How will I pay for care?
There are multiple options to pay for care in our center depending upon an individual’s situation.
- Private Payment.
- Supplemental/long-term care insurance.
If the person does not have Medicare, Medicaid or long-term care insurance, then private payment would be your option. Bills will be generated by the Business Office Manager on a monthly basis and are to be paid upon receipt. Upon placement, the first thirty (30) days of your loved ones stay are to be paid in advance. Our Business Office Manager will assist with any further questions.
Medicare is accepted for placement for those residents who qualify for the benefit and who meet the Medicare requirements for skilled services in our facility. The qualifications briefly stated are:
- Individuals 65 or older.
- Those who have End Stage Renal Disease (permanent kidney failure).
- People who have had certain disabilities for more than two years.
Medicare requirements for a skilled stay at our facility are:
- The individual must have active Medicare Part A.
- The individual must have a 3 night qualifying stay as an in-patient in an acute care hospital within the last 30 days prior to admission to a nursing facility.
- The individual must require a daily “skilled service,” while at the facility.
The Medicare benefit covers the following:
- Pays 100% of the cost of services in a nursing facility during the first 20 days of placement.
- Beginning day 21 up to day 100, either the individual, Medicaid, or other supplemental insurance will be responsible for paying a coinsurance portion.
- The benefit pays for all medically necessary supplies and services requiring skilled nursing or skilled rehabilitation staff on a daily basis.
- These services may include room and meals, routine nursing care, supplies and equipment, pharmacy services, physical therapy, speech therapy and occupational therapy.
- *Note: The Medicare Part A entitlement may cover costs listed above for UP to 100 days. The individual MUST require a skilled service as defined by Medicare for the entire 100 days. There is no guarantee that 100 days can be used if the resident’s condition stabilizes.
The individual or responsible party must apply for this benefit at their local WV Department of Health and Human Resources. As defined by the Medicaid program, eligibility is determined on the basis of financial and medical need. This need is established by the applicant’s meeting four major points of eligibility:
- Medical need.
- Nursing home certification.
- Monthly income.
- Countable assets.
Medical Need is established by the review of the WV PASSAR. This form can be picked up at our facility, a referring physician’s office or hospital. The individual’s attending physician must certify the medical need and indicate that nursing home placement is needed. The completed PASSAR form must be submitted to the West Virginia Medical Institute (WVMI) for review of medical necessity. Nursing Home Certification means essentially that the individual must be placed with a nursing home that is certified by the state of WV. Medicaid payment can only be made to those certified homes electing to participate in the Medicaid program. Our facility is certified by WV. Monthly income is reviewed by the local Medicaid office to determine eligibility of Medicaid benefits. Specific information regarding income guidelines may be obtained by contacting your local West Virginia Department of Health & Human Services (WVDHHR) office. Countable Assets include, but are not limited to: money in checking/savings accounts, certificates of deposit, stocks, bonds, cash-on-hand, retirement accounts such as IRA’s, cash value on life insurance policies and property other than one’s home. The individual’s total countable assets cannot exceed $2,000 to be eligible for Medicaid. Specific questions regarding approval should be directed to your local WVDHHR office.
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