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

More documents

Recommendations

Info

CHAPTER 514NURSING FACILITY SERVICESXXXXX, 2011APPENDIX 3INVOICE FOR REIMBURSEMENT OF NURSE AIDE TRAININGAND COMPETENCY EVALUATIONPAGE 1 OF 2
West Virginia Department of Health and Human ResourcesBureau for Medical ServicesInvoice for ReimbursementNurse Aide Training and Competency EvaluationThis form is to be submitted with all documentation as listed on page 2 of this invoice, to the Bureau forMedical Services.PurposeFacility I.D.( ) 1. Nurse Aide Training Cost Provider Number:( ) 2. Competency Evaluation Cost Facility Name:Nurse Aide Information:Social Security Number:Name: __________________________Address: __________________________________________________Facility Phone Number:Nurse Aide Training Information:Trainer Name: ________________________Address: ______________________________Location: ______________________________Training Date Start: __________________MM DD YYFinish:__________________MM DD YYDate Exam was passed: ________________( ) Nurse Aide Training (Max $400)$_________( ) Competency Evaluation (Max $100)$__________Training Plan Code Number: ___________Cost of Training:Invoice Amount$___________Submitted by: ____________________________________ Date: _________________________________(Signature) MM DD YY_____________________________________(Title)
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 and 70: If it has been determined that a fa
Page 71 and 72: CHAPTER 514NURSING FACILITY SERVICE
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: V. ELIGIBILITY DETERMINATION DATE:
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?