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

514.10.2 Dental ServicesGenerally, dental care is not a covered service and is not reimbursable as a fee for service.However, in accordance with Chapter 505 Dental and Oral Health, emergent dental care foradults is covered and defined as treatment for pain, infection, fractures, and trauma. Coverageis limited to the Least Expensive Professionally Acceptable Alternative Treatment (LEPAAT).Please refer to the local Department of Health and Human Resources (DHHR) office for furtherinformation.514.10.3 Vision Care ServicesCovered vision services may be found in Chapter 525 Vision Services. All covered servicesMUST be medically necessary and prescribed by an enrolled physician.514.10.4 Podiatry ServicesThe Medicaid Program covers podiatry services, with certain limitations, furnished to a residentwhen referred by the attending physician.Routine foot care is not a covered service, except for residents referred by the physician for thetreatment of a metabolic disease (such as diabetes). Routine foot care includes, but is notlimited to, the cutting or removal of corns or calluses, the trimming of nails, observation andcleaning of the feet, nail care not involving surgery, and other hygienic and maintenance care.Routine foot care is considered a part of the nursing services provided by facility staff.The regulations detailed in Chapter 520 Podiatry Services for the Medicaid program apply tonursing facility residents.514.10.5 Laboratory, X-Ray, and Other Diagnostic ServicesLaboratory and x-ray services are covered as ancillary services when provided by a certifiedand participating hospital or laboratory upon the order of the attending physician as needed todiagnose or treat an illness, accident, or injury.The resident's initial medical evaluation which is required within 48 hours after admission mayinclude a chest x-ray and/or routine laboratory work in order to safeguard against the spread ofdisease and to ensure adequate medical care.42 CFR 483.75 (j) (1) states: the facility must provide or obtain laboratory services to meet theneeds of its residents. The facility is responsible for the quality and timeliness of the services.A nursing facility that provides laboratory services must follow Clinical LaboratoryImprovements Amendment (CLIA) regulations as applicable. Please refer to Chapter 529Laboratory Services.Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 47January 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.