Chapter 514 - Nursing Facility Services - DHHR - State of West ...
Chapter 514 - Nursing Facility Services - DHHR - State of West ...
Chapter 514 - Nursing Facility Services - DHHR - State of West ...
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<strong>514</strong>.10.6 Emergency Ambulance Transportation <strong>Services</strong><strong>West</strong> Virginia Medicaid reimburses emergency transportation services rendered to membersresiding in nursing facilities when the services are medically necessary. <strong>Services</strong> must berendered in the nearest hospital or facility that has the appropriate equipment and personneland is documented in the nursing facility transfer agreement. Please refer to <strong>Chapter</strong> 524Transportation <strong>Services</strong> for further emergency guidelines.Use <strong>of</strong> an ambulance merely for the member or the nursing facility’s convenience is not coverednor is residence in a NF adequate justification for the utilization <strong>of</strong> transportation via ambulance.The following are not emergency transportation services and will not be reimbursed;Transport for services routinely available at the nursing facility;Transport for personal services;Transport for services that do not meet medical necessity guidelines;Transportation for services where the level <strong>of</strong> transportation does not meet the medicalnecessity requirements <strong>of</strong> the member;Transportation to any location that does not render covered medical, diagnostic ortherapeutic services.This list is not intended to be all inclusive.<strong>514</strong>.10.7 Hospice/<strong>Nursing</strong> <strong>Facility</strong> Resident<strong>West</strong> Virginia Medicaid maintains a separate program <strong>of</strong> Hospice <strong>Services</strong> for individuals whoare residents <strong>of</strong> a nursing facility. If a member electing hospice care is a resident <strong>of</strong> a <strong>West</strong>Virginia Medicaid certified nursing facility, the administrator or designee may contract with aMedicare/Medicaid certified hospice agency to provide hospice services for eligible individualswho qualify medically for both the hospice benefit and Medicaid nursing facility benefits.Medicare certification <strong>of</strong> a nursing facility is not a requirement <strong>of</strong> this program. The hospiceagency must enroll with the Medicaid agency to be a provider <strong>of</strong> this benefit in nursing facilities.The hospice agency staff must follow the nursing facilities policies and procedures.The room and board component provided by the nursing facility shall include the provision <strong>of</strong> aliving space, nutrition, and ancillary services normally provided for residents. Ancillary servicesmay include, but are not limited to, the basic activities <strong>of</strong> daily living, social and activityprograms, and laundry and housekeeping.The hospice provider is responsible for specialized services covered by Medicare or Medicaid,including but not limited to, medications associated with the terminal illness and assistance withcare planning. The hospice provider becomes an active participant in the interdisciplinary careplan team and the care plan must be immediately updated to reflect these changes. Emotionalsupport for the member and the member’s family is also provided. The hospice must billMedicare and Medicaid for all covered services, including nursing facility room and board. TheDepartment <strong>of</strong> Health and Human Resources <strong>Chapter</strong> <strong>514</strong>: <strong>Nursing</strong> <strong>Facility</strong> <strong>Services</strong> Page 48January 1, 2013DISCLAIMER: This manual does not address all the complexities <strong>of</strong> Medicaid policies and procedures,and must be supplemented with all <strong>State</strong> and Federal Laws and Regulations.