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

514.5.3 Physician ServicesAccording to 42 CFR 483.40, a physician (MD or DO) must personally approve in writing, arecommendation that a person be admitted to a NF. Each resident’s care must be supervisedby a physician at all times. The administrator or designee shall ensure that the medical care ofeach resident is supervised by a physician. Another physician must supervise the medical careof residents when their attending physician is unavailable.The attending physician must review the resident’s total program of care, including medicationsand treatments, and examine the resident personally at each visit. The physician must write,sign and date progress notes at each visit and sign and date all physician orders. Any specialistwho is called into the nursing facility must have a physician’s order for the service signed priorto the date of service. Standing orders are not allowed and routine screening services are notcovered in relation to the specialist.The resident must be seen within 72 hours following the admission to the nursing facility and atleast every 30 days for the first 90 days after the admission and as the resident’s conditionwarrants. After the 90 day requirement been met, the physician must visit every 60 days ormore often as the resident’s condition warrants.After the initial visit, and completion of the visits required during the resident’s first 90 days inthe nursing facility, at the option of the physician, required visits may alternate between personalvisits by the physician and visits by a qualified physician extender (a physician’s assistant, anadvance practice registered nurse or a clinical nurse specialist) who is licensed as such by theState of West Virginia, performing within their scope of practice, and is under the supervision ofthe physician following the above requirements. If the physician elects to alternate visits with aqualified physician extender, all requests for reimbursement from the Medicaid program must besubmitted under the servicing provider’s number. Please refer to Chapter 519 PractitionerServicesThe administrator or designee must provide or arrange for the provision of physician services 24hours of every day.514.5.4 Nursing ServicesAccording to 42 CFR 483.30, the nursing facility must have sufficient nursing staff to providenursing and related services to attain or maintain the highest practical physical, mental andpsychosocial well-being of each resident, as determined by resident assessments and individualplans of care. The administrator and director of nursing at the nursing facility must followlicensure requirements to provide health services which assure that each resident receivestreatments, medications, diets and other health services as prescribed and planned all hours ofeach day.The primary duties of certified nurse aides consist of direct resident care andservices, as distinguished from the duties of paid feeding assistants andhousekeeping, laundry and dietary functions.Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 25January 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.