Skilled and Non Skilled Nursing Care Agency - Policies and Procedures - Pennsylvania state Licensure

Introducing our comprehensive Skilled and Non-Skilled Nursing Care Agency Policies and Procedures package designed specifically for Pennsylvania State Licensure. We understand the critical importance of adhering to state regulations and maintaining the highest standards of care in the home health industry. Our meticulously crafted set of policies and procedures is your key to achieving and sustaining compliance while delivering exceptional healthcare services.

PDF Preview:  Download

Table of Contents

Introduction    
Vision    
Mission    
Core Values    
Document Control    
Statement of Policy    
Adherence to CHAPTER 1181 - Nursing Facility Care    
Scope of Benefits for Categorically Needy Recipients    
Scope of Benefits for Medically Needy Recipients    
Scope of Benefits for State Blind Pension Recipients    
Scope of Benefits for Qualified Medicare Beneficiaries    
Scope of Benefits for General Assistance Recipients    
General Payment Policy for Nursing Facility Care    
Payment Conditions for Nursing Facility Care    
Payment Conditions Related to the Recipient’s Initial Need for Care    
Payment Conditions Related to the Recipient’s Continued Need for Care    
General Limitations on Payment for Nursing Facility Care    
Limitations on Payment for Reserved Beds    
Limitations on Payment for Reserved Beds – Interpretation and Billing Procedures    
Charges for Bed Hold Days    
Reimbursement for Hospital Reserved Bed Days During a Medicare Benefit Period    
Limitations on Payment for Prescription Drugs    
Limitations on Payment During Strike or Disaster Situations Requiring Patient Evacuation    
Payment for Intermediate and Heavy Care/Intermediate Services in Dually Certified Skilled Beds    
Utilizing Medicare as a Resource    
Services Included in the Interim Per Diem Rate    
Nurse-Aide Programs Reimbursement    
No compensable Services    
Method of Payment for Nursing Facility Care    
Cost Reporting Procedures    
Cost-Finding Procedures    
Setting Ceilings on Allowable Net Operating Costs    
Setting Interim Per Diem Rates    
Upper Limits of Payment    
Annual Adjustment of Payment    
Annual Reporting Requirements    
Interim Reporting Requirements    
Final Reporting Requirements    
Auditing Requirements Related to Cost Reports    
Auditing Requirements Related to Patient Fund Management    
Scope of Claims Review Procedures    
Review of Need for Admission    
Inspections of Care    
Facility Course of Action Following Inspections    
Facility Utilization Review Requirements    
Provider Misutilization and Sanctions Policy    
Compliance with Cost Reporting Requirements    
Maintenance of Adequate Records    
Correction of Deficiencies    
Adherence to Certification Requirements for Care    
Adherence to Medical Evaluation Requirements    
Management and Restitution of Patient Funds    
Facility's Right to a Hearing    
Allowable Costs Determination for Skilled and Intermediate Care Facilities    
Cost Reimbursement Principles and Method    
General Principles for Allowable Costs    
Cost Reporting Procedures    
Cost Apportionment and Allocation    
Efficiency Incentive    
Depreciation and Interest Reimbursement    
Establishing Ceilings for Allowable Net Operating Costs    
Determining the Interim Per Diem Rate    
Determining a Cost-Related Prospective Rate for Certain Facilities    
Determining the Interim Per Diem Rate for a New Facility or a Facility with a Change of Ownership    
Final Per Diem Rate    
Standards for General and Selected Costs    
Changing the Basis for Allocating Cost Centers    
Bed Changes During a Cost Reporting Period    
Bed Occupancy Allowance    
General Administration Allowance    
General Administration Salaries    
Nursing Staff Allowance    
Social Service Staff    
Contracted Management Services    
Volunteer and Donated Services of Individuals    
Pastoral Services    
Medicare Part B Type Services    
Medicare Part B Adjustments—Statement of Policy    
Recreational Services    
Other Practitioner Services    
Drug Services    
Clarification of the Term 'Written' in Drug Services    
Utilization, Medical Review, and Program Audits    
Depreciation Allowance    
Elimination of Funded Depreciation    
Interest Allowance    
Bad Debt Expense    
Fund Raising Expenses    
Costs of Related Parties    
Rental of Property and Plant    
Prudent Buyer Concept    
Excluded Expenses and Revenues    
Costs Related to Revenue Producing Items    
Income Reduction on Allowable Costs    
Direct Provider Payments Exclusion    
Implementation of OBRA-87 Provisions    
Scope of OBRA-87 Provisions    
Background    
Discussion    
Nurse Aide Training and Competency Evaluation System    
Nurse Aide Registry System    
Preadmission Screening Program    
Preadmission Screening Program for Nurse Aide Training and Competency    
Preadmission Screening Program Management    
Preadmission Screening Evaluations    
Charging for Preadmission Screening    
Notification of Preadmission Screening Results    
Timing of Determinations for Preadmission Screening    
Active Treatment Determination and Management    
Confidentiality of Preadmission Screening Information    
Adverse Determination Appeals Process    
Adverse Determinations    
Who May Appeal    
When an Appeal Is Required to Be Filed    
What an Appeal is Required to Contain    
Where Appeals Should Be Filed    
How and Where Hearings Will Be Conducted    
How Long It Will Take to Get a Decision   
 
Forms    
Client Intake Form    
Physician Form with Responsible Party Info    
Nurse Assessment Form    
HIPAA Form    
Neglect and Abuse Form    
Client Consent Form    
Three Emergency Contacts    
Staff Supervisory Review Form    
Confidentiality Form    
Client Service Plan Form    
Client Rights Acknowledgment Form    
Incident/Accident Report Form    
Employee Training and Competency Evaluation Form    
Client Satisfaction Review Form    
Visit Record Form    
Complaint Form