Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Services

12/01/2003

  • ALFs are required to offer three meals, laundry and housekeeping services, assistance with ADLs and personal needs, and a program of social and recreational activities. Required health services include providing a licensed registered nurse to conduct health assessments and periodic monitoring, assigning the basic tasks of nurse delegation, and providing intermittent nursing services for residents with stable and predictable medical needs. Before billing Medicaid, ALFs are required to pursue other potential sources of reimbursement such as insurance benefits and Medicare.

  • Nursing tasks may be delegated. These tasks include almost all nursing tasks except for intra-muscular, intra-venous, and intra-dermal injections. Nurse delegation is done by licensed nurses for each individual client as deemed appropriate by the nurse. The nursing task is delegated in writing to an individual non-licensed provider and cannot be expanded without the approval of the nurse. Staff or volunteers under 18 years of age may not assist with medication administration or delegated nursing tasks, and must be supervised when providing bathing, toileting or transferring services.

  • Facilities are required to provide medication management and administration, and they must have policies and procedures to assure that all administered medications are reviewed every 90 days. Medication and treatment administration systems must be approved by a pharmacist consultant, registered nurse, or physician.

  • Facilities also must coordinate home health services for residents with complex, unstable or unpredictable needs, and hospice services for those who meet eligibility criteria for Medicare's hospice program.

  • Each facility must have sufficient staff to meet the 24-hour scheduled and unscheduled needs of each resident and to respond in emergency situations.

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