17 KAR 3:020 - Charges for room and board, goods, and services at state veterans' nursing homes
RELATES TO: KRS 40.320, 40.325, 38 U.S.C. 1745(a), 42 C.F.R. Parts 413, 483
NECESSITY, FUNCTION, AND CONFORMITY: KRS 40.320 identifies the Commonwealth's duty to provide for the well-being of elderly and disabled veterans within state veterans' nursing homes. KRS 40.325(3) authorizes the Department of Veterans' Affairs to promulgate any administrative regulations necessary to operate the homes in compliance with applicable state and federal statutes and regulations. This administrative regulation establishes the methodology for establishing charges for room and board, goods, and services at state veterans' nursing homes.
Section
1. Definitions.
(1) "Ancillary
services" means services for which a separate charge is customarily made.
Ancillary services include, for example, physical therapy, occupational
therapy, speech therapy, laboratory procedures, x-ray services, oxygen
services, optometry services, podiatry services, dentist services, audiology
services, and pharmacy goods and services.
(2) "Non-routine goods or services" mean
those that are directly identifiable with an individual resident and which are
not customarily intended for use by all residents including such things as
transportation, special activities, cable television services, pay-per-view
channels, private or personal phone service, hospitalization, ambulance
services, hearing aids, dentures, cosmetology or beautician services (other
than basic haircuts), orthotic devices, and specialty care and
equipment.
(3) "Nursing facility"
means a state veterans' home (SVH) operated by the Kentucky Department of
Veterans Affairs.
(4) "Private pay"
means residents who pay for their nursing home care out of personal
funds.
(5) "Private room" means a
room in a state veterans' home that was not built in accordance with the
federal VA's community living center or small house design requirements, VHA
Handbook, Section 1142.01, or Small House Model design guide, and does not have
a roommate.
(6) "Resident" means a
Kentucky veteran admitted to a state veterans' nursing facility.
(7) "Room and board" means the room, dietary
services, social services, nursing services, basic laundry services, the use of
equipment and facilities, and routine medical and surgical supplies.
(8) "Routine goods or services" mean those
which are not identifiable to a particular individual resident, but which are
used by all residents.
(9)
"Semi-private room" means a room in a state veterans' home that was not built
in accordance with the federal VA's community living center or small house
design requirements, VHA Handbook, Section 1142.01, or Small House Model design
guide, and does have a roommate.
(10) "Suite" means a private suite with a
private bathroom including a shower that was built in accordance with the
federal VA's community living center or small house design requirements, VHA
Handbook, Section 1142.01, or Small House Model design guide.
Section 2. Charges at State
Veterans Nursing Homes.
(1)
(a) The private pay rate for room and board
at a state veterans' nursing facility shall be established by each facility
based on the total cost of care, community rates, and available revenue
sources.
(b) Any change to a
facility's charges for room and board, goods, or services shall require advance
notification in accordance with 42 C.F.R. Part 483 , Subpart
B-483.10(g)(18)(ii).
(c) There
shall be a separate and distinct charge for a semi-private room, a private
room, and a suite.
(2)
The total monthly charge for a private pay resident shall be:
(a) The applicable private pay rate for room
and board;
(b) Any charge for
non-routine goods or services; and
(c) Any charge for ancillary
services.
Section
3. Computation of Room and Board Charges.
(1) The monthly charge for a Medicaid
qualified resident shall be established by the Kentucky Department of Medicaid
services in accordance with 907 KAR 1:006. All items and services considered by
the Medicaid program to be non-covered as defined in 907 KAR 1:022, that were
provided to Medicaid residents during any period of a covered stay, may be
billed to the resident or another payer.
(2) If a veteran meets the requirements
established in 38 U.S.C. 1745(a) for a service-connected disability, the
veteran shall not be charged for any room and board, goods, or
services.
(3) The monthly charge
for a Medicare recipient qualifying for skilled services shall be the
applicable co-payments as established by the Centers for Medicare and Medicaid
services in 42 C.F.R. Part 413.
(4)
A late fee of six (6) percent per annum may be assessed on any unpaid
balances.
Section 4.
Incorporation by Reference.
(1) The following
material is incorporated by reference:
(a)
U.S. Department of Veterans Affairs, "VHA Handbook, Section 1142.01", August
13, 2008; and
(b) U.S. Department
of Veterans Affairs, "Small House Model design guide", January 2017.
(2) This material may be
inspected, copied, or obtained, subject to applicable copyright law, at the
Office of Kentucky Veterans Centers, Kentucky Department of Veterans Affairs,
1111B Louisville Road, Frankfort, Kentucky 40601, Monday through Friday, 8:00
a.m. to 4:30 p.m. This material is also available on the U.S. Department of
Veterans Affairs Web site at
https://www.va.gov/vhapublications/index.cfm.
Notes
STATUTORY AUTHORITY: KRS 40.325(3)
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