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Medicaid

SERVICES UNDER ALL-INCLUSIVE RATE

West Virginia Department of Health and Human Resources (DHHR) through its Bureau for Medical Services (BMS) will pay an all-inclusive per diem rate for nursing facility services. This rate represents payment for all medically necessary and medically appropriate services and items that are required to be provided by the nursing facility to achieve optimum quality care and quality of life for each resident.

These services include:

  • Nursing Services
  • Therapy Services
  • Non-Prescription Items
  • Medical Supplies, Accessories and equipment
  • Room and Board
  • Laundry
  • Food and Dietary Services
  • Activities Program
  • Social Services
  • Non-Emergency Transportation Services

Allowable Resident Charges

Allowable resident charges, are charges by the facility to the resident/financial representative that are amenities/items/services above the “all inclusive rate” that are requested by the resident or responsible party. Additional charges must be explained to the resident/responsible party during the admission process. The following may be used as examples of allowable resident charges: telephone, television/radio, personal comfort items, cosmetic items personal clothing, personal reading materials, flowers and plants, social events and entertainment offered outside the scope of an activities program, and special care services such as privately hired individuals. Commercial laundry/dry cleaning expenses for personal items of clothing will be the responsibility of the resident.

For a Medicaid resident desiring a private room, the administrator or designee may charge the difference between the facility’s actual charge for room and board of a semi-private room and the charge for room and board of a private room. For a Medicaid resident’s whose medical condition warrants an isolation/private room, the administrator or designee may not charge an additional fee.

Contribution to the Cost of Care

As a part of the financial eligibility determination for the Medicaid nursing facilities benefit, the DHHR calculates the dollar amount the individual must contribute to the cost of care every month. The monthly Medicaid payment to the nursing facility will be reduced by the dollar amount of the contribution to the cost of care (resource). The administrator or designee is responsible for collecting the monthly contribution to the cost of care.

Prescribed Drugs

The Medicaid Program covers most of the drugs that are prescribed by your doctor. Drugs sold over-the-counter must be prescribed by your doctor to be covered.

Some drugs have limits and some may require prior approval.

Learn more about Medicaid at www.dhhr.wv.gov/bms/documents/yourguidemedicaid.pdf.