The MA LTC rate of reimbursement to LTC facilities includes the costs for routine services. The LTC facility may not bill a resident for services which are included in the rate. These services include, but are not limited to, the following:
Regular room, dietary services, social services and other services required to meet certification standards, medical and surgical supplies, and the use of equipment and facilities.
General LTC services, including but not limited to, administration of oxygen and related medications, hand feeding, incontinency care, tray service, and enemas.
Hair care services to the extent that the LTC facility has established these as reasonable services available to all residents of the facility. The facility must provide certain hair care services which are considered necessary for hygiene. The facility must inform the individual of the types and frequency of the services provided.
Items furnished routinely and relatively uniformly to all residents, such as water pitchers, basins, bedpans and resident gowns.
Items furnished, distributed, or used individually in small quantities such as alcohol, applicators, cotton balls, band-aids, antacids, aspirin (and other non-prescription drugs ordinarily kept on hand), suppositories, and tongue depressors.
Items used by residents but which are reusable and expected to be available, such as ice bags, bed rails, canes, crutches, walkers, wheelchairs, traction equipment, and other durable medical equipment.
EXCEPTION: The cost of a wheelchair may be deducted from the MA LTC individual’s payment towards the cost of care if the individual wanted to purchase that specific wheelchair. For example, if the individual was planning to return home and take the wheelchair. However, the individual must be made aware that the facility is required to provide the wheelchair as long as the individual is in the facility.
Special dietary supplements used for tube feeding or oral feeding, such as elemental high nitrogen diets, even if written as a prescription item by a physician.
Laundry services including personal clothing. In intermediate care facilities for the mentally retarded or individuals with other related conditions, laundry services also include the individual’s personal clothing.
Non-emergency medical transportation services.
Other special medical services of a rehabilitative, restorative, or maintenance nature, designed to restore or sustain the individual's physical and social capacities.
NOTE: The LTC facility is required to locate medical services which the facility does not provide, such as dental care.
Personal care items including a patient gown, shampoo, skin lotion, comb, brush, toothpaste, toothbrush, and denture cream.
55 Pa. Code § 1181.51 applies to entire section
Issued March 12, 2012