Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 4 - LONG TERM CARE HOSPITALS › Section 317:30-5-64 - Inpatient and routine services

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  Long Term Care Hospital services includes routine items and services that must
				  be provided directly or through appropriate arrangement by the facility when
				  required by Medicaid residents. Charges for routine services may not be made to
				  resident's personal funds or to resident family members, guardians or other
				  parties who have responsibility for the resident. If reimbursement is available
				  from Medicare or another public or private insurance or benefit program, those
				  programs are billed by the facility. In the absence of other available
				  reimbursement, the facility must provide routine services from the funds
				  received from the regular Medicaid vendor payment and Medicaid resident's
				  applied income, or spenddown amount.
(b) An ad hoc committee composed of
				  recognized nursing facility representatives and Oklahoma Health Care Authority
				  staff will review the listing at least annually for additions or deletions, as
				  indicated. Routine services should be patient specific and in accordance with
				  standard medical care. Routine Services include, but are not limited to:
(1) Regular room;
(2) Dietary Services:
(A) regular diets,
(B) special diets,
(C) salt and sugar substitutes,
(D) supplemental feedings,
(E) special dietary preparations,
(F) equipment required for preparing and
				  dispensing tube and oral feedings, and
(G) special feeding devices (furnished or
				  arranged for);
(3)
				  Medically related social services to attain or maintain the highest practicable
				  physical, mental and psychosocial well-being of each resident, nursing care,
				  and activities programs (costs for a private duty nurse or sitter are not
				  allowed);
(4) Personal services -
				  personal laundry services for residents (does not include dry
				  cleaning);
(5) Personal hygiene
				  items (personal care items required to be provided does not include electrical
				  appliances such as shavers and hair dryers, or individual personal batteries)
				  include:
(A) shampoo, comb and
				  brush;
(B) bath soap;
(C) disinfecting soaps or specialized
				  cleansing agents when indicated to treat or prevent special skin problems or to
				  fight infection;
(D) razor and/or
				  shaving cream;
(E) nail hygiene
				  services; and
(F) sanitary napkins,
				  douche supplies, perineal irrigation equipment, solutions and disposable
				  douches;
(6) Routine
				  oral hygiene items including:
(A)
				  toothbrushes,
(B)
				  toothpaste,
(C) dental
				  floss,
(D) lemon glycerin swabs or
				  equivalent products,
(7)
				  Necessary items furnished routinely as needed to all patients, e.g., water
				  pitcher, cup and tray, towels, wash cloths, hospital gowns, emesis basin,
				  bedpan, and urinal.
(8) The
				  facility will furnish as needed items such as alcohol, applicators, cotton
				  balls, tongue depressors. Also, first aid supplies including small bandages,
				  ointments and preparations for minor cuts and abrasions, enema supplies,
				  including disposable enemas, gauze, 4 × 4's ABD pads, surgical and
				  micropore tape, telfa gauze, ace bandages, etc.
(9) Over the counter drugs (non-legend) not
				  covered by the prescription drug program (PRN or routine). In general, long
				  term care hospitals are not required to provide any particular brand of
				  non-legend drugs, only those items necessary to ensure appropriate care.
(A) If the physician orders a brand specific
				  non-legend drug with no generic equivalent, the facility must provide the drug
				  at no cost to the patient. If the physician orders a brand specific non-legend
				  drug that has a generic equivalent, the facility may choose a generic
				  equivalent, upon approval of the ordering physician;
(B) If the physician does not order a
				  specific type or brand of non-legend drug, the facility may choose the type or
				  brand;
(C) If the recipient,
				  family, or other responsible party (excluding long term care hospital) prefers
				  a specific type or brand of non-legend drug rather than the ones furnished by
				  the facility, the recipient, family or responsible party may be charged the
				  difference between the cost of the brand the resident requests and the cost of
				  the brand generally provided by the facility. (Facilities are not required to
				  provide an unlimited variety of brands of these items and services. It is the
				  required assessment of resident needs, not resident preferences, that will
				  dictate the variety of products facilities need to provide);
(D) Before purchasing or charging for the
				  preferred items, the facility must secure written authorization from the
				  recipient, family member, or responsible party indicating his or her desired
				  preference, the date and signature of the person requesting the preferred item.
				  The signature may not be that of an employee of the facility. The authorization
				  is valid until rescinded by the maker of the instrument;
(10) The facility will furnish or obtain any
				  necessary equipment to meet the needs of the patient upon physician order.
				  Examples include: trapeze bars and overhead frames, foot and arm boards, bed
				  rails, cradles, wheelchairs, foot stools, adjustable crutches, canes, walkers,
				  bedside commode chairs, hot water bottles or heating pad, ice bags, sand bags,
				  traction equipment, I.V. stands, etc.;
(11) Physician prescribed lotions, ointments,
				  powders, medications and special dressings for the prevention and treatment of
				  decubitus ulcers, skin tears and related conditions, when medications are not
				  covered under the Vendor Drug Program or other third party payor;
(12) Supplies required for dispensing
				  medications, including needles, syringes including insulin syringes, tubing for
				  IVs, paper cups, medicine containers, etc.;
(13) Equipment and supplies required for
				  simple tests and examinations, including scales, sphygmomanometers,
				  stethoscopes, clinitest, acetest, dextrostix, pulse oximeters, blood glucose
				  meters and test strips, etc.;
(14)
				  Underpads and diapers, waterproof sheeting and pants, etc., as required for
				  incontinence or other care.
(A) If the
				  assessment and care planning process determines that it is medically necessary
				  for the resident to use diapers as part of a plan to achieve proper management
				  of incontinence, and if the resident has a current physician order for adult
				  diapers, then the facility must provide the diapers without charge;
(B) If the resident or the family requests
				  the use of disposable diapers and they are not prescribed or consistent with
				  the facility's methods for incontinent care, the resident/family would be
				  responsible for the expense;
(15) Oxygen for emergency use, or
				  intermittent use as prescribed by the physician for medical
				  necessity;
(16) Other physician
				  ordered equipment to adequately care for the patient and in accordance with
				  standard patient care, including infusion pumps and supplies, and nebulizers
				  and supplies, etc.