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

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The nursing facility administrator or designee assumes responsibility for the provision ofservices directly or through outside resources to meet the needs of each resident. Theresidents and their representatives or volunteers may not perform direct care services forindividuals. At a minimum, the administrator or designee of the nursing facility is required toensure the facility complies with WV Legislative Rule 64 CSR 13 for services to be providedin a licensed nursing home or an extended care unit of a licensed hospital.The nursing facility must assure that all staff are properly licensed and competent to provideappropriate care.514.4.4 General AdministrationThe governing body is responsible to ensure the nursing facility is administered in a manner thatenables it to use its resources effectively and efficiently to attain or maintain the highestpracticable physical, mental, and psychosocial well-being of each resident.Policies must be documented as to the provision of services to residents in order to addressquality of life, quality of care, resident rights and any other services within the scope of nursingfacility services.514.4.5 Governing Body and ManagementThe management of the nursing facility must identify an individual or individuals as thegoverning authority of the facility in accordance with 42 CFR 483.410 and WV Legislative Rule64CSR13.514.4.6 Physical Environment RequirementsIn order to participate in the West Virginia Medicaid Title XIX Program nursing facilities must beequipped and maintained to provide a functional, sanitary and comfortable environment for allresidents admitted for care.The nursing facility must be in compliance with the 2005 Edition of the National Fire ProtectionAssociation (NFPA) of “NFPA 99 Standards for Health Care Facilities” as promulgated andmandatory references issued by CMS as currently published or modified in the future.Additionally, BMS requires adherence to the Guidelines for Design and Construction of Hospitaland Health Care Facilities in establishing the Standard Appraised Value (SAV) for the capitalcomponent of the nursing facility rate.BMS pays for an annual SAV inspection. If the first SAV inspection has been completed and thenursing facility requests an additional SAV inspection, the nursing facility is responsible forpayment to the appraisal company approved by BMS, who completes the additional SAVinspection.When the nursing facility has proposed changes to the physical plant, the governing body ordesignee of the nursing facility is responsible to notify BMS, in writing.Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 21January 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.
514.4.7 Administrative PoliciesThe governing body of a nursing facility must ensure the development of policies andprocedures regarding all aspects of the operation of the facility, including policies andprocedures regarding the provision of care and services to residents. These policies must beavailable to each resident and his/her representative.All policies and procedures regarding the provision of care and services to residents must reflectcurrent accepted standards and practices and must be reviewed and approved by the governingbody or designee at least annually. All of these policies must be written or presented in alanguage/method of communication that can be understood by any individual admitted to thefacility.Additionally, all individuals residing within the facility must be informed in a language/method ofcommunication which the individual or legal representative can understand regarding all rightsand policies affecting their acceptance of services provided by the facility.514.4.8 Emergency/Disaster Preparedness ProcedureThe nursing facility’s governing body or designee must have detailed written plans andprocedures to meet all potential emergencies and disasters, such as fire, severe weather, andmissing residents and must train all employees in emergency procedures when they begin towork in the facility, periodically review the procedures with existing staff, and carry outunannounced staff drills using those procedures.The nursing facility’s emergency / disaster preparedness procedures must include at aminimum:How to shelter in place when indicated and how to care for residents when sheltering inplace;How to evacuate all or part of the facility when indicated and how to care for residents inan emergency shelter when evacuation of the NF is indicated;Notification of the attending physician, EMS, law enforcement and other personsresponsible for the residents;Arrangements for transportation;Arrangements for hospitalization;Arrangements for other appropriate services;Arrangements for emergency physician services, if the attending physician is notimmediately available;Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 22January 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.
Page 1 and 2: CHAPTER 514 - COVERED SERVICES, LIM
Page 3 and 4: 514.4.11 Services Provided by Outsi
Page 5 and 6: 514.10.4 Podiatry Services ........
Page 7 and 8: 514.13.47 Field Audit .............
Page 9 and 10: in the balance as part of the proce
Page 11 and 12: Minimum Data Set (MDS) - a core set
Page 13 and 14: eimbursement and annually thereafte
Page 15 and 16: A change in ownership of a nursing
Page 17 and 18: The Commissioner, in his or her dis
Page 19 and 20: 514.3.2 Civil Money Penalty (CMP)A
Page 21: Employment of an individual with on
Page 25 and 26: The agreement / contract must clear
Page 27 and 28: Where residents are in a nursing fa
Page 29 and 30: 514.5.10 Food and Dietary DirectorI
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Page 33 and 34: evaluator. All Level II evaluators
Page 35 and 36: It is the responsibility of the nur
Page 37 and 38: abuse and controlled drugs as ident
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Page 41 and 42: Upon transfer to another nursing fa
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Page 45 and 46: the resident’s physical condition
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Page 57 and 58: ownership and control has occurred
Page 59 and 60: The standard hours PPD, by bed grou
Page 61 and 62: The Model Nursing Facility Standard
Page 63 and 64: Starting with its total costs, incl
Page 65 and 66: eimbursable. For example: if a faci
Page 67 and 68: 514.13.37 Cost AdjustmentReported f
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Page 71 and 72: CHAPTER 514NURSING FACILITY SERVICE
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Changes in Ownership, either in par
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CHAPTER 514NURSING FACILITY SERVICE
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II. MEDICAL ASSESSMENTDate ________
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III. MI/MR ASSESSMENTDATE: ________
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V. ELIGIBILITY DETERMINATION DATE:
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West Virginia Department of Health
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