He-E 802.08 - Covered Services

He-E 802.08. Covered Services

(a) Pursuant to 42 CFR 483, the following services shall be covered nursing facility services:

(1) Nursing services in accordance with 42 CFR 483.30, including:

a. Services provided to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care; and

b. Services provided on a 24-hour basis in accordance with resident care plans;

(2) Dietary services in accordance with 42 CFR 483.35, including:

a. Providing each resident with a nourishing, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident;

b. Employing a qualified dietician either full-time, part-time, or on a consultant basis; and

c. Providing therapeutic diets, as prescribed by the attending physician;

(3) Activities program services in accordance with 42 CFR 483.15(f), including an ongoing program of activities directed by a qualified professional and designed to meet, in accordance with the residents' assessments, the interests and the physical, mental, and psychosocial well-being of each resident;

(4) Medically related social services, in accordance with 42 CFR 483.15(g), including:

a. Services provided to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident; and

b. Employing a qualified social worker if the facility has more than 120 beds;

(5) A non-private room;

(6) Routine personal hygiene items and services as required to meet the needs of residents, including, but not limited to, hygiene supplies, comb, brush, bath soap, disinfecting soaps or specialized cleansing agents when indicated to treat special skin problems or to fight infection, razor, shaving cream, toothbrush, toothpaste, denture adhesive, denture cleaner, dental floss, moisturizing lotion, tissues, cotton balls, cotton swabs, deodorant, incontinence care and supplies, sanitary napkins and related supplies, towels, washcloths, hospital gowns, over the counter drugs, hair and nail hygiene services, bathing, and basic personal laundry;

(7) Specialized medical services in accordance with 42 CFR 483.45, including, but not limited to, physical therapy, speech-language pathology, occupational therapy, inhalation therapy including oxygen, laboratory, radiology, mental health services, and those ancillary services listed in He-E 806.06, and provided by the facility or obtained by the facility from a qualified outside provider;

(8) Dental services in accordance with 42 CFR 483.55, including:

a. Providing or obtaining from an outside resource routine dental services to the extent covered by the state plan;

b. Providing or obtaining from an outside resource emergency dental services; and

c. Assistance with:

1. Making dental appointments;

2. Arranging for transportation to and from the dentist's office; and

3. Prompt referrals to a dentist for lost or damaged dentures;

(9) Pharmacy services in accordance with 42 CFR 483.60, including:

a. Following procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of each resident;

b. Medical supplies, pharmaceutical items, and non-legend drugs, that is, drugs prescribed by a licensed practitioner that are normally purchased over the counter, which are stocked at nursing stations or on the floor in gross supply and distributed individually in small quantities to meet the needs of each resident; and

c. Pharmacy service consultation of a licensed pharmacist;

(10) Physician services in accordance with 42 CFR 483.40; and

(11) Specialized services in accordance with 42 CFR 483.120 for residents with an intellectual disability or mental illness.

(b) The services in (a) above shall be covered to the extent that they are required in each resident's care plan.

(Amended by Volume XXXIX Number 16, Filed April 18, 2019, Proposed by #12741, Effective 3/20/2019, Expires 9/16/2019.)

#7751, eff 8-17-02, EXPIRED: 8-17-10

New. #9786, INTERIM, eff 9-20-10; ss and renumbered by #9888-A, eff 3-19-11 (formerly He-E 802.03)

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