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

Substantial Compliance - a level of compliance with the requirements of participation such thatany identified deficiencies pose no greater risk to resident health or safety than the potential forcausing minimal harm.514.2 PROVIDER PARTICIPATION REQUIREMENTSThe governing body or designee of a nursing facility participating in the Medicaid Program mustfully meet the standards established by the West Virginia Secretary of the Department of Healthand Human Resources (WVDHHR); all applicable State and Federal laws governing theprovision of these services as currently promulgated or amended in the future; and allregulations contained herein or issued as Medicaid Policy. The Federal standards takeprecedence over State requirements except where State requirements are more restrictive.A nursing facility may be a freestanding entity qualifying and serving as a long-term-careprovider or it may be a distinct part of a larger institution. If the distinct part is operating asanother part of an institution, the distinct part must be an identifiable unit and meet all of therequirements for a nursing facility.514.2.1 State LicensureAs a condition of participation as a nursing facility in the West Virginia Title XIX MedicaidProgram, a free-standing nursing home or distinct part of a hospital must be currently licensedin accordance with the applicable State Code and Legislative Rule. The nursing home orhospital must meet and maintain the standards for licensure on a continuing basis. Whenrequired by the nursing home or hospital licensure rule, the nursing facility must be administeredby a licensed nursing home administrator, who is legally responsible for establishing andimplementing policies regarding the management and operations of the facility and who holdsan approved, current license, as required by State law. The nursing facility must also meet allFederal and State standards for participation in the Title XIX Medicaid Program and remain incompliance with all other applicable Federal, State, and Local laws, rules, and regulationsaffecting the health and safety of all residents.514.2.2 Provider EnrollmentThe nursing home or hospital distinct part must submit a completed, signed and dated providerenrollment application and a nursing facility agreement in order to apply with the Bureau forMedical Services for approval to participate in the Title XIX Medicaid Program. Prior to approvalas a provider, a Certificate of Need (CON) must be approved by HCA. The nursing home orhospital distinct part must meet Medicaid certification requirements. Upon approval of theapplication and the agreement by BMS, a provider number will be assigned by BMS’ fiscalagent. See Common Chapter 300, Provider Participation Requirements.514.2.3 Nursing Facility Provider AgreementA nursing facility provider agreement must be approved by BMS prior to eligibility forDepartment of Health and Human Resources Chapter 514: Nursing Facility Services Page 11January 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.