| (A) The funds must be identified as money that will
escheat to the state.
(B) If the facility held the funds in accordance with
paragraph (3) of this subsection, the facility must include the notarized
affidavit described in paragraph (3)(A) of this subsection.
(g) Assurance of financial security. The facility must
purchase a surety bond, or otherwise provide assurance satisfactory
to the Secretary of Health and Human Services to ensure the security
of all personal funds of residents deposited with the facility.
(1) The amount of a surety bond must equal the average
monthly balance of all the facility's resident trust fund accounts
for the 12-month period preceding the bond issuance or renewal date.
(2) Resident trust fund accounts are specific only
to the single facility purchasing a resident trust fund surety bond.
(3) If a facility employee is responsible for the loss
of funds in a resident's trust fund account, the resident, the resident's
family, and the resident representative are not obligated to make
any payments to the facility that would have been made out of the
trust fund had the loss not occurred.
(h) Items and services that may not be charged to a
resident's personal funds.
(1) The facility may not impose a charge against the
personal funds of a resident for any item or service for which payment
is made under Medicaid or Medicare.
(2) Items or services included in Medicare or Medicaid
payment that may not be billed to the resident's personal funds by
the facility include:
(A) nursing services as required in §19.1001 of
this chapter (relating to Nursing Services);
(B) dietary services as required in §19.1101 of
this chapter (relating to Food and Nutrition Services);
(C) an activities program as required in §19.702
of this chapter (relating to Activities);
(D) room and bed maintenance services;
(E) routine personal hygiene items and services as
required to meet the needs of the resident, including:
(i) hair hygiene supplies, including shampoo, comb,
and brush;
(ii) bath soaps, disinfecting soaps, or specialized
cleansing agents when indicated to treat special skin problems or
to fight infection;
(iii) razor and shaving cream;
(iv) toothbrush, toothpaste, and dental floss;
(v) denture adhesive and denture cleanser;
(vi) moisturizing lotion;
(vii) tissues, cotton balls, and cotton swabs;
(viii) deodorant;
(ix) incontinent care and supplies, to include, cloth
or disposable incontinent briefs;
(x) sanitary napkins and related supplies;
(xi) towels and washcloths;
(xii) hospital gowns;
(xiii) over-the-counter drugs;
(xiv) hair and nail hygiene services; and
(xv) personal laundry; and
(F) medically-related social services as required in
§19.703 of this chapter (relating to Social Services General
Requirements).
(3) A facility must base necessity for and type of
incontinent brief described in paragraph (2)(E)(ix) of this subsection
on an assessment of the resident's medical and psychosocial condition
and resulting determination.
(i) Items and services that may be charged to a resident's
personal funds. The facility may charge a resident for requested services
that are more expensive than or in excess of covered services in accordance
with §19.2601 of this chapter (relating to Vendor Payment (Items
and Services Included)). The following list contains general categories
and examples of items and services that the facility may charge to
a resident's personal funds if they are requested by a resident, if
the facility informs the resident that there will be a charge, and
if payment is not made by Medicare or Medicaid:
(1) telephone;
(2) television or radio for personal use;
(3) personal comfort items, including smoking materials,
notions and novelties, and confections;
(4) cosmetics and grooming items and services in excess
of those for which payment is made under Medicare or Medicaid;
(5) personal clothing;
(6) personal reading material;
(7) gifts purchased on behalf of a resident;
(8) flowers and plants;
(9) social events and entertainment offered outside
the scope of the activities program, provided under §19.702 of
this chapter;
(10) noncovered special care services, such as privately
hired nurses and aides;
(11) private room, except when therapeutically required,
such as isolation for infection control;
(12) specially-prepared or alternative food requested
instead of the food generally prepared by the facility, as required
in §19.1101 of this chapter; and
(13) incontinent briefs if the resident representative
submits a written request to the facility and the attending physician
and director of nurses (DON) determine and document in the clinical
record that there is no medical or psychosocial need for supplies.
(j) Request for items or services that may be charged
to a resident's personal funds.
(1) The facility can only charge a resident for an
item or service not included under §19.2601 of this chapter if
the resident or the resident representative specifically requests
the item or service.
(2) The facility must not require a resident or resident
representative to request any item or service as a condition of admission
or continued stay.
(3) The facility must inform, orally and in writing,
the resident or resident representative, when the resident or resident
representative requests an item or service for which a charge will
be made, that there will be a charge for the item or service and the
amount of the charge.
(k) Access to financial record. The individual financial
record must be available on request to the resident, resident representative,
and representative.
(l) Quarterly statement.
(1) The individual financial record must be available,
through quarterly statements and on request, to the resident, representative
payee, and resident representative.
(2) The statement must reflect any resident's funds
that the facility has deposited in an account as well as any resident's
funds held by the facility in a petty cash account.
(3) The statement must include at least the following:
(A) balance at the beginning of the statement period;
(B) total deposits and withdrawals;
(C) interest earned, if any;
(D) bank name and location of any account in which
the resident's personal funds have been deposited; and
(E) ending balance.
(m) Banking charges.
(1) Charges for checks, deposit slips, and services
for pooled checking accounts are the responsibility of the facility
and may not be charged to the resident or resident representative.
(2) Bank service charges and charges for checks and
deposit slips may be deducted from the individual checking accounts
if it is the resident's written, individual choice to have this type
of account.
(3) Bank fees on individual accounts established solely
for the convenience of the facility are the responsibility of the
facility and may not be charged to the resident or resident representative.
(4) The facility may not charge the resident or resident
for the administrative handling of either type of account.
(5) If the facility places any part of the resident's
funds in savings accounts, certificates of deposit, or any other plan
whereby interest or other benefits are accrued, the facility must
distribute the interest or benefit to participating residents on an
equitable basis. If pooled accounts are used, interest must be prorated
on the basis of actual earnings or end-of-quarter balances.
(n) Access to funds.
(1) Disbursements from the trust fund.
(A) A request for funds from the trust fund or trust
fund petty cash box may be made, either orally or in writing, by the
resident, or resident representative to cover a resident's expenses.
(B) The facility must respond to a request received
during normal business hours at the time of the request.
(C) The facility must respond to a request received
during hours other than normal business hours immediately at the beginning
of the next normal business hours.
(2) Discontinuing trust fund participation.
Cont'd... |
