State of Michigan Nursing Home Administrator Exam

PATIENT TRUST FUNDS

1) Policy:
Must have a policy.
May state that the facility will not handle monies in excess of $5,000.00.
The facility may charge a reasonable fee not to exceed the ACTUAL COST of providing service.

2) Required Printed Information:
This must be given resident upon admission.
A statement that the facility will handle personnal funds if no other person is available.
Periodic statement of accounts (Minimum: Quarterly)

3) Procedure: American Institute of CPA
Quarterly statements including all activity, (A-H) in easily readable form.

Written account of all personal funds held in trust must be sent to the executor, administrator, rep payee or next of kin within 10 DAYS OF THE DEATH OF A PATIENT.

Account must be closed and balance sent to resident within 3 DAYS OF DISCHARGE.

Access to Funds

4) Financial records:
not less than two (2) hours during normal business hours.

5) Petty Cash:
during all normal business hours.

Accounts

6) Funds:
Cannot be CO-MINGLED with any other facility funds (Can with Residents’)

7) Interest Bearing Accounts:
May keep up to $200.00 in a non-interest bearing account of petty cash fund.

Money in excess of $200.00 shall be deposited in an interest bearing account within 15 days of the date the $200.00 minimum is exceeded.

8) Designation For Patient Unable To Handle Own Funds:
Facility notifies the Family Independence Agency, Adult Protective Services in writing when a mentally incompetent patient has no one to act on his behalf.

9) Sale Or Transfer of Ownership
Written receipt from new owner acknowledge receipt of the funds for safeguarding.

10) Surety Bond:
Not LESS than $2,000.00 or 125% of the previous year’s patient trust funds average balance held, whichever is greater.

Michigan State Plan For Long Term Care

11) Department of Community Health (MDCH or DCH)
DCH is responsible for the Medicaid Program under contract to the federal agency named Centers for Medicare and Medicaid Services (CMS).

MDCH also contracts with other departments and agencies to provide specific services.

12) Medical Services Administration (MSA)
This agency, under authority of MDCH writes policy, acts as fiscal intermediary, designs categorical reimbursement programs, audits and authorizes facility-specific reimbursement rates.

13) Bureau of Health Systems: DCH
has this bureau under its department for oversight of the quality of care within nursing homes through the certification process.

The actual certifying agency is CMS. This is accomplished through the surveys and inspections.

14) Department of Community Health, Bureau of Construction Codes, Office of Fire Safety.
DCH contracts with Office of Fire Safety to conduct the Life Safety Code portion of the survey.

15) Michigan Department of Human Services (DHS):
DCH contacts with DHS who determine an individuals Medicaid eligibility and “co-payment” responsibility. DHS utilized the local offices for direct contract with applicants.

16) Bureau of Health Professions: DCH
Has this bureau under its department for oversight and licensing of Nursing Home Administrator (NHA)

17) Michigan Department Community Health
This Department contracts directly with the federal agency CMS and as such is designated responsibility for Title XIX of the Social Security Act.

Currently this program is 56% federally funded and 44% state funded.

18) Medical Service Administration (MSA)
itself handles two primary aspects of the program POLICY AND REIMBURSEMENT.

Medicaid Policy

19) Providers must adhere to
ALL POLICIES TO PARTICIPATE

20) Facility must be licensed
MANDATORY

21) Certification of Facility
VOLUNTARY

22) MDCH uses the
Bureau of Health Systems to perform surveys for this certification.

23) Delivery of Services (Fairness/Non-Discrimination Doctrine)
Services Reimbursed by MSA are listed in the Medicaid manual.

Facilities MUST render covered services to ALL ELIGIBLE recipients in the same scope, quality, and manner as provided to the general public.

24) Compliance:
Facility must render services in accordance with all federal and state statutory and regulatory requirements.

25) Medicaid is Payor of :
LAST RESORT

26) Medicaid Payment is:
PAYMENT IN FULL (critical issue)

For covered services the facility must except the Medicaide reimbursement rate as payment in full for each and every Medicaid recipient.

