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

The West Virginia Medicaid Program will remit to the hospice provider, who is contracted toprovide services in the nursing facility, 95% of the daily rate which would have been paid to thenursing facility for care of this member had they not elected hospice coverage. The hospice willreimburse the nursing facility for the cost of room and board, as identified in their contract. Theamount of reimbursement will be based on the nursing facility base per diem rate with theMedicaid adjustment for the acuity of the beneficiary. The claim form for billing is the UB04 andcannot be billed electronically. Documentation identifying the specific case mix class of theindividual must be attached.514.12.3 Reimbursement RequirementsThe West Virginia nursing facility reimbursement system is prospective with semi-annual rateadjustments. It is designed to treat all parties fairly and equitably, i.e., the resident, taxpayer,agency and facility. To meet these goals, complete and accurate cost data must be maintainedby each facility with cost reports accurately prepared and submitted on a timely basis.The basic principles and methodology for the system are described in this chapter. Detailedinstructions and guidelines are published in the revised West Virginia Medicaid Long Term CareUsers Guide to Reimbursement, which is hereby incorporated by reference into theseregulations.Federal and State law, the West Virginia State Plan and Medicaid regulations coverreimbursement principles in the following order. When Medicaid regulations are silent andMedicare cost principles and regulations are silent, then generally accepted accountingprinciples (GAAP) will be applied. None of these secondary applications will serve to reduce theDepartment’s ability to apply “reasonable cost” limits under Medicaid.514.13 COST REPORTINGAll participating facilities are required to maintain cost data and submit cost reports according tothe methods and procedures specified in this chapter and the Medicaid Reimbursement Guidefor Long Term Care Nursing Facilities (see www.dhhr.wv.gov/bms), whichever is morerestrictive.514.13.1 Chart of AccountsThe Medicaid Chart of Accounts (MCOA) is mandated by the West Virginia Department ofHealth and Human Resources (WVDHHR) for nursing facility service providers who are requiredto complete the Financial and Statistical Report for Nursing Homes (Medicaid Cost Report) aspart of their participation in the Medicaid program. The MCOA details the account number,account name, file/field specification (FIELD), page and line reference (MAP) and description ofitems applicable for each account. The FIELD column contains the file and field layout forsubmission of the Medicaid Cost Report.Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 53January 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.