Selecting an appropriate healthcare setting for your loved one requires careful consideration. While these decisions can be complicated and confusing, the social services team at each center makes the process easier by providing clear answers to your most pressing questions.
What will I need prior to nursing home placement?
Our social worker will need a release of medical information to assist you in collecting the following forms:
- Completed and approved PASSAR (Pre-Admission Screening Form).
- Current medical history
- Medical diagnosis
- Physician’s orders
How will I pay for nursing home care?
- Private payment
- Supplemental Insurance
If your loved one does not have Medicare, Medicaid or any other form of medical insurance, then private payment would be your option. Please contact a social worker for a copy of fees and rates, as well as the schedule of bills (due upon receipt).
Upon placement, the first thirty (30) days of your loved one’s stay must be paid in advance. Our business office manager is available to assist you with further details or questions.
Medicare is accepted for placement for those residents who quality for the benefit and who meet the Medicare requirements for skilled services in our facility. The qualifications 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 include:
- The individual must have an active Medicare Part A benefit.
- The individual must have a three-day, 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 (i.e., examples, therapy, IVs, daily wound care for extensive injuries).
Medicare benefits cover 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 co-insurance portions.
- The co-insurance rate as set by Medicare is established in January of each year.
- The benefits pay 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.
- There is no guarantee that Medicare will pay for 100 days of skilled care should the resident’s condition stabilize.
The individual or responsible party must apply for this benefit at their local West Virginia 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
Explanation of Terms
“Medical Need” is established by the review of the WV PASSAR. This form is available 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” essentially means that the individual must be placed within a nursing home that is certified by the state of West Virginia. Medicaid payment can only be made to those certified homes electing to participate in the Medicaid program. Mapleshire is certified by the State of West Virginia.
“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 WVDHHR office.
“Countable Assets” include, but are not limited to the following:
- Money in checking and savings accounts
- Certificates of deposit, stocks, and/or bonds
- Retirement accounts
- 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. Our social service director can help you with this process.