10.07.09.04

.04 Admission Procedures and Requirements.

A. At the time of admission of a resident, and whenever information changes during the resident's stay, the nursing facility shall notify the resident and, when applicable, a representative or interested family member, in writing and orally, in a language that is easily understood of all terms of admission including, but not limited to the:

(1) Residents' Bill of Rights;

(2) Nursing facility's policies and procedures that implement the Residents' Bill of Rights;

(3) Rules of resident responsibility;

(4) Nursing facility's complaint procedure;

(5) Nursing facility's visitation rules;

(6) Procedures for obtaining a determination from the Medical Assistance Program of the amount of the resident's funds available to pay for the cost of the resident's care;

(7) Procedures for establishing eligibility for Medicaid and for receiving refunds for previous private payments covered by these benefits, including the right to request an assessment under 42 U.S.C. §1396r(5)(c) for the purpose of determining the:

(a) Extent of a couple's nonexempt resources at the time of institutionalization; and

(b) Amount of a couple's resources to be attributed to the community spouse as the spouse's equitable share of resources which are not considered available for payment toward the cost of the institutionalized spouse's medical care or for determining Medicaid eligibility for the institutionalized spouse; and

(8) Resident's rights under State law to formulate advance directives.

B. Upon admission of a resident, a nursing facility shall:

(1) Document in the resident's clinical record whether the resident has executed an advance directive and, if an advance directive exists, keep a copy of the advance directive in:

(a) The resident's clinical record; or

(b) A location within the nursing facility which is accessible to appropriate administrative, nursing, and medical personnel on a 24-hour a day basis;

(2) Prepare an inventory of all property that the resident is bringing into the nursing facility;

(3) Request the resident or representative to identify:

(a) Those items with a value of $100 or more;

(b) Any damage to an item existing before admission of the resident; and

(c) Whether the resident is retaining possession of each item or is entrusting the item to the nursing facility for safekeeping on behalf of the resident;

(4) Give to the resident and, when applicable, the resident's representative or interested family member, a copy of the inventory prepared under §B(2) of this regulation; and

(5) Advise the resident and, when applicable, a representative or interested family member:

(a) Whether the nursing facility has purchased insurance to cover a resident's tangible personal property for loss or damage due to the facility's negligence; and

(b) Of the limits of insurance coverage.

C. With information provided by the resident or representative, a nursing facility shall periodically update the inventory of the resident's personal property with respect to items having a value of $100 or more.

D. Required Notification. A nursing facility shall notify in writing:

(1) A resident who is entitled to Medicaid benefits at the time of admission, or when the resident becomes eligible for benefits, of:

(a) Items and services that are included in the per diem rate under Medicaid, and for which the resident may not be charged;

(b) Other items and services that the nursing facility offers and for which the resident may be charged, and the current range of charges for each item and service;

(c) The nursing facility's obligation following admission to notify the resident and, when applicable, the agent or interested family member, of any changes made to the items and services for which the resident may or may not be charged;

(d) The fact that the resident may not be required to pay for an item or service not covered by Medicaid unless the:

(i) Resident or, when applicable, the agent, knowingly requests the item or service; and

(ii) Resident receives the item or service; and

(e) The resident's right, within 90 days of receiving an item or service, to request an itemized statement of charges that:

(i) Briefly and clearly describes each item or service, the amount charged for it, and the identity of the payer billed for the service; and

(ii) Contains a statement in bold and conspicuous print as to when interest may be assessed consistent with Regulation .05B(8) of this chapter;

(2) A private-pay resident, or the resident's agent, of:

(a) The items and services included in the nursing facility's basic per diem rate;

(b) The items and services that are covered by Medicare, and of the amount of any copayments or deductibles;

(c) Other services that the nursing facility offers and for which the resident may be charged, and the current range of charges for the services, including but not limited to charges related to a resident's monthly drug regimen review and other non-drug-related pharmacy costs;

(d) Whether the costs for supplies used in the performance of a service are included in the service charge and the costs of these supplies, within 24 hours of request, when the costs are not included in the service charge; and

(e) The resident's right, within 90 days of receiving an item or service or within 30 days of payment, to request an itemized statement of charges that:

(i) Briefly and clearly describes each item or service, the amount charged for it, and the identity of the payer billed for the service; and

(ii) Contains a statement in bold and conspicuous print as to when interest may be assessed consistent with Regulation .05B(8) of this chapter; and

(3) A resident of changes to be made to the items and services specified in §D(1) and (2) of this regulation, and increases in any fee or charge, or a new fee or charge, or a change in billing procedures, at least 45 days before the increase, new charge, or change becomes effective.

E. A nursing facility shall:

(1) Give the resident a copy of the statement of items, services, and charges provided by the facility;

(2) Provide information regarding services to be rendered by other health care providers, including:

(a) The cost to the resident;

(b) Transportation arrangements; and

(c) Direct or indirect financial interests that the nursing facility has in the provider.