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

514.10.6 Emergency Ambulance Transportation ServicesWest Virginia Medicaid reimburses emergency transportation services rendered to membersresiding in nursing facilities when the services are medically necessary. Services 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 Chapter 524Transportation Services for further emergency guidelines.Use of 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 of 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 of transportation does not meet the medicalnecessity requirements of the member;Transportation to any location that does not render covered medical, diagnostic ortherapeutic services.This list is not intended to be all inclusive.514.10.7 Hospice/Nursing Facility ResidentWest Virginia Medicaid maintains a separate program of Hospice Services for individuals whoare residents of a nursing facility. If a member electing hospice care is a resident of a WestVirginia 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 of a nursing facility is not a requirement of this program. The hospiceagency must enroll with the Medicaid agency to be a provider of 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 of aliving space, nutrition, and ancillary services normally provided for residents. Ancillary servicesmay include, but are not limited to, the basic activities of 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 of Health and Human Resources Chapter 514: Nursing Facility Services Page 48January 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.