Ala. Admin. Code r. 560-X-10-.04

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-10-.04 - Covered And Noncovered Services

(1) Services included in basic (covered) nursing facility charges.

(a) All nursing services to meet the total needs of the resident including treatment and administration of medications ordered by the physician.

(b) Personal services and

(c) Room (semiprivate or ward accommodations) and board, including special diets and tubal feeding necessary to provide proper nutrition. This service includes feeding residents unable to feed themselves.

(d) All services and

(e) Bed and bath linens.

(f) Nursing and treatment

(g) Safety and treatment equipment such as bed rails, standard walkers, standard wheelchairs, intravenous administration stands, suction apparatus, oxygen concentrators and other items generally provided by nursing facilities for the general use of all residents.

(h) Materials for prevention and treatment of bed sores.

(i) Medically necessary over-the-counter (non-legend) drug products ordered by a physician, with the exception of over-the-counter insulin covered under the Pharmacy program. Generic brands are required unless brand name is specified in writing by the attending physician.

(j) Laundry services of personal apparel.

(2) Special (noncovered) services not ordinarily included in basic nursing facility charges. These services, drugs, or

(a) Prosthetic devices, splints, crutches, and traction apparatus for individual residents.

(b) If payment is not made by Medicare or Medicaid, the facility must inform the resident/personal representative that there will be a charge, and the amount of the charge. Listed below are general categories and examples of items:

1. Telephone;

2. Television/radio for personal use;

3. Personal comfort items, including smoking materials, notions and novelties, and confections;

4. Cosmetic and grooming items and services in excess of those for which payment is made under Medicaid or Medicare;

5. Personal clothing;

6. Personal reading matter;

7. Gifts purchased on behalf of a resident;

8. Flowers and plants;

9. Social events and entertainment offered outside the scope of the required activities program;

10. Noncovered special care services such as privately hired nurses or aides;

11. Private room, except when therapeutically required (for example: isolation for infection control).

12. Specially prepared or alternative foods request instead of the food generally prepared by the facility;

13. Beauty and barber services provided by professional barbers and beauticians.

(c) Services of licensed professional physical therapist.

(d) Routine dental services and

(e) Tanks of oxygen.

(3) Other services are provided by Medicaid under separate programs, including prescription drugs as listed in the Alabama Drug Code Index, hospitalization, laboratory and x-ray services, and physician services.

Author: Laura Walcott, Administrator, LTC Program Management Unit

Ala. Admin. Code r. 560-X-10-.04

Rule effective October 1, 1982. Emergency rule: Effective October 1, 1990. Amended: Effective February 13, 1991. Emergency rule: Effective September 6, 1991. Amended: Effective December 12, 1991. Amended: Filed March 9, 1994; effective April 13, 1994. Amended: Filed August 11, 2003; effective September 15, 2003. Amended: Filed June 10, 2005; effective July 15, 2005.

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§401, et seq.