Member Login
Search

F571 – Charges for Medicaid & Medicare Covered Services

F571 in Appendix PP directs the nursing home providers that they are unable to charge a resident for any services that are covered under Medicare or Medicaid services, unless the charge is for deductible or co-insurance. The regulation outlines that covered services include:

  • Nursing services
  • Food and nutrition services
  • Activities programming
  • Maintenance services
  • Routine personal hygiene items or services including but not limited to hair hygiene supplies, comb, brush, bath, soap, disinfecting soaps, or specialized cleansing agents when needed to treat special skin problems or fight infection, razor, shaving cream, toothbrush, toothpaste, denture adhesive, denture cleaner, dental floss, moisturizing lotion, tissues, cotton balls, cotton swabs, deodorant, incontinence care and supplies, sanitary napkins, towels, washcloths, hospital gowns, over the counter drugs, hair and nail hygiene services, bathing assistance, and basic personal laundry.
  • Medically related social socials
  • Hospice services if elected by the resident and paid for under Medicare or Medicaid.

The regulation also includes items or services that can be charged to a resident, if they are not required to achieve goals in the resident’s care plan and payment is not made by Medicare and/or Medicaid for the service. These include:

  • Telephone, including cellular phone (note this would be a personal phone as the resident is able to make or take private calls on the nursing home’s phone line).
  • Television, radio, personal computers, or other electronic devices for personal use.
  • Personal comfort items including smoking materials (if allowed), notions, novelties and confections.
  • Cosmetic and grooming items in excess of those excluded above.
  • Personal clothing
  • Personal reading matter
  • Gifts purchased on behalf of the resident
  • Flowers and plants
  • Cost to participate in special outs or social events that are outside of the scope of the activities program.
  • Non-covered special care services such as privately hired nurses or aides
  • Private rooms (unless it is medically necessary with an example provided of isolation to prevent transmission of infection).
  • Specially prepared or alternate food requested (unless it is generally prepared with the meal)
    • The nursing home may not charge for special foods or meals that are medically prescribed such as dietary supplements that are ordered by the resident’s practitioner
    • The nursing home must take into consideration the residents’ needs and preferences and the overall cultural and religious make-up of the population

Additionally, the nursing home can only charge a resident for a non-covered service if the resident specifically requests the item. (For example, you cannot charge all residents for the use of a personal phone if the resident did not request the personal phone.) You cannot require that the resident use special items or services as a condition of admission or retention, and you must inform the resident or their responsible party of any charges and the amount of those charges both orally and in writing.

While this regulation is not frequently cited, there are occasions when it has been. An example would be that a nursing home began charging a resident for a specific item but did not include the item on the admission paperwork as a possible charge and did not notify the resident prior to charging the item that they would receive a charge for it. If the documentation in the resident’s record does not support the nursing home’s due diligence in notifying the resident or their representative of possible charges, then you may be facing non-compliance.

Some examples of when you can charge vs. cannot:

  • General shampoo and conditioner would be an item that could not be charged, but if a resident requested a specific type of shampoo and conditioner that is not medically necessary, the nursing home can require that the resident pay for it.
  • The nursing home cannot charge for items used during a craft that is part of the activity programming, but if the activity programming included an outing to go to a specific restaurant, then the nursing home could require the resident pay for their meal.
  • Specialty diet or food items can get tricky, as you need to allow for cultural and religious needs. For example, if your nursing home admits a Jewish resident, you should expect that the resident will want Kosher foods.