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

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gerichairs, crutches, canes, bedside commodes, traction equipment, blood pressure equipment,protective restraints, lifts, nebulizers, air mattresses, weight scales and gait belts.514.8.5 Room and BoardCovered services include the resident’s room and basic room furnishings, including a bed ofproper size, length, and height for each resident; a clean, well–maintained, comfortablemattress of the proper length for each resident; pillows; clean linens and bedding appropriate tothe weather and climate; functional furniture appropriate to the resident’s needs; and individualcloset space with clothes racks, hangers and shelves.514.8.6 LaundryCovered services include laundry services such as basic personal laundry.514.8.7 Food and Dietary ServicesCovered services include all nutritional meals, snacks, food supplements, tube feedings,supplies and equipment required for tube feedings, and food substitutes needed for specialdiets.514.8.8 Activities ProgramCovered services include the cost for the provision of an activities program for residents.514.8.9 Social ServicesCovered services include the provision of medically-related social services and coordinationwith other social service agencies in the resident’s community and the resident’s family.514.8.10 Non-Emergency Transportation ServicesNursing facilities must provide non-emergency medical transportation (NEMT) which includesnon-emergency ambulance transportation for all residents. If the nursing facility does notprovide these services with a facility owned vehicle, the facility must contract with atransportation vendor that provides non-emergency van and non-emergency ambulancetransportation. These contracted services for transportation are not billable to West VirginiaMedicaid by the facility or transportation provider. Additionally any nursing facility that may beenrolled as a non-emergency transportation provider with WV Medicaid shall not bill for NEMTreimbursement for transportation provided to their residents. The nursing facility must coverthe cost of these transportation services and may be counted as an allowable expense on thecost report, under nursing- purchased services.However, the cost of all non-emergency medical transportation, provided by a vehicle owned bythe nursing facility, is included in the all-inclusive Medicaid rate. Refer to section 514.13.19.Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 39January 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.
Upon transfer to another nursing facility, it is the responsibility of the receiving nursing facility toprovide the transportation to their facility. This is because the sending facility is not reimbursedfor the day of discharge and the receiving facility is reimbursed for the day of admission.514.9 RESIDENT RIGHTSAs promulgated in 42 CFR 483.10, the resident has a right to a dignified existence, selfdetermination,and communication and access to persons and services inside and outside thefacility.514.9.1 Notice of RightsA facility must protect and promote the rights of each resident, including each of the rightsdefined below. Written policies and procedures must be implemented to ensure that eachresident or his/her representative is fully informed of his/her rights and responsibilities.Notification of resident rights must be provided periodically during the stay to theresident/representative.The administrator or designee must encourage and assist the resident throughout the period ofstay to exercise rights as a resident and a citizen including the right to vote, formulate advanceddirectives and meet and organize in resident/representative groups to voice grievances andrecommend changes in policies and services to facility staff and/or other representatives ofchoice free from restraint, interference, coercion, discrimination or reprisal. The administrator ordesignee must assure each resident civil and religious liberties, privacy of telephone and writtencommunications, provide services and care consistent with special needs and individualpreference, and respond promptly to requests.In the case of a resident adjudicated to be incompetent, the rights described in this provisionshall be exercised by the individual’s guardian or committee, in accordance with the WestVirginia Guardianship Act. If the resident has not been adjudged incompetent by the State, anylegal surrogate designated in accordance with State Law may exercise the resident’s rights tothe extent provided by State Law.The administrator or designee must inform each resident and/or his/her representative bothorally and in writing, in a language or method of communication that the resident understands ofhis/her rights and of all rules and regulations governing patient conduct and responsibilities.Such information must be provided prior to or at the time of admission, or in the case ofresidents already in the facility, upon the facility’s adoption or amendment of resident right’spolicies. Written acknowledgment of the receipt of resident rights information must bemaintained within the facility.The administrator or designee will keep all personal and medical records private and refuse toallow access to these records without written authorization by the resident/representative unlessState and/or Federal regulations regarding release of information supersedes. The resident oris/her representative will have access to all records pertaining to the resident including clinicalDepartment of Health and Human Resources Chapter 514: Nursing Facility Services Page 40January 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 and 36: It is the responsibility of the nur
Page 37 and 38: abuse and controlled drugs as ident
Page 39: 514.8.1 Nursing ServicesCovered ser
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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