Nursing Facility and Swing Bed Services - Montana Medicaid ...

Original Nursing Facility Page, January and Swing 2005Bed Services Nursing Replacement Facility and Page, Swing January Bed Services 2011Montana Department of Public Health and Human ServicesA level-of-caredeterminationmust becompleted for allMedicaid clientsand should bedone forpotentialMedicaid clients.Level-of-care determination. The Department’s contractor performs alevel-of-care determination to assess medical necessity and appropriateness ofplacement for Medicaid clients seeking long-term care services. Alevel-of-care determination must be completed before Medicaid payment canbe authorized. For this reason, the Department recommends that a level-of-caredetermination be completed for any resident who has even the possibility ofbecoming Medicaid-eligible. Even if a resident is found to be retroactivelyeligible for Medicaid, the facility cannot be paid if a level-of-caredetermination has not been completed. Level-of-care and continued-stayreviews are performed regularly to verify medical necessity and skilled orintermediate determinations.To request a level-of-care review, providers mail or fax a completedDPHHS-SLTC-86 (located in Appenix A: Forms) to the Department’s contractor(see Key Contacts). The Department’s contractor must receive the requeston or before the date the applicant is admitted to the facility. Once the applicantis approved, the provider may bill Medicaid for the services.Nurse Aide Requirements (ARM 37.40.322)Under Federal regulation, nursing facilities may not employ a nurse aide for morethan four months, unless the individual completes a state-approved Nurse AideTraining and Competency Evaluation Program (NATCEP) and is certified competentto provide nursing and nursing-related services.Nursing facilities may employ an individual as a nurse aide for up to four monthsso long as the individual meets one of the following:• Is a full-time employee enrolled in a state-approved training andcompetency evaluation program• Has applied to complete the competency evaluation program• Has demonstrated competence for all nursing tasks to be performed by participatingin such a programAnyone who wants to be employed in a nursing facility as a nurse aide must successfullycomplete a NATCEP and become a certified nurse aide (CNA). Nurseaide training programs in Montana are offered by nursing facilities, communitycolleges, adult education programs, and independent contractors.Nurse aide registryFederal regulation requires the state to establish and maintain a registry of allindividuals who successfully complete a NATCEP or CEP. This registry ismaintained by the Quality Assurance Division (QAD) and is used by nursingfacilities to verify the nurse aide’s certification status (see Key Contacts). Thenames of individuals who have successfully completed the competency evalu-Don’tMissThis!2.2 Covered Services