January 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.