Medicaid/Medicare Benefits at Neshoba General

Services & Items Covered by the Medicaid Per Diem Rate

Many patients covered by Medicaid and Medicare have a lot of questions about the costs of their care and what is or is not covered. The information below outlines many of the details about Medicare and Medicaid coverage at Neshoba General.

During the course of a covered Medicaid stay, the facility may not charge a patient for the following items and services:

• Nursing services
• Specialized rehabilitative services
• Dietary services
• Activity programs
• Room/bed maintenance services
• Routine personal hygiene items and services
• Personal laundry
• Over-the-counter drugs and legend drugs

The following items are included in the Medicaid Per Diem rates. Exceptions are items covered by Medicare Part B or any other third party. These items may not be billed to the resident, family, or responsible party.

This is not an all-inclusive list:

• Adhesive Tape
• Alcohol
• Applicators
• *Arm Slings
• Band-aids
• Basins
• Bed Pans
• Bed Rails
• Bibs
• Blood Pressure Equip.
• Canes
• Catheters (any size)
• Catheters (indwelling)
• Commode chairs
• Cost to meet definition of nursing facilities
• Cotton Balls
• Cotton tipped applicators
• *Crutches
• Dental Floss
• Denture adhesive
• Denture cleaner
• Deodorant
• Dietary
• Disposable Diapers (when ordered by the resident's physician due to medical necessity)
• *Drainage Sets
• Enteral & Parenteral Therapy
• Extra Linens
• Gauze sponges
• Gloves (sterile & un-sterile)
• Green Soap
• Hair & Nail hygiene service
• Heating pads
• Hospital gowns
• Ice bags
• Incontinence care & supplies
• Infusion room board
• Invalid rings
• *Irrigation trays
• IV trays & IV tubing
• Laundry services
• Legend drugs (not covered by Medicaid drug program)
• Medicine dropper
• Lubricating jelly
• Medical & Surgical supplies (minor)
• Moisturizing lotion
• *Nasal tube feeding
• Needles (various sizes)
• Nursing services
• Nursing supplies & dressings
• Oxygen (administration, supply of & related meds)
• Overhead trapeze equipment
• Over-the-counter drugs
• Patient gowns
• Pumps (aspiration & suction)
• Razors
• Regular room
• Restorative nursing care
• Restraints
• Sanitary napkins
• Semi-private room
• Shaving cream
• Sheepskins
• Soap
• Social Services
• Specimen cups or bottles
• Syringes (all sizes)
• Thermometers
• Tissues
• Toilet tissue
• Tongue depressors
• Toothbrush & toothpaste
• Towels
• Traction Equipment
• Urinal (male or female)
• Under pads (chux, etc)
• Use of equip. & Facilities
• Walkers
• Washcloths
• Water pitchers
• Wheelchairs

*These items may not be included in allowable costs for Medicaid residents who are age 65 or over, as Medicaid automatically pays for Medicare Part B coverage, unless payment for these items is not available under Medicare Part B.

It is not permissible to collect any deposit for non-covered services on behalf of any Medicaid resident.

Prospective rates may be adjusted by Division of Medicaid (DOM) pursuant to changes in Federal and/or State laws or regulations. All plan changes must be approved by the federal grantor agency. Based on allowable and reasonable costs, DOM establishes maximum per diem standard reimbursement rates for each facility. Each facility is furnished a copy of Attachment 4.19 of the State Plan, which is also known as The Long-Term Care Reimbursement Plan.

Hygiene Supplies & Services, covered by the Medicaid Per Diem Rate. A facility's hair hygiene policy, must include the provision of combs, brushes, shampoos, trims and simple haircuts by the facility at no charge to the residents. Hair hygiene services include trims and simple haircuts provided by facility staff as part of routine grooming care. Trims and simple haircuts include all haircuts that maintain or enhance each resident's dignity and respect in full recognition of his or her individuality.

Included in allowable cost for Medicaid purpose are all hair hygiene supplies and services not charged to the resident. A facility may charge only for hair hygiene supplies and services requested in addition to or in place of those normally supplied or offered by the facility. Haircuts, permanent waves, hair coloring and relaxing performed by barbers and beauticians not employed by a facility may be charged to a resident requesting these services. However, if the facility's policy is to use licensed barbers and/or beauticians for trims and simple haircuts, then residents may not be charged for these services. The resident must be informed of the charge for the supplies and services in advance and an authorization form must be signed by the responsible party and/or resident.

Each facility must maintain written hair hygiene policies that describe what supplies and services are included in the per diem rate.

Medicaid Supply Items Covered by Medicaid

Certain supply items may be billed to the Mississippi Medicaid program for nursing facility residents.

These items are:

• Ostomy supplies: A Medicaid-approved durable medical equipment supplier has a unique provider number to bill these items. A nursing facility may bill Medicare Part B for those supplies used by residents, which are covered by Part B. A nursing facility may include the cost of these items for residents under the age of 65 who are not covered by Medicare Part B on the annual cost report. Proper documentation must be retained to support these costs.
• Oxygen cylinders: Oxygen cylinders may be provided by durable medical equipment suppliers and billed directly by them to the fiscal agent. Oxygen supply costs may be included in the facility's cost report. Supplies and equipment (other than an oxygen cylinder and its contents), which are required for the administration of oxygen, may not be billed directly to Medicaid. These items, as well as oxygen concentrators, central oxygen systems, IPPB Machines, etc., are covered through the cost report per diem rates established for each nursing facility.

Private Room Coverage by Medicaid

The overall average cost per day, determined from the cost reports, includes the costs of private rooms. The average cost per day is used to compute National Formulary (NF) reimbursement rates. Therefore, the cost of a private room is included in our reimbursement rates.

When a resident is in a private room due to medical necessity (prescribed and ordered by a physician), no extra charge will be made to the resident, his/her family, or the Medicaid program. In accordance with 42 CFR 447.15, the LTS Reimbursement Plan and Provider Agreement, the Medicaid reimbursement will be considered as payment in full of the resident.

When a resident is in a private room by resident or family choice (not prescribed or ordered by a physician), a resident may be charged the difference between the private room charge and the semi-private room charge if the provider informs the resident at the time of his/her admission of the amount of the share. In accordance with the Long Term Care Reimbursement Plan and Medicaid policy, facilities may not charge residents or their families for services covered by the Medicaid reimbursement rate, which does not specifically include semi-private room accommodations.

Non-Covered Services & Charges

The facility must inform each Medicaid resident of the items and services offered by the facility but not covered by Title XVIII or the facility's Medicaid per diem rate. This notification must include both the items and services and the corresponding amounts for which the resident may be charged. The information must be presented in writing before or at the time of admission or upon the resident becoming eligible for Medicaid. Residents and/or their responsible parties must be notified in advance of changes in the provision of services and/or charges for the services.

The facility may charge any amount greater than or equal to the Medicaid rate for non-Medicaid residents for the prevision of services under the State Medicaid Plan consistent with the notice outlined above.

While the facility may set their basic per diem charge for non-Medicaid representative explaining leave policies, this information must define the period of time during which the resident will be permitted to return and resume residence. If the resident's absence exceeds Medicaid's bed-hold limit, the resident will be readmitted to the facility on the first availability of a semi-private bed if the resident still requires the services provided by the facility.