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

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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.
Where residents are in a nursing facility located in a distinct part of a largerinstitution, each part of the institution must be separately staffed with adequatenursing personnel regardless of size.24-hour health service requires that the number and type of personnel be sufficientto meet the total needs of the residents.514.5.5 Director of Nursing (DON)The administrator must designate, in writing, a registered nurse (RN), who is licensed by theWest Virginia Board of Examiners for Registered Professional Nurses (RN Licensing Board), toserve as the Director of Nursing (DON) on a full-time basis. The DON must be on duty at leastfive days a week, eight consecutive hours a day. The administrator and DON are responsiblefor ensuring the nursing facility has sufficient direct care staff to deploy across all shifts andunits to meet the assessed needs of resident on 24-hour basis.514.5.6 Licensed NurseThe administrator or designee is responsible for designating a licensed nurse to serve as acharge nurse on each shift. If an RN is not available in the facility, a licensed practical nurse(LPN) may serve in this capacity. All RNs and LPNs are required to follow the policies andprocedures of the NF and work within the scope of their individual licenses.A NF must have an RN on duty, in the facility, for at least eight consecutive hours, seven days aweek. In NFs with fewer than sixty beds, the DON may serve to meet this requirement. Duringperiods when there is not an RN on duty, there must be an RN on call.514.5.7 Certified Nurse Aide (C.N.A)The administrator or designee must receive registry verification from the West Virginia NurseAide Registry that a nurse aide has met training and/or competency evaluation requirementsprior to hire into the nursing facility and retain these documents in the individual’s personnel file.514.5.8 Social ServicesThe administrator or designee is responsible for designating a qualified social worker suited bytraining or experience, in accordance with WV Legislative Rule 64CSR13 and 42 CFR483.15(g)(1)(2)(3)(i)(ii), to provide or arrange for the provision of social services as needed bythe resident to promote the resident highest physical, mental and psychosocial wellbeing.These services must be integrated with all other elements of the overall plan of care.The social worker is an individual who is currently licensed by the West Virginia Board of SocialWork Examiners as a licensed social worker, (LSW) at entry level or higher and has somebackground, knowledge or experience related to social service activity in order to perform thisfunction. If the facility’s governing body/ designee does not employ an individual qualified bytraining or experience, arrangements must be made through written agreement/contract with anDepartment of Health and Human Resources Chapter 514: Nursing Facility Services Page 26January 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 and 22: Employment of an individual with on
Page 23 and 24: 514.4.7 Administrative PoliciesThe
Page 25: The agreement / contract must clear
Page 29 and 30: 514.5.10 Food and Dietary DirectorI
Page 31 and 32: #27: Individual has skilled needs i
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
Page 39 and 40: 514.8.1 Nursing ServicesCovered ser
Page 41 and 42: Upon transfer to another nursing fa
Page 43 and 44: 514.9.2 Transfer and Discharge Poli
Page 45 and 46: the resident’s physical condition
Page 47 and 48: 514.9.10 Conveyance Upon DischargeU
Page 49 and 50: 514.10.6 Emergency Ambulance Transp
Page 51 and 52: 514.10.8 Documentation Requirements
Page 53 and 54: certification must include document
Page 55 and 56: It is not mandatory for providers t
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
Page 69 and 70: If it has been determined that a fa
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Page 73 and 74: Changes in Ownership, either in par
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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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