The facility may not seek additional payment from residents or families for covered services.

27) For NON-COVERED SERVICES
The facility may seek payment from the recipient IF the resident chooses the service AND is informed of the charge PRIOR to receiving the service.

Record Keeping

28) Retention:
Facility services – 6 years
Orders of Contracted Services (Not records) – 6 years

Attending Physician

29) Attending Physicians’ responsibility
Federal and State regulations require the attending physician (MD or DO licensed in Michigan) to provide specific services to recipients.

30) Physician Compliance
It is the facilities responsibility

31) Physician Visits
Every 30 days for first 90 days, then every 60 days thereafter (more frequently if medically necessary)

32) Physicians’ must have
Written Plan of Care, signed

Annual Requirements for Inspection of Care

33) Under State Plan, DCH utilizes its
Bureau of Health Services to complete this during the annual survey.

Process assures that residents are receiving the appropriate care at the APPROPRIATE level of care.

Grounds for Termination of Enrollment or Refusal to Renew

34) Facility actions that:
Threaten the health, safety, or welfare of Medicaid recipients (determined through the survey process)

35) Facility actions that:
Threaten the fiscal integrity of the Medicaid program.

Abuse of Resident Trust Fund

36) Enforcement actions:
Failure to meet the federal conditions of enrollment or participation

Failure to meet the Certification Standards

Termination or suspension of Medicare automatically does the same to Medicaid

37) Patient Pay Amount
recipient must pay to the nursing home each month the amount of income determined to be in excess.

Facility is responsible for collecting

May NOT bill Medicaid for uncollected portion.

38) Co-insurance:
Must be applied to the FIRST DAYS OF STAY.

Remember facility MAY NEVER CHARGE A MEDICAID RECIPIENT MORE than the MEDICAID RATE.

39) Medicaid resident is discharged on the 11th of the month. How much do you charge whom if:

Private Pay Rate: $100.00 per day
Medicaide Rate: $80.00 per day
Patient Payed: $1000.00 per day

Amount due = Medicaid Rate X Days of Stay (80.00 X 10 = 800.)

Facility may charge for day of Admission, but not day of Discharge.
So stay = 10 days.

You must notify the local DSS office of all discharges.

Amount due from (to) resident = Amount Due – Patient Pay Amount for month
(800 – 1000 = -200)
You owe resident $200.00
Bill Medicaid 0.00

39). Under NO circumstances may a facility change the payment status of the resident to private pay and charge the full $100.00.
The DHS determines whether or not the recipient is Medicaid eligible. If the resident had stayed more days, you would have billed Medicaid.

40) Prior authorization for Services is Mandatory for
all recipients BEFORE receiving care.

41) Prior authorization for Routine Services is accomplished
Through the PreAdmissions Screening of PASAAR. Conducted by MDCH by contract to local Community Mental Health (CMH).

Pre-payment review for nursing need.

42) Prior Authorization for Ancillary Services
is Mandatory for all ancillary services (Therapies and Durable medical equipment).

43) Invoice (DSS-1073) is submitted to DCH AFTER
SERVICES RENDERED. You may bill both ROUTINE and ANCILLARY services on the same bill.

44) Therapeutic Leave Days:
Each recipient is entitled to 10 hospital leave days providing:

Hospitalization is unexpected
Return Anticipated within 10 days
Resident returns before day 10

REIMBURSEMENT

45) DCH
is the fiscal intermediary for Medicaid program.

46) Reimbursement Structure:
limits are established by legislature.

47) Cost Reporting:
to determine the facility-specific rates, DCH utilizes the MICHIGAN STATISTICAL and OPERATING COST REORT which must be filed within 90 days of the facility’s fiscal year end.

Relationship Between Medicare and Medicaid

48) Many recipients are eligible for both types of benefits.
If so, then facility MUST first bill Medicare, receive initial payment and then bill Medicaid

49) Medicare Part A:
Routine Services plus Ancillaries

Medicare pays in full for days 1 – 20

On Day 21, you begin to bill co-insurance (Medicaid) for day 21 – 100.

