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

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514.7.5 MDS Submission Criteria for Reimbursement .......................................................... 36514.7.6 Care Area Assessments (CAA’s) ............................................................................. 37514.7.7 Care Plan (CP) ........................................................................................................ 37514.8 Services Under All-Inclusive Rate ............................................................................ 37514.8.1 Nursing Services ..................................................................................................... 38514.8.2 Therapy Services ..................................................................................................... 38514.8.3 Non-Prescription Items ........................................................................................... 38514.8.4 Medical Supplies, Accessories and Equipment ........................................................ 38514.8.5 Room and Board ..................................................................................................... 39514.8.6 Laundry ................................................................................................................... 39514.8.7 Food and Dietary Services ....................................................................................... 39514.8.8 Activities Program .................................................................................................... 39514.8.9 Social Services ........................................................................................................ 39514.8.10 Non-Emergency Transportation Services ................................................................ 39514.9 Resident Rights ....................................................................................................... 40514.9.1 Notice of Rights ....................................................................................................... 40514.9.2 Transfer and Discharge Policies .............................................................................. 42514.9.3 Bed Reservation ...................................................................................................... 43514.9.4 Medical Leave of Absence ....................................................................................... 44514.9.5 Therapeutic Leave of Absence ................................................................................ 44514.9.6 Resident Personal Funds......................................................................................... 45514.9.7 Deposit of Funds ..................................................................................................... 45514.9.8 Accounting and Records .......................................................................................... 45514.9.9 Notice of Certain Balances ...................................................................................... 45514.9.10 Conveyance upon Discharge ................................................................................... 46514.9.11 Allowable Resident Charges .................................................................................... 46514.10 Ancillary Services .................................................................................................... 46514.10.1 Orthotics and Prosthetics ......................................................................................... 46514.10.2 Dental Services ....................................................................................................... 47514.10.3 Vision Care Services ............................................................................................... 47Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 3January 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.
514.10.4 Podiatry Services ..................................................................................................... 47514.10.5 Laboratory, X-Ray, and Other Diagnostic Services .................................................. 47514.10.6 Emergency Ambulance Transportation Services ..................................................... 48514.10.7 Hospice/Nursing Facility Services ............................................................................ 48514.10.8 Documentation Requirements for Hospice/Nursing Facility Authorization ................ 50514.11 Documentation and Record Retention Requirements .............................................. 50514.11.1 Resident Record System ......................................................................................... 50514.11.2 Demographic Information ......................................................................................... 50514.11.3 Medical Information ................................................................................................. 51514.12 Payment and Billing Procedures .............................................................................. 52514.12.1 Payment and Billing Procedures Non-Hospice ......................................................... 52514.12.2 Nursing Facility Billing Procedures for Hospice Patients .......................................... 52514.12.3 Reimbursement Requirements ................................................................................ 53514.13 Cost Reporting ......................................................................................................... 53514.13.1 Chart of Accounts .................................................................................................... 53514.13.2 Financial and Statistical Report................................................................................ 54514.13.3 Cost Reporting and Filing Periods ........................................................................... 54514.13.4 Extension Requests ................................................................................................. 54514.13.5 Penalty – Delinquent Reporting ............................................................................... 55514.13.6 Correction of Errors ................................................................................................. 55514.13.7 Changes in Bed Size ............................................................................................... 55514.13.8 Projected Rates ....................................................................................................... 55514.13.9 Projected Rates – Change of Ownership ................................................................. 55514.13.10 Maintenance of Records .......................................................................................... 56514.13.11 Census Data ............................................................................................................ 56514.13.12 Allowable Costs for Cost Centers ............................................................................ 57514.13.13 Standard Services ................................................................................................... 57514.13.14 Mandated Services .................................................................................................. 57514.13.15 Nursing Services ..................................................................................................... 57514.13.16 Cost of Capital ......................................................................................................... 58Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 4January 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: 514.4.11 Services Provided by Outsi
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 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
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It is not mandatory for providers t
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ownership and control has occurred
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The standard hours PPD, by bed grou
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The Model Nursing Facility Standard
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Starting with its total costs, incl
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eimbursable. For example: if a faci
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514.13.37 Cost AdjustmentReported f
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If it has been determined that a fa
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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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Chapter 514 - Nursing Facility Services - DHHR - State of West ...

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