Mont. Admin. r. 37.40.305

Current through Register Vol. 23, December 6, 2024

Rule 37.40.305 - NURSING FACILITY SERVICES: REIMBURSABLE SERVICES

(1) Nursing facility services include but are not limited to the following or any similar items:

(a) the practice of nursing, as defined in 37-8-102, MCA, which must be rendered in conformity with the Standards of Professional Nursing Practice from the American Nurses Association;

(b) services necessary to provide for residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life;

(c) services required to attain or maintain the highest practicable physical, mental, and psychosocial well being of each Medicaid recipient who is a resident in the facility;

(d) items furnished routinely to all residents without charge, such as resident gowns, water pitchers, basins, and bed pans;

(e) items routinely provided to residents including but not limited to:

(i) antibacterial/bacteriostatic solutions, including betadine, hydrogen peroxide, 70% alcohol, merthiolate, zepherin solution;

(ii) cotton;

(iii) denture cups;

(iv) deodorizers (room-type);

(v) distilled water;

(vi) enema equipment and/or solutions;

(vii) facial tissues and paper toweling;

(viii) finger cots;

(ix) first aid supplies;

(x) foot soaks;

(xi) gloves (sterile and unsterile);

(xii) hot water bottles;

(xiii) hypodermic needles (disposable and nondisposable);

(xiv) ice bags;

(xv) incontinence pads;

(xvi) linens for bed and bathing;

(xvii) lotions (for general skin care);

(xviii) medication-dispensing cups and envelopes;

(xix) ointments for general protective skin care;

(xx) ointments (antibacterial);

(xxi) personal hygiene items and services, including but not limited to:

(A) bathing items and services, including but not limited to towels, washcloths, and soap;

(B) hair care and hygiene items, including but not limited to shampoo, brush, and comb;

(C) incontinence care and supplies appropriate for the resident's individual medical needs;

(D) miscellaneous items and services, including but not limited to cotton balls and swabs, deodorant, hospital gowns, sanitary napkins and related supplies, and tissues;

(E) nail care and hygiene items;

(F) shaving items, including but not limited to razors and shaving creme;

(G) skin care and hygiene items, including but not limited to bath soap, moisturizing lotion, and disinfecting soaps or specialized cleansing agents when indicated to treat special skin problems or to fight infection; and

(H) tooth and denture care items and services, including but not limited to toothpaste, toothbrush, floss, denture cleaner and adhesive;

(xxii) safety pins;

(xxiii) sterile water and normal saline for irrigating;

(xxiv) sheepskins and other fleece-type pads;

(xxv) soaps (hand or bacteriostatic);

(xxvi) supplies necessary to maintain infection control, including those required for isolation-type services;

(xxvii) surgical dressings;

(xxviii) surgical tape;

(xxix) over-the-counter drugs (or their equivalents), including but not limited to:

(A) acetaminophen (regular and extra-strength);

(B) aspirin (regular and extra-strength);

(C) cough syrups;

(D) specific therapeutic classes D4B (antacids), D6S (laxatives and cathartics) and Q3S (laxatives, local/rectal) including but not limited to:

(I) Milk of Magnesia;

(II) mineral oil;

(III) suppositories for evacuation (Dulcolax and glycerine);

(IV) Maalox; and

(V) Mylanta;

(E) nasal decongestants and antihistamines;

(xxx) straw/tubes for drinking;

(xxxi) suture removal kits;

(xxxii) swabs (including alcohol swab);

(xxxiii) syringes (disposable or nondisposable hypodermic; insulin; irrigating);

(xxxiv) thermometers, clinical;

(xxxv) tongue blades;

(xxxvi) water pitchers;

(xxxvii) waste bags;

(xxxviii) wound-cleansing beads or paste;

(f) items used by individual residents which are reusable and expected to be available, including but not limited to:

(i) bathtub accessories (seat, stool, rail);

(ii) beds, mattresses, and bedside furniture;

(iii) bedboards, foot boards, cradles;

(iv) bedside equipment, including bedpans, urinals, emesis basins, water pitchers, serving trays;

(v) bedside safety rails;

(vi) blood-glucose testing equipment;

(vii) blood pressure equipment, including stethoscope;

(viii) canes, crutches;

(ix) cervical collars;

(x) commode chairs;

(xi) enteral feeding pumps;

(xii) geriatric chairs;

(xiii) heat lamps, including infrared lamps;

(xiv) humidifiers;

(xv) isolation cart;

(xvi) IV poles;

(xvii) mattress (foam-type and water);

(xviii) patient lift apparatus;

(xix) physical examination equipment;

(xx) postural drainage board;

(xxi) room (private or double occupancy as provided in ARM 37.40.331 );

(xxii) raised toilet seat;

(xxiii) sitz baths;

(xxiv) suction machines;

(xxv) tourniquets;

(xxvi) traction equipment;

(xxvii) trapeze bars;

(xxviii) vaporizers, steam-type;

(xxix) walkers (regular and wheeled);

(xxx) wheelchairs (standard) in a range of sizes, weights, and accessories to meet the needs of nursing facility residents; and

(xxxi) whirlpool bath;

(g) laundry services whether provided by the facility or by a hired firm, except for residents' personal clothing which is dry cleaned outside of the facility; and

(h) nonemergency routine transportation as defined in ARM 37.40.302(11).

Mont. Admin. r. 37.40.305

NEW, 2005 MAR p. 1046, Eff. 7/1/05; AMD, 2018 MAR p. 1608, Eff. 8/11/2018

AUTH: 53-2-201, 53-6-113, MCA; IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA