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

514.10.8 Documentation Requirements for Hospice/Nursing Facility AuthorizationFor each individual who applies for hospice coverage in a nursing facility, election of servicesand physician certification documentation is required. Please refer to Chapter 509 HospiceServices. The hospice provider must submit to BMS or its designee for review of the followinginformation:An agreement between the specific nursing facility and the hospice provider that eachwill provide its appropriate services to residents who qualify, andDocumentation to support the medical necessity for each covered hospice service andthe financial eligibility documentation for the specific individual regarding Medicare andMedicaid.As with hospice services provided in other settings, those hospice services provided in nursingfacilities apply only to the terminal condition or disease. For health needs not related to theterminal diagnosis, established West Virginia Medicaid policies and procedures are to befollowed.The authorization information must be submitted with the first claim for payment.514.11 DOCUMENTATION AND RECORD RETENTION REQUIREMENTSThe administrator or designee must comply with the documentation and maintenance of recordsrequirements described in Common Chapter 100, General Information; Common Chapter 300,Provider Participation Requirements, and Common Chapter 800, General Administration. Inaddition to the documentation requirements described in those chapters, the followingrequirements also apply to payment for nursing facility services.514.11.1 Resident Record SystemA resident record system must be maintained which assures that the record is available toprofessional and other staff directly involved with the resident as well as authorizedrepresentatives.Resident records must be safeguarded against destruction, loss, or unauthorized use and mustcomply with all Health Information Portability and Accountability Act (HIPAA) regulations.Records must be retained for a minimum of five years following a resident's discharge.Representatives of the WVDHHR and USDHHS may have access to the resident records at anytime without the consent of the resident or responsible party. A separate clinical record must bemaintained for each resident at a location that is accessible to appropriate nursing facility staffwith all entries recorded in accordance with current professional standards and practices.514.11.2 Demographic InformationThe clinical record must include at a minimum the following information:Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 50January 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.