CMS Manual System - Louisiana Department of Health and Hospitals

(J) Noncovered special care services such as privately hired nurses or
aides.
(K) Private room, except when therapeutically required (for example,
isolation for infection control).
(L) Specially prepared or alternative food requested instead of the food
generally prepared by the facility, as required by §483.35 of this
subpart.
Intent §483.10(c)(8)
The intent of this requirement is to specify that facilities not charge residents for items
and services for which payment is made under Medicare or Medicaid.
Interpretive Guidelines §483.10(c)(8)
The facility may charge the resident the difference for requested services that are more
expensive than or in excess of covered services in accordance with §489.32 of this
chapter. (This does not affect the prohibition on facility charges for items and services
for which Medicaid has paid. See §447.15, which limits participation in the Medicaid
program to providers who accept, as payment in full, Medicaid payment plus any
deductible, coinsurance, or co-payment required by the plan to be paid by the individual.)
If a State plan does not cover an item or service, such as eyeglasses, the resident may
purchase that item or service out of his/her funds. See §483.15(g), F250 for the facility‘s
responsibility to assist the resident in obtaining those services.
Procedures §483.10(c)(8)
As appropriate during Phase 2 of the survey, review the written information given to
Medicare/Medicaid eligible residents and family members on admission that notifies
them of the items and services that are covered under Medicare or the State plan. Review
a sample of residents‘ monthly statements to ensure that personal funds are not used to
pay for covered services. If charges found on monthly statements indicate that residents
may have paid for covered items or services, determine if these items or services are over
and above what is paid by Medicare or Medicaid.
If, through observations or interviews of residents selected for comprehensive or focused
review, the team determines that families or residents hire sitters, and/or that a large
number of residents or families are paying for outside food, determine if these practices
reflect inadequate staffing and/or food.
Interpretive Guidelines §483.10(c)(8)(i)(E)
Prescription drugs are part of the pharmaceutical services that facilities are required to
provide. (See §483.25(l) and (m), and §483.60.) However, at times, a resident needs a