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1992.11.12 :  Medicare, Medicaid -- Unwarranted Nursing Home Charges

Contact: Bob Hardy (202) 690-6145
November 12, 1992

       Nursing home residents must not be charged for services
and items already covered by Medicare and Medicaid payments to
the facilities, according to a federal regulation published today
to reaffirm longstanding policy.
       HHS Secretary Louis W. Sullivan, M.D., said the final
regulation in today's Federal Register "clarifies and strengthens
our policies for protecting nursing home residents from
unwarranted charges."
       Under the regulation, a nursing home resident must not be
forced to request or buy extra items and services outside the
coverage of the Medicare or Medicaid programs. A resident who
requests non-covered services must be told in advance of the
charges to be paid out of pocket.
       William Toby Jr., acting administrator of the Health Care
Financing Administration, explained that the regulation "not only
protects the resources of a vulnerable population, but also 
provides nursing home management and inspectors with more
definitive guidance on permissible charges against residents'
funds."
       Examples of items and services that are covered by
Medicare and Medicaid and may not be billed to enrollees by the
nursing facility include nursing and dietary services mandated by
law and regulation, the activities program each nursing home is
required to have for residents, room and bed maintenance
services, routine personal hygiene items and services, and
medically related social services.
       Routine personal hygiene items and services covered by
Medicare and Medicaid payments to nursing homes include, but are
not limited to, hair hygiene items and services, shaving
supplies, toothbrushes and other items for dental care, personal
laundry, bathing supplies, hospital gowns and over-the-counter
drugs.

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