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

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outside resource (a person or agency) to provide direct medically-related social services asneeded by the resident or to act as a consultant.The chief function of the social worker is to help with problems which inhibit or prevent theresident's social adjustment and, because of this, affect his/her ability to benefit from their stayin the nursing facility.Social service activity is not limited to the resident alone, but will usually include contact with theresident's family, close friends, and the coordination of services with other agencies, such asWVDHHR, Social Security Administration (SSA), Veteran's Administration (VA), Aging &Disability Resource Centers, community service organizations, etc. A good working knowledgeof community resources is a valuable asset for the social worker.The social worker is to provide indirect services to the resident through staff education both byparticipation in the nursing facility’s in-service training program and through conferences withstaff who are concerned with the resident’s care. To carry out this function, the social worker willneed to have a thorough knowledge of the nursing facility’s method of operation and itspractices and policies.Sales and marketing activities do not constitute medically-related social services.514.5.9 Activities DirectorIn compliance with 42 CFR 483.15 (f) (1)(2)(i) (A)(B)(ii)(iii)(iv) the nursing facility administrator ordesignee must provide for an ongoing program of activities designated to meet, in accordancewith the comprehensive assessment, the interests and the physical, mental, and psychosocialwell-being of each resident.The administrator or designee must designate a qualified professional who is a qualifiedTherapeutic Recreation Specialist or an Activities Professional, who is licensed or registered, byan accrediting body on or after October 1, 1990.The Activities Director is responsible for developing programs which provide constructivesupervision and services directed toward restoring and maintaining each resident at his/her bestpossible functional level including activities designed to encourage self-care and independence.The Activities Director shall develop a plan for independent and group activities for eachresident in accordance with his/her needs and interests. The plan is incorporated in the overallplan of care and is reviewed with the resident's participation at least quarterly and revised asneeded and documented in the care plans and MDS.The activities director shall provide opportunities for meaningful activities and socialrelationships. These may include holiday celebrations, parties, indoor and outdoor games, orpersonal hobbies. Educational or recreational activities sponsored by groups within thecommunity should be encouraged and planned with these community groups or agencies.Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 27January 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.
514.5.10 Food and Dietary DirectorIn accordance with 42 CFR 483.35 and WV Legislative Rule 64CSR13, the administrator ordesignee must employ a qualified dietitian either full-time, part-time or on a consultant basis.A qualified licensed dietitian is one who is registered by the Commission on Dietetic Registrationand licensed by the West Virginia Board of Licensed Dietitians or is qualified by the WestVirginia Board of Licensed Dietitians, and is licensed by that board to provide professionalnutritional services in West Virginia.Consultation will be based upon the resident needs and will occur at intervals of no less thanevery 30 days and for no less than 8 hours.If a full-time qualified dietitian is not employed, the administrator or designee must, inaccordance with WV Legislative Rule 64CSR13, utilize the services of a full-time qualifieddietary manager who shall meet one of the following qualifications:A dietetic technician registered by the American Dietetic Association; orA certified dietary manager as certified by the Dietary Manager’s Association; orA graduate of an associate or baccalaureate degree program in foods and nutrition orfood service management.The dietary manager, under the direction of the dietitian, is responsible for the daily operation ofthe dietetic service. A nursing facility must employ sufficient support personnel competent tocarry out the functions of the dietary service. The administrator or designee shall ensure thedietary manager utilizes the services of sufficient support personnel competent to carry out thefunctions of the dietary service.The dietary manager must ensure the nutritional needs of all residents are met and thatpreferences are accommodated. Each resident must have a physician’s order for the specifictype of diet he/she is to receive as set forth in the nursing facility’s dietary manual.Rules regarding the frequency of meals, sanitary conditions and emergency supplies may befound at WV Legislative Rules 64CSR13 (Nursing Homes) and 64CSR17 (FoodEstablishments).514.6 ELIGIBILITY REQUIREMENTSEligibility requirements for residents are as follows:514.6.1 Application ProcedureAn application for nursing facility benefits may be requested by the resident, thefamily/representative, the physician, or a health care facility. The steps involved in approval forpayment of nursing facility services are:Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 28January 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 and 26: The agreement / contract must clear
Page 27: Where residents are in a nursing fa
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
Page 71 and 72: CHAPTER 514NURSING FACILITY SERVICE
Page 73 and 74: Changes in Ownership, either in par
Page 75 and 76: CHAPTER 514NURSING FACILITY SERVICE
Page 77 and 78: II. MEDICAL ASSESSMENTDate ________
Page 79 and 80:
III. MI/MR ASSESSMENTDATE: ________
Page 81 and 82:
V. ELIGIBILITY DETERMINATION DATE:
Page 83 and 84:
West Virginia Department of Health
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