Chapter 514 - Nursing Facility Services - DHHR - State of West ...

Minimum Data Set (MDS) - a core set of screening, clinical, and functional status elementscompleted by an IDT of which the resident is the principal member. It also includes commondefinitions and coding categories that form the foundation of the comprehensive assessment forall residents of long-term care facilities certified to participate in Medicare and Medicaid.Misappropriation of Property - the deliberate misplacement, exploitation, or wrongful misuseof a resident’s belongings or money.Neglect - the failure to provide goods and services necessary to avoid physical harm, mentalanguish, or mental illness.Nursing Facility - defined as an institution (or a distinct part of 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 of injured,disabled, or sick persons, or on a regular basis, health-related care and services toindividuals who because of their mental or physical condition require care and services(above the level of room and board) which can be made available to them only throughinstitutional facilities, and is not primarily for the care and treatment of mental diseases andhas in effect a transfer agreement (meeting the requirements of §1861(1)) with one or morehospitals having agreements in effect under §1866.Patient Resource (or Resident Resource) Amount - the amount calculated by the WVDHHRwhich the resident must contribute to the cost of 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 of 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 of 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 of Medicaidreimbursement only, the resident may be identified as a Member of the Medicaid program.Resident Council - a group of 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 of Health and Human Resources Chapter 514: Nursing Facility Services Page 10January 1, 2013DISCLAIMER: This manual does not address all the complexities of Medicaid policies and procedures,and must be supplemented with all State and Federal Laws and Regulations.