A program provider must not charge an individual or require
an individual to expend personal funds for items and services that
are the program provider's responsibility to provide, except as authorized
by §9.255(a)(1) of this title (relating to Items and Services
Purchased with Personal Funds), because they are included in the ICF/MR
Program reimbursement rate or are covered by other Medicaid programs.
These items and services include:
(1) medical services and therapies, e.g., physical
exams, physical therapy, occupational therapy, and nutritional, speech,
audiological, psychological, social, and medical evaluations;
(2) prescribed and over-the-counter medication:
(A) for an individual who is not eligible for Medicare
Part D benefits; or
(B) for an individual who is eligible for Medicare
Part D benefits if the medication is prescribed and is in a category
that is not covered by Medicare Part D;
(3) medical equipment and supplies, e.g., nasogastric
tubes, feeding pumps, catheters, sheepskins, and egg crate pads;
(4) laboratory services;
(5) eye exams and eyeglasses, except:
(A) the difference between the Medicaid payment and
the actual cost of the eyeglasses as authorized by §9.255(a)(2)
of this title; or
(B) as authorized by §9.255(a)(6) of this title;
(6) non-cosmetic dental services and items, e.g.,
intra- and extra-oral examinations, prescribed dental treatments and
follow-up visits, dentures, braces, crowns, toothbrushes, toothpaste,
mouthwash, dental floss, and disclosing solution;
(7) specialized equipment and adaptive devices that
are medically necessary or are necessary to meet the objectives in
the individual's IPP, e.g., hearing aids, hearing aid batteries, electric
razor, shoe closures, and shoe insoles;
(8) training and habilitation services, e.g., vocational
training, congregate training, and day activity services;
(9) behavioral reinforcers used in behavior modification
programs, e.g., candy, soft drinks, cereal, coffee, toys, and magazines;
(10) meals, snacks, and special diets, as listed on
the program provider's menu, whether provided at the facility or elsewhere;
(11) non-cosmetic personal hygiene items, e.g., shampoo,
conditioner, soap, deodorant, anti-perspirant, body lotion, insect
repellant, suncreen, shaving supplies, comb, hair brush, facial tissues,
toilet tissue, sanitary napkins, tampons, and diapers;
(12) shampooing, haircutting, basic hairstyling, and
shaving, including mustache and beard trimming;
(13) laundering personal clothing;
(14) facility furnishings and housewares, e.g., bedroom
furniture, kitchenware, bath towels, dish towels, and bed linens;
(15) repairing and maintaining the facility's physical
plant, including training and day activity areas;
(16) expenses that are associated with activities that
are part of the program provider's recreational program e.g., meals,
lodging, registrations, and tickets;
(17) transportation costs to and from:
(A) an activity included in an individual's IPP, including
health care services, congregate training, day activity services and
supported employment, except for competitive employment; or
(B) an activity that is part of the program provider's
recreational program;
(18) fees charged by financial institutions, including
service fees and check printing charges, if an individual's personal
funds are managed in a pooled account or if the program provider
chooses to manage those funds in a separate account;
(19) managing an individual's personal funds; and
(20) a charge incurred if the program provider mismanages
an individual's personal funds.
|