50) A recipient must enroll in Medicare Part A to be eligible for Medicaid.
If a recipient refuses to enroll, he is automatically denied Medicaid.

51) Medicare Part B:
Ancillary Services provided

Outpatient or Medical Services

Therapies (Non Medicare A)

Billable Medical Supplies D.M.E.

Diagnostic Services

Payment: Bill deductible to Medicaid

Workers Compensation

52) Purpose:
Alternative to employer “tort” liability in the legal system.

53) Sole:
Workers Compensation is the sole remedy for workers injured or disabled in the corse of employment.

54) Employees accepting workers compensation
cannot sue the employer

55) Workers Compensation Benefits
are statutory

56) Workers Compensation Rates
are set by rating agency on behalf of insurers

57) Workers Compensation Claims
appeals process is handled by state bureau

58) “Rate Making”
Process used in determining rates to be charged by insurance companies. Rates are set by the bureau

59) “Loss Experience”
Actual Payments and reserves for anticipated payments added together.

60) “Manual (or Book) Rate”
Assume parity with the averages within a given employer group, such as clerical, nursing, maintenance.

61) “Reserves”
Estimates of medical cost and lost time payment (including fringe benefits) that are set aside by the carrier for each anticipated injury AT THE TIME THE CLAIM IS FILED.

62) Michigan is a Total Disability State:
any injury is considered total disability. Either you can work or you can not.

63) Compensable injuries:
any injury arising out of and in the course of employment.

death due to or rising out of the course of employment

any injury received going to or from the workplace on the premises
where work is to be performed and within a reasonable time before and after working hours.

Coverage Liabilities

64) Employers Mandatory Participation:
Every private employer who employs one or more employees 35 hours per week or more for 13 weeks or longer.

65) Compensation Payments:
No loss time compensation shall be paid unless the employee is incapacitated from earning wages for more than one week.

66) Benefits Level:
Maximum weekly benefit is 90% of State average weekly wages as set by the Department of Consumer and Industry Services

67) Statue of Limitations:
Two years from date of injury, or two years from the time that employee knows that injury is work related.

Employers’ Responsibility To Bureau

68) Form 100
“Employers’ Basic Report of Injury” Filed immediately with
The “Bureau of Workers’ Compensation” and copies distributed to
The insurance carrier
The employer and
The employee

69) Form 104
“Petition for Hearing” –

70) Form 107
“Notice of Dispute” aq

Union Process of Recognition and Certification

71) Petition NLRB (National Labor Relations Board
potential union members for interest with signature cards.

show interest must be equal to or greater than 30% of potential bargaining unit interested.

the election (NLRB Conducts; 50% plus 1 of potential bargaining unit members voting wins)

The Nursing Home shall provide a written copy of facility rules and regulations:
to the patient or the patient’s representative upon admission and when the rules and regulations are changed.

The Policy shall be developed by a:
Patient Care Policy Committee

The Patient Care Policy Committee must consist of:
At least 1 Physician, the Director of Nursing, and the Administrator, with such additional memebers as the committee dems appropriate.

Oxygen Administration:
Only personnel who have been trained to administer oxygen shall do so and that Oxygen shall only be administered on the Order of a Physician or as authorized in Emergency Situations.

Infection Control Committee
The Director of Nursing and Representative of Administration, dietary, housekeeping, and maintenace services.

Medical Examination of Patients
1) Except in the case of a Friday Admission, in which case the patient shall be exaimed by a licensed physician within 72 hours.

2) A patient admiitted to a home shall be examained by a licensed physician within 48hours after admission

Medical Examination of Patient currently in the facility:
Shall be seen and, to the extent appropriate, shall be examined by a licensed physician at least once every 60 days, unless justified otherwise and documented by the attending

Standing Orders Must be:
Reproduced in the patients Clinical record and shall be signed by attending physician within 48 hours.

