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>.13.49 Credits and AdjustmentsThe <strong>State</strong> will account for the return <strong>of</strong> the Federal portion <strong>of</strong> all overpayments to CMS inaccordance with the applicable Federal laws and regulations.<strong>514</strong>.14 NURSE AIDE TRAINING AND REIMBURSEMENTIn accordance with CFR 483.154 (3), reimbursement is available for nursing facilities that areeligible and approved by OHFLAC to conduct nurse aid training classes in their facility. Theeducational costs for Nurse Aide training may be reimbursed to the facility where the trainingand evaluation was held at a maximum <strong>of</strong> $400 for training and $100 for competency evaluationto equal $500. Reimbursement is only available to the nursing facility after the individual hassuccessfully passed the complete competency evaluation and the training nursing facilityverifies the nurse aid has been hired as a nurse aid either at the training facility or anothernursing facility. The documentation <strong>of</strong> employment must be attached to the reimbursement form(see Appendix 3) and it must consist <strong>of</strong> a letter from the administrator at the hiring nursingfacility stating the individual has been hired as a nurse aid, along with dates <strong>of</strong> hire. Thisreimbursement is only available to a nursing facility once in a lifetime per individual Nurse Aide.<strong>514</strong>. 15 MOUNTAIN HEALTH CHOICES (MHC)<strong>Nursing</strong> home services are covered for the Traditional, Basic and Enhanced adult benefitpackages with appropriate prior authorization and approval requirements. Service coverage,prior authorization requirements, service limitations and all policy information that must befollowed as outlined in this policy.When a member is admitted to a nursing facility, the member is removed from MHC and placedin the traditional program because it is considered long term care. This occurs on the first <strong>of</strong> themonth following the admission when the member is admitted before approximately the 20th <strong>of</strong>the month, but no later than the 1st <strong>of</strong> the second month. <strong>Services</strong> will be covered uponadmission if the member meets all program and eligibility requirements. Inpatient rehabilitationservices provided in nursing homes are not covered separately for any adult benefit plans.Department <strong>of</strong> Health and Human Resources <strong>Chapter</strong> <strong>514</strong>: <strong>Nursing</strong> <strong>Facility</strong> <strong>Services</strong> Page 69January 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.