Nursing Facility Services

Definition

A nursing facility is a health-related facility which fully meets the requirements for state nursing facility licensure and must be surveyed for compliance with the requirements of participation in the Medicaid program by the South Carolina Department of Health and Environmental Control (SCDHEC) Bureau of Certification and be certified as meeting federal and state requirements of participation for long-term care facilities.

· Provides 24 hour care by licensed/certified staff

Services

Basic services and items furnished in a nursing facility that are inclusive in the Medicaid nursing facility per diem rate and must not be charged to the patient include the following:

· Nursing Services

·Special Services

·Personal Services

· Room and Board

· Safety and Treatment Equipment

·  Medications

·  Medical Supplies and Oxygen

Licensing, Certification and Quality of Care-SCDHEC

· SCDHEC is the licensing and survey authority for all NFs.

· SCDHEC is responsible for establishing and maintaining the health standards for private and public institutions in which Medicaid residents receive services.

·  SCDHEC surveys NFs to determine whether NFs  meet the requirements to participate in the Medicare and Medicaid programs.

·  SCDHEC also surveys all facilities for compliance or noncompliance with long-term care facility requirements.

Dual Certification

· The state plan requires that if a facility wants to participate in Medicaid and is eligible to participate in Medicare, it must participate in both programs.

Contracts

·  Any certified NF  requesting participation in the Medicaid program must contract with SCDHHS to become a provider of services.

· A Medicaid contract is issued to a NF in full compliance with all state and federal requirements.

Levels of Care

· An individual seeking Medicaid must meet skilled or intermediate level of care.  Community Long Term Care nurse consultants conduct level of care for individuals seeking Medicaid NF placement.

Complex Care

· South Carolina Medicaid Complex Care program implements a patient assessment system that targets Medicaid-eligible hospital patients who no longer require hospitalization, but do meet the nursing facility level of care.

Recurring Income

· When individuals apply for Medicaid to assist with payment of institutional care (NF), the financial eligibility determination is a two-step process.

·   The first step will determine if the resident meets the Medicaid eligibility requirements. If the resident meets the Medicaid eligibility requirements, then the second step will determine the amount of available income the resident must contribute toward the cost of care.

·  The resident’s monthly recurring income amount is determined by SCDHHS

Number of NFs:

·  Total number of licensed NFs:  195        

· Total number of beds: 20,156

· Medicaid participating NFs: approx.. 153 + DMH operated NFs = 156

o   Approx: 16, 903 beds  (Medicare/Medicaid beds)

Permit Day

Medicaid Permit day means a day of service  provided to a Medicaid patient in a Medicaid certified nursing home which holds a Medicaid days permit.

Links: 

South Carolina Long Term Bed Locator

http://www.nfbl.sc.gov/

SCDHEC Licensed Facilities by Type: Nursing Homes

https://sc-dhec.maps.arcgis.com/apps/webappviewer/index.html?id=e8b4eea83cab491bb3e3663093e14656

SC Healthy Connections Medicaid Provider Manual

https://scdhhs.gov/provider-type/nursing-facility-services-11012005-edition-posted-11052005

Nursing Facility Service Forms

https://www.scdhhs.gov/internet/pdf/manuals/Nursing/Forms.pdf

 

 

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