Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 101 - Standards for Payment for Nursing Facilities › Subchapter F - Vendor Payments › Section II-10149 - Services and Supplies

Current through Register Vol. 50, No. 6, June 20, 2024
A. Regulations
					 pertaining to this subsection are incorporated under the state plan for the
					 Medicaid program and included in the Medicaid Eligibility Manual
					 (MEM).
B. Services and Supplies
					 Included. The nursing facility shall be responsible for providing the following
					 services, supplies, and equipment to Medicaid residents:
1. room, board, and therapeutic diets;
					 and
2. food supplements or food
					 replacements, including at least one brand of each type (i.e., regular, high
					 fiber, diabetic, high nitrogen).
NOTE: This does not include enteral/parenteral nutrients,
						accessories and/or supplies.
3. General services as listed below:
a. professional nursing services;
b. an activities program with daily
					 supervision of such activities;
c.
					 medically-related social services; and
d. other services provided by required staff
					 in accordance with the plan of care.
4. Personal Care Need. The facility shall
					 provide personal hygiene items and services when needed by residents to
					 include:
a. hair hygiene supplies;
b. comb;
c. brush;
d. bath soap;
e. disinfecting soaps or specialized
					 cleansing agents when indicated to treat special skin problems or to fight
					 infection;
f. razors;
g. shaving cream;
h. toothbrush;
i. toothpaste;
j. denture adhesive;
k. denture cleaner;
l. dental floss;
m. moisturizing lotion;
n. tissues;
o. cotton balls;
p. cotton swabs;
q. deodorant;
r. incontinence supplies;
s. sanitary napkins and related
					 supplies;
t. towels;
u. washcloths;
v. hospital gowns;
w. hair and nail hygiene services;
x. bathing;
y. basic personal laundry;
z. incontinence care.
NOTE: Special hair cuts, permanent waves, and other such
						services, which are provided by a licensed barber or beautician at the request
						of the resident shall be paid directly by residents from their personal funds,
						or by their legal representative or sponsors, unless provided as a free service
						by the facility.
5. Drugs
a.
					 Over the counter drugs are part of pharmaceutical services that the nursing
					 facility is responsible for providing when it is specified in the resident's
					 plan of care. If the prescribing physician does not specify a particular brand
					 in the written order, a generic equivalent is acceptable. If the physician
					 specified a particular brand, the nursing facility would have to incur the cost
					 of providing that drug. If the physician does not specify a particular brand,
					 but the resident insists on receiving a particular brand, the nursing facility
					 is not required to provide the requested drug. However, if the facility honors
					 the resident's request, it may, after giving appropriate notice, make a charge
					 to the resident's funds for the difference between the cost of the requested
					 item and the cost of the generic.
b. Presceiption drugs prescribed by the
					 attending physician shall be filled by the Pharmacy. Reimbursement shall be
					 made as follows.
i. The pharmacy shall submit
					 claims to the state Medicaid program for drugs covered under the
					 program.
ii. The resident is
					 financially responsible for prescription drugs not covered under the Medicaid
					 program. The limit of the liability is from the resident's resources. A legal
					 representative or sponsor cannot legally be held personally liable for the
					 resident's debt; such person can only be required to pay the resident's debts
					 from the resident's funds. Prior to charging a resident, for a medication, the
					 prescribing physician should be notified that it is not covered by the Medicaid
					 program and asked if an equivalent alternative that is covered can be
					 prescribed. A resident should not be denied a needed medication simply because
					 of inability to pay.
6. Wheelchairs
a. Standard Wheelchair. Standard wheelchairs
					 shall be provided in adequate numbers to meet the temporary mobility or general
					 transporation needs of residents.
b. Customized Wheelchairs. Customized
					 wheelchairs may be obtained for Medicaid recipients with prior authorization
					 through the DME program of Medicaid. If this is not an option for the resident,
					 the nursing facility shall attempt to arrange for the provision of customized
					 wheelchairs as needed through family, community resources, etc. Customized
					 wheelchairs purchased by the nursing facility shall be allowable in the cost
					 report.
Repairs to a wheelchair owned by a resident are not the
						responsibility of the facility. For residents who are unable to pay for such
						repairs, the facility shall assist them in finding alternative funding
						sources.
7.
					 Other. The facility shall also provide an adequate number of the following
					 items:
a. standard, adjustable
					 walkers;
b. crutches;
c. over-bed tables;
d. bedside commodes;
e. lifts;
f. restraints;
g. sheepskins or similar decubitus prevention
					 and treatment devices;
h.
					 mechanical supports such as Posey vest-type;
i. suction machines for general use (DME
					 Program will purchase, with prior approval, suction machines and other related
					 equipment for those residents meeting the DME program need
					 requirements);
j. glucometers and
					 diabetic supplies;
k. blood
					 pressure cuffs;
l.
					 stethoscopes;
m. other such items
					 which are generally a part of nursing facility treatment.
NOTE: A facility is not required to provide clothing
						except in emergency situations. If provided, it shall be of reasonable
						fit.