Del. Medical Assistance Program Hospice Provider Specific Policy Manual § 13.0

The following is a list of what Medicaid pays for and what the nursing home is required to

supply.

I. The Facility Will Provide:

A. Medical Supplies

1. Adhesive tape and Band-Aids

2. Cellucotton, cotton, and cotton balls

3. Disposable diapers and/or incontinent pads

4. Gauzes and lamb’s wool

5. Paper handkerchiefs

6. Thermometers

7. Water proof sheets

B. Medical Equipment

1. Bed pans, urinals, and commodes

2. Catheters

3. Crutches

4. Emesis basins and enema bags

5. Hot water bottles and ice bags

6. Invalid rings

7. Nasal atomizers

8. Rectal tubes

9. Rubber gloves and finger cots

10. Syringes and needles

11. Wheelchair and walkers

C. Non-Medical Supplies

1. O.T. Supplies

2. R.T. Supplies

D. Non-Legend Drugs and Medications

1. Analgesic (aspirin, aspirin compounds, Tylenol, etc.)

2. Antiseptics (mercurochrome, merthiolate, zephiran, betadine, etc.)

3. Dental and oral (dentifrice’s, denture adherents, mouthwash, etc.)

4. Dermatologics (phisohex, rubbing alcohol, soap, talcum powder, hydrogen

peroxide, petrolatum, lotions, creams, ointments, etc.)

5. Diagnostics (acetest tablets, clinitest tablets, taptest, etc.)

6. Laxatives, enemas, lubricants, (cascara, milk of magnesia, mineral oil,

prepared enemas, etc.)

7. Dietary supplements (sustagen, meritene, vitamins, etc.)

E. Services

1. Shave

2. Shampoo given by facility employees

3. Laundering of linens

4. Hand feeding

5. Incontinence care and training

6. Cost of billing procedures

7. Personal laundry

The Patient and/or Family May be Billed for:

A. Personal Items

1. Cosmetics

2. Cologne, perfume, aftershave, etc.

3. Letter paper, stamps, and greeting cards

4. Newspapers and magazine subscriptions

5. Clothing

6. Cigarettes

B. Services

1. Shampoo given by beautician

2. Hair cut or set

3. Permanent

4. Personal dry cleaning

II. Federal law prohibits nursing homes from charging Medicaid members or their families

for items and services covered by Medicaid.

III. Nursing homes that accept Medicaid cannot ask Medicaid members or their families for

contributions as a condition of admission or charge fees to supplement the Medicaid

rate.

A. Federal regulations prohibit the displacement of a resident once admitted to a nursing

home participating in the Medicaid program on the basis of a change in source of

payment for the resident. One example of a prohibited action would occur when a

Medicaid participating nursing home refuses to continue to care for a resident because

the individual’s source of payment has changed from private funds to Medicaid. A

second example would be when a nursing home terminated one or more services to a

resident who goes on Medicaid. It is important to note there should be evidence that the

nursing home’s termination of service was based on a medical rather than a financial

reason.

B. Federal laws prohibit a nursing home from requiring a Medicaid eligible member or the

legal custodian or guardian of a resident to supplement Medicaid coverage for basic

care and services. This includes requiring continuation of a “private pay contract” once

the resident becomes eligible for Medicaid; and/or asking for contributions, donations, or

gifts as a condition of admission or continued stay.