Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1739.2 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM - LONG TERM CARE PROSPECTIVE PAYMENT SYSTEM › Section 17-1739.2-4 - Services included in the basic PPS rate

Current through June, 2024
(a) The reasonable
				and necessary costs of providing the following items and services shall be
				included in the basic PPS rate and shall not be separately reimbursable, unless
				specifically excluded under subsection (b):
(1) Room and board;
(2) Administration of medication and
				treatment and all nursing services;
(3) Development, management, and evaluation
				of the written patient care plan based on physician orders that necessitate the
				involvement of skilled technical or professional personnel to meet the
				recipient's care needs, promote recovery, and ensure the recipient's health and
				safety;
(4) Observation and
				assessment of the recipient's unstable condition that requires the skills and
				knowledge of skilled technical or professional personnel to identify and
				evaluate the recipient's need for possible medical intervention, modification
				of treatment, or both, to stabilize the recipient's condition;
(5) Health education services, such as gait
				training and training in the administration of medications, provided by skilled
				technical or professional personnel to teach the recipient self-care;
(6) Provision of therapeutic diet and dietary
				supplements as ordered by the attending physician;
(7) Laundry services, including items of
				recipient's washable personal clothing;
(8) Basic nursing and treatment supplies,
				such as soap, skin lotion, alcohol, powder, bandages, applicators, tongue
				depressors, cotton balls, gauze, adhesive tape, incontinent pads, V-pads,
				thermometers, blood pressure apparatus, plastic or rubber sheets, enema
				equipment, and douche equipment;
(9) Non-customized durable medical equipment
				and supplies used by individual recipients, but which are reusable. Examples
				include items such as ice bags, hot water bottles, urinals, bedpans, commodes,
				canes, crutches, walkers, wheelchairs, and side-rail and traction
				equipment;
(10) Activities of the
				patient's choice (including religious activities) that are designed to provide
				normal pursuits for physical and psychosocial well being;
(11) Social services provided by qualified
				personnel;
(12) Maintenance
				therapy; provided, however, that only the costs that would have been incurred
				if nursing staff had provided the maintenance therapy will be included in
				calculating the basic PPS rates;
(13) A review of the drug regimen of each
				resident at least once a month, by a licensed pharmacist, as required for a
				nursing facility to participate in Medicaid.
(14) Provision of and payment for, through
				contractual agreements with appropriate skilled technical or professional
				personnel, other medical and remedial services ordered by the attending
				physician which are not regularly provided by the provider. The contractual
				agreement shall stipulate the responsibilities, functions, objectives, services
				fee, and other terms agreed to by the provider and the person or entity that
				contracts to provide the service; and
(15) Recurring, reasonable and incremental
				costs incurred to comply with OBRA 87.