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

More documents

Recommendations

Info

514.13.49 Credits and AdjustmentsThe State will account for the return of the Federal portion of all overpayments to CMS inaccordance with the applicable Federal laws and regulations.514.14 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 of $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 of employment must be attached to the reimbursement form(see Appendix 3) and it must consist of a letter from the administrator at the hiring nursingfacility stating the individual has been hired as a nurse aid, along with dates of hire. Thisreimbursement is only available to a nursing facility once in a lifetime per individual Nurse Aide.514. 15 MOUNTAIN HEALTH CHOICES (MHC)Nursing 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 of themonth following the admission when the member is admitted before approximately the 20th ofthe month, but no later than the 1st of the second month. Services 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 of Health and Human Resources Chapter 514: Nursing Facility Services Page 69January 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.
CHAPTER 514NURSING FACILITY SERVICESXXXXX, 2011APPENDIX 1AGREEMENT FOR NURSING FACILITY PARTICIPATION IN THETITLE XIX MEDICAID PROGRAMPAGE 1 OF 4
Page 1 and 2:
CHAPTER 514 - COVERED SERVICES, LIM
Page 3 and 4:
514.4.11 Services Provided by Outsi
Page 5 and 6:
514.10.4 Podiatry Services ........
Page 7 and 8:
514.13.47 Field Audit .............
Page 9 and 10:
in the balance as part of the proce
Page 11 and 12:
Minimum Data Set (MDS) - a core set
Page 13 and 14:
eimbursement and annually thereafte
Page 15 and 16:
A change in ownership of a nursing
Page 17 and 18:
The Commissioner, in his or her dis
Page 19 and 20: 514.3.2 Civil Money Penalty (CMP)A
Page 21 and 22: Employment of an individual with on
Page 23 and 24: 514.4.7 Administrative PoliciesThe
Page 25 and 26: The agreement / contract must clear
Page 27 and 28: Where residents are in a nursing fa
Page 29 and 30: 514.5.10 Food and Dietary DirectorI
Page 31 and 32: #27: Individual has skilled needs i
Page 33 and 34: evaluator. All Level II evaluators
Page 35 and 36: It is the responsibility of the nur
Page 37 and 38: abuse and controlled drugs as ident
Page 39 and 40: 514.8.1 Nursing ServicesCovered ser
Page 41 and 42: Upon transfer to another nursing fa
Page 43 and 44: 514.9.2 Transfer and Discharge Poli
Page 45 and 46: the resident’s physical condition
Page 47 and 48: 514.9.10 Conveyance Upon DischargeU
Page 49 and 50: 514.10.6 Emergency Ambulance Transp
Page 51 and 52: 514.10.8 Documentation Requirements
Page 53 and 54: certification must include document
Page 55 and 56: It is not mandatory for providers t
Page 57 and 58: ownership and control has occurred
Page 59 and 60: The standard hours PPD, by bed grou
Page 61 and 62: The Model Nursing Facility Standard
Page 63 and 64: Starting with its total costs, incl
Page 65 and 66: eimbursable. For example: if a faci
Page 67 and 68: 514.13.37 Cost AdjustmentReported f
Page 69: If it has been determined that a fa
Page 73 and 74: Changes in Ownership, either in par
Page 75 and 76: CHAPTER 514NURSING FACILITY SERVICE
Page 77 and 78: II. MEDICAL ASSESSMENTDate ________
Page 79 and 80: III. MI/MR ASSESSMENTDATE: ________
Page 81 and 82: V. ELIGIBILITY DETERMINATION DATE:
Page 83 and 84: West Virginia Department of Health
show all

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

Create successful ePaper yourself

Delete template?

Save as template?