Telephone or Verbal Orders Recorded by the licensed nurse in charge
Shall be countersigned by the physician withhin 48 hours.

The Director of Nursing
Shall be a Registered with specialized training or relevant experience in the area of gerontology and shall be employed FULL TIME BY ONLY 1 NURSING HOME

The Charge Nure
A licensed nurse shall be the charge nurse on each shift or tour of duty and shall be responsible for the immediate direction and supervision of nursing care provided to patients.

In Homes less than 30 beds the Director of Nursing
May serve as Charge Nurse on a shift when present for full shift.

Reporting and enforcement of nurse staff requirements:
A home Shall maintain for a priod of Not Less than 2 years , employee time records, including time cards or their equivalent and payroll record

An Ambulatory Resident/Patient shall have a complete Tub or Shower
under staff supervision at least once a week, unless the physician writes an order to the contrary.

A Bedfast Resident/Patient shall be assisted with bathing or bathed completelt
at least twice a week and shall be partially bath daily and as required due to secretions, excretions, or odoors.

A patient’s Clothing or Bedding shall be changed Promptly
when they become wet or soiled

A patient shall be Weighed and have his or her vital signs tanken and recorded
On Admission and at least Monthly thereaftter or more frequently if ordered by a physician.

Begining Patient Care Planning
An assessment of a patient shall be initiated by licensed nursing personnel within 24 hours of admission and the results of the assessment shall be documented in the patients clinical record.

A Patient Care Confrence
shall be held periodically, but not less than Once Every 90 Days to evaluate a patient’s needs and evaluate care plan

Equipment and Supplies Bed
An individual bed not less than 36 inches wide and 72 inches long, or longer when necessary, with springs in good condition, and a mattress not less than 5 inches thick in good condition, with a nonobsorbent cover.

The home Shall provide a written copy of facility rules and regulations
To the patient or the patients representative upon admission and when the rules and regulations are changed

Diversional Activities
A Home shall provide an on going diversional activities program that stimulates and promotes social interaction, communication, and constructuctive living.

Patient Counsel
shal permit the formation of a patient/resident counsel by interested patients, and at time of admission to home shall inform all of the counsel and the rules if any

When the Dietary or Food service supervisor is other than a registered dietitian
The supevisor shall receive routine consultation and tecnical assisstance from a registered dietitian (R.D) not less than 4 hours every 60 days.

Food and Nutritional Needs of a patient
Shall be met in accordance with the physicians orders in keeping with acceptable standards of practice of most recent recommended daily dietary allowences

Not less than 3 meals or their equivalent
shall be served daily, at regular times, with not more than a 14 – hour span between a substantial evening meal and breakfast.

Menus, postings, filing
as actually served to patients must be kept for preceding 3 montns on file in the home

Food acceptance record
shall be retained in the facility

Self Administration of Medication by a Patient
shall not be permitted, except when special circumstances exist and when supported by a physician’s written order and justification

Diagnostic Services
An arrangement shall be made by the administrator for obtaining promptly and conveniently a clinical laboratoy, x-ray, or other diagnostic services ordered by the physician

A written report of each diagnostic test and service
shall be included in the patients clinical record within 1 week

Clinical Records of DISCHARGED patients
shall be completed within 30 days following discharge.
Clinical records shall be under the supervision of a full time employee of the home

Clinical Records are Retained for a Minimum of
6 years from date of discharge or, in the case of a minor, 3 years after the individual comes of age under state law, which ever is longer.

Accident Records and Incident Reports
shall be prepared for each accident or incident involving a patient, personnel, or visitor and shall include all of the following information.

Employee Records and work Schedules
a daily work schedule shall be prepared in writting and be maintaned to show the number and type of personnel on duty in the home for the previous 3 months

A Time Record for each employee
shall be maintained for not less than 2 years

“Medical Audit”
means the retrospective examination, review, and evaluation of the clinical application of medical knowledge utilized in the diagnosis and treatment of poatients as revealed n the patient’s clinical record and carried out for purpose of education, accountability, and quality control.

