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

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of all personnel at the nursing facility;All State and Federal regulations, including WV Legislative Rule 64CSR13 (theNursing Home Licensure Rule) which are relevant to the employees position.The personnel files for each individual employed by the nursing facility must include writtendocumentation indicating the dates the employee participated and completed the orientationprogram and any staff development in-service training conducted thereafter.514.7.2 Pharmacy ServicesAn administrator or designee must assure that pharmaceutical services are provided asoutlined in 42 CFR 483.60 to accurately and safely provide or obtain pharmaceutical services,which include the provision of routine and emergency medications and biologicals andconsultation of a licensed pharmacist, in order to meet the needs of its residents.The administrator or designee shall assure the development and implementation of writtenprocedures based on policies approved by the governing body, including procedures thatassure the accurate acquisition, receipt, dispensing and administration of all medications andbiologicals.The administrator or designee shall assure that pharmaceutical services are provided inaccordance with this policy and all other applicable Federal, State and local laws and the rulesof the West Virginia Board of Pharmacy. The administrator or designee must employ or obtainthe services of a pharmacist who is licensed to practice in West Virginia and is currentlyregistered as a consultant pharmacist with the West Virginia Board of Pharmacy.The consultant pharmacist shall review the medication regimen of each resident once a monthor more frequently based on the resident’s needs. The consultant pharmacist shall documentthe results of each resident’s medication regimen review in the resident’s medical record. Themedication regimen review shall include substances that are regarded as herbal products ordietary supplements. The consultant pharmacist shall report any irregularities in the medicationregimen to the attending physician and the director of nursing. The nursing facilities pharmacistconsultant must be available to advise the nursing facility regarding Medicaid drug coverageand limitations.Drugs and biologicals used in the nursing facility must be labeled in accordance with therequirements of Federal, State and local laws, rules and regulations. The labels must includethe appropriate accessory and cautionary instructions with the expiration date when necessaryand must conform to the physician order and must adhere to all applicable State Board ofPharmacy rules for labeling.In accordance with State and Federal laws, the administrator or designee must store all drugsand biologicals in locked compartments under proper temperature controls and permit onlyauthorized personnel to have access to the keys. The governing body or designee mustprovide separately locked, permanently affixed compartments for the storage of drugs subject toDepartment of Health and Human Resources Chapter 514: Nursing Facility Services Page 35January 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.
abuse and controlled drugs as identified by Federal regulations. The nursing facility may alsouse single unit package drug distribution systems in which the quantity stored is minimal and amissing dose can be readily detected.The administrator or designee must establish a policy to assure residents’ requests for obtainingprescription medications from sources other than the contracted pharmacy will be honored.Prescription drugs are covered for residents of nursing facilities when prescribed by a qualifiedpractitioner and furnished by a Medicaid participating pharmacy. The coverage rules andregulations may be found in Chapter 518 Pharmacy Services.Residents are exempt from all co-pay requirements. Non-covered drugs are not reimbursed byMedicaid for residents of nursing facilities.514.7.3 Rehabilitation ServicesIf specialized rehabilitative services such as, but not limited to, physical therapy, speechlanguagepathology, occupational therapy, respiratory therapy and psychological or psychiatricrehabilitative services, are required in the resident’s comprehensive plan of care, theadministrator or designee must provide the required services directly or in accordance with 42CFR 483.45 and §514. 8.2 of this manual. These services are covered services included in thereimbursement from Medicaid.514.7.4 Minimum Data Set (MDS)The Minimum Data Set (MDS), Version 3.0 with the RUGs III and the West Virginia-specificSection S are to be used by NFs to fulfill the federally mandated requirements for payment.These forms may be found in the Resident Assessment Instrument (RAI) Manual as publishedand periodically updated by CMS; please refer to OHFLAC website for Section S instructionswww.wvdhhr.org/ohflac specifications.CMS requires that a comprehensive MDS assessment be completed on every resident admittedinto a NF by day 14 of the admission and reassessed on at least a quarterly basis and annuallythereafter. Reference should be made to the RAI manual for the complete Omnibus BudgetReconciliation Act (OBRA) assessment schedule.514.7.5 MDS Submission Criteria for ReimbursementBMS utilizes the MDS assessments to determine (through the West Virginia specific 29 – casemix grouper), the acuity level of each individual residing in the nursing facility. West Virginia hascase mix classes 01-29, (when billed on the UB claim form or 837I format, the scores aredepicted as AAA01-AAA29). The case mix workbook may be found online atwww.dhhr.wv.gov/bms. The billing schedule is published annually, which may also be found onthe BMS website at www.dhhr.wv.gov/bms, with the nursing facility billing deadline dates, aswell as the MDS extraction date.Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 36January 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 and 28: Where residents are in a nursing fa
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: It is the responsibility of the nur
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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