405 IAC 5-31-4.5 - Per diem services, state nursing facility
Authority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 4.5.
(a) Those
services and products furnished by a state nursing facility for the usual care
and treatment of patients are reimbursed in the per diem rate in accordance
with 405 IAC 1-17. The per diem rate
for state nursing facilities includes the following services:
(1) Room and board:
(A) room accommodations;
(B) all dietary services; and
(C) laundry services.
(2) Nursing care.
(3) The cost of all medical and nonmedical
supplies and equipment, which includes those items generally required to assure
adequate medical care and personal hygiene of patients, is included in the
nursing facility per diem.
(4)
Durable medical equipment (DME), and associated repair costs, routinely
required for the care of patients, including, but not limited to:
(A) ice bags;
(B) bed rails;
(C) canes;
(D) walkers;
(E) crutches;
(F) standard wheelchairs;
(G) traction equipment; and
(H) oxygen and equipment and supplies for its
delivery; are covered in the per diem rate and may not be billed to Medicaid by
the facility, an outside pharmacy, or any other provider. Nonstandard items of
DME and associated repair costs that have received prior authorization must be
billed to Medicaid directly by the DME provider. Facilities may not require
members to purchase or rent such equipment with their personal funds. DME
purchased with Medicaid funds becomes the property of the office. The office
must be notified when the member no longer needs the equipment.
(5) Medically necessary therapy
services, which include:
(A)
physical;
(B)
occupational;
(C) respiratory;
and
(D) speech pathology;
services.
(6) Dental
services.
(7) Optometric
services.
(8) Transportation
services, except for emergency medical transportation services.
(9) Pharmaceutical products.
(10) The cost of both legend and nonlegend
water products in all forms and for all uses.
(b) The services set out in subsection (a)
provided to a Medicaid resident residing in a state nursing facility are
reimbursed through the per diem rate except as follows:
(1) Hospital services rendered due to an
acute illness or injury may be billed to Medicaid directly by the hospital.
Individual exceptions to other medical care that must be rendered by
practitioners outside the facility require prior authorization from the
office.
(2) Dental services
provided in the facility shall be included in the per diem rate. Necessary
dental services that cannot be provided on-site by the dental staff require
prior authorization by the office. Dental services prior authorized by the
office must be billed to Medicaid directly by the outside dental provider.
Admission of a member to a hospital for the purpose of performing dental
services requires prior authorization by the office.
Notes
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No prior version found.