“Quality Control”
means the planned and systematic medical management actions which assures the consistent acceptabe quality of health care and services rendered to patients including the use of variousmonitoring techniques.

“Utilization Review”
means retrospective, concurrent, and prospective review of the provision and utilzation of health care services by providers and recipients in terms of cost, effectiveness, efficiiency, and quality

Home Entrance for Physically Hanicapped
IN A NEW CONSTRUCTION, addition, major change, or conversion after AUGUST 22, 1969, at least 1 entrance Shall provide easy access for the Physically handicapped

A minimum od 20 square feet of floor space per patient bed
Shall be provided for dayroom, dining room, recreation, and activity purposes.

A new contruction after August 22, 1969 Shall provide
A sleep, day, dining room, recreation, or activity room with a minimum ceiling height of 8 feet

20 feet of unobstructed vision space outside of any
window in a room requiring windows. One additional foot shall be added to the minimum distance of 20 feet for each 2 foot rise above the first story up to a max of 40 feet of required unobstructed space

A multi bed patient room (not more than 4 beds)
shall have a 3 foot clearance btw beds and not less than 70 square feet of usable floor space per bed

The temerature of HOT WATER at plumbing fixtures used by patients
shall be regulated to provided tempered water NOT LESS than 120 degrees fahrenheit.

A room used for patients shall maintain a regular daytime temperature
of NOT LESS than 72 dehrees fahrenheit

Kitchen and Dietary
A Reliable Thermometer
shall be provided for each refrigerator and freezer

In new construction (August 22, 199) general storage space of
10 square feet shall be provided in the home

In a 100 bed Nursing Home Day Staff
8:1 ration RN?LPN/ CNA

In a 100 bed Nursing Home Evening Staff
12:1 ratio RN/LPN/CNA

In a 100 bed Nursing Home Night Saff
15:1 ration RN/LPN/CNA

Class Outlines and Lesson Plans
shall be retained in the facility for not less than 2 years

MIOSHA
General recording criteria
You must consider an injury or illness to meet the criteria, if it results in
a) DEATH
b) Days away from work
c) Restricted work or transfer to another job
d) Medical treatment beyond first aid
e) LOSS of consciousness

MIOSHA
Retention and Updating
Must save MIOSHA 300 Log during the 5 year storage period

MIOSHA
Hospitilization
Within 8 hours after death of any employee from a work-related incident or the inpatient hospitialization of 3 ormore employees as a result of a work-related incident

MIOSHA incident reporting
You must orally report the fatality/multiple hospitilization by telephone or in person to the Michigan Department of Consumer and Industrial Services, Bureau of Safety and Regulation, State Secondary complex

MIOSHA
If the Building Office is Closed, May I report the incident by leaving a message on MIOSHA’s answering machine, faxing the bureau office, or sending an e-mail?
NO! If you can’t talk to a person at the bureau office you must report the fatality or multiple hospitilization incident using the 800 number

800-858-0397

“Licensed bed capacity”
means the autorized and licensed bed complement of a nursing home

Rule #107 Type Documentation
When the statue or these rules required a document or parts of a document to be printed in 12 point type the distance btw the top

Rule # 111 Governing Body
The governing body of the nursing home shall assume full responsibility for the overall conduct and operation of the home

The Governing Body Shall Appoint a
Licensed Nursing Home Administrator and shall deligate to the administrator the responsibility of operating the facility according to the policy and perceedures they established

Rule #112 Posting Resident Rights
Shall develop, adopt, post in a public place, distribute, and implement a Policy on the rights and responsibilities of patients in accordance with the requirements

All patient complaints shall be investigated with in
15 days of the complaint and home within 30 days following the complaint the home shall provide complintee a written status report or results of investigation

Patient Trust
Policy that home will not handle funds freater than $5,000.00

Patient has the right to have a representative from_____________ to handle his/her funds
Social Security Administration

Disaster Plan
Shall have a written Plan or procedure to be followed in case of fire, explosion, or other emergency

A regular Simulated Drill
shall be held for each shift NOT LESS than 3 times per year

Building Construction
If the building has a common wall with a nonconforming building, the common wall is a fire barrier having at least two hour fire resistance rating

Interior Walls and Partitions in building of Type I or Type II
construction shall be noncombustible or limited-combustible material.

