Clearpol's Opinion of this Guidance as of 10-21-22
Clearpol Inc. does not make any guarantees regarding the accuracy of the opinions provided on our platform. Please use your own judgement.
Clearpol's Summary of this Guidance
Nursing homes and other healthcare facilities must inform their Medicaid-eligible residents in writing of the items and services covered and not covered under Medicaid or by the facility's per diem rate, including the cost of those items and services, at the time of admission or when the resident becomes eligible for Medicaid. When changes are made to the items and services covered, the facility must inform the resident in writing as soon as is reasonably possible. Facilities must also inform the resident of services available in the facility and the charges for those services not covered under Medicare/Medicaid or by the facility's per diem rate before or at the time of admission and periodically during the resident's stay. If a resident dies, is hospitalized, or is transferred and does not return to the facility, the facility must refund to the resident, resident representative, or estate any deposit or charges already paid, less the facility's per diem rate, for the days the resident actually resided or reserved or retained a bed in the facility. The facility must also refund to the resident or resident representative any and all refunds due the resident within 30 days from the resident's date of discharge from the facility. The terms of an admission contract by or on behalf of an individual seeking admission to the facility must not conflict with the requirements of these regulations.
Nursing homes and other healthcare facilities must also give a Notice of Medicare Non-Coverage (NOMNC) to all Medicare beneficiaries at least two days before the end of a Medicare covered Part A stay or when all of Part B therapies are ending. If the facility believes Medicare will not pay for extended care items or services that a physician has ordered, the facility must provide a Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN) to the beneficiary before it furnishes those non-covered extended care items or services to the beneficiary. The SNF ABN provides information to beneficiaries so that they can decide if they wish to continue receiving the skilled services that may not be paid for by Medicare and assume financial responsibility. In this case, the facility must file a claim when requested by the beneficiary (this claim is called a "demand bill") and may not charge the beneficiary for Medicare covered Part A services during demand bill process.
Nursing homes and other healthcare facilities must take the necessary steps to ensure they comply with these regulations by properly informing their residents of the items and services covered and not covered under Medicaid or by the facility's per diem rate, including the cost of those items and services, and by providing the appropriate notices to Medicare beneficiaries.
Clearpol Inc. does not make any guarantees regarding the accuracy of the opinions or summaries provided on our platform. Please use your own judgement.
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