Interior Walls and Partitions in building of Type I or Type II
shall be noncombustible or limited-combustible materials

Interior Finish 2000 EXISTING
Interior finish for corridors and exitways, includeing exposed interior surface of building has flame spread rating of Class A or Class B

Interior Finish 2000 NEW
Must have Flame Spread Rating of Class A or Class B. LOWER PORTION OF CORRIDOR WALLS CAN BE CLASS C

Corridor Walls and Doors 2000 EXISTING
are separated from use areas by walls constructed with at least 1/2 hour fire resistance rating.

Corridor Walls 2000 NEW
NO fire resistance rating is required for corridor walls.

Doors 2000 EXISTING
doors protecting corridor opening in other than required enclosures of verticle openings, exits, or hazardous areas shall be constructed of 1 3/4 inch sold-bond wood

Doors in Sprinkler buildings
are only required to resist smoke.

Exit Components 2000 Exists
such as stairways are enclosed with construction having a fire resistance rating of at least one hour,

Smoke Barriers New 2000
shall be provided to form at least two smoke compartments on every sleeping room floor for more than 30 patients

The smoke compartment
shall not exceed 22,500 square feet and smoke barrier shall not exceed 200 feet

Exit and Exit Access
Not less than Two exits, REMOTE from each other, are provided for each floor or fire section of the building

Exit and Exit access shall be arranged such that no
cooridor, aisle or passageway has a pocket or dead-end exceeding 30 feet

Width of Aisle or Corridors 2000 EXISTING
clear and unobstructed, serving as exits shall be at least 4 feet

Width of Aisles or Corridors 2000 NEW
clear and unobstructed serving as exit access in hospitals and nursing homes shall be at least 8 feet

Illumination of Means and Egress including exit discharge
is arranged so that failor of any single lighting fixture (bulb) will not leave the area in darkness

Emergency Lighting of at least
1 1/2 hour duraton is provided in accordance

Fire Alarm System 2000 Existing
There shall be ANNUNCIATION of the fire alarm system to an approved central station.

Fire Alarm System 2000 NEW
There shall be remote annunciation of the fire alarm system to an approved central station

Automatic Smoke Detection 2000 New
An automatic dectection system is installed in all cooridors with detector spacing not further apart than 30 ft on center, nor more than 15 ft from any wall.

Windor and Door 2000 Existing
Every patient sleeping room shall have an outside window or outside door.

The allowable height shall not exceed 36 inches (91 cm) above the floor.

Soiled linen or trash collection receptacles
shall not exceed 3 gal (121) in capacity

Oxygen storage locations of greater than
3,000 cu ft are enclosed by a one-hour separation.

Generators are inspected
weekly and exercised under LOAD for 30 minutes per month and shall be in accordance

National Fire Protection Association
Private, nonprofit organizaton – NOT A GOVERNMET AGENCY.

Author of Life Safety Code

Nursing Homes are required by OBRA to meet LSC

Proceedure in Event of Fire
1) Removing all residents involved
2) Transmitting alarm
3) Isolating the fire by closing doors
4) Evacuating by plan

Stairs: Clearance
44″; riser height – 7″ max

Smoke Towers
stair enclosure designed to limit penetration of heat and smoke. No more than 1% of the volume of air in stairwell will emanate from fire area

Handrails at bottom of stairs
Must extend parallel to floor for 12″

Windows must have
opening force requirement of no more 5lbs.

Preventive Maintenance
1) Save expense of requirs
2) Save labor
3) Assure safety

Facility Temperature
71F – 81F

Bed Space for each Patient
80 sq ft per resident in multi-bed rooms,
100 sq ft in private room

Obra Requirement for Housekeeping
Services necessary to maintain a sanitary, orderly, and clean interior.

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