<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.07.09.04" title_num="10" subtitle_num="07" chapter_num="09" heading="Admission Procedures and Requirements.">
  <paragraph num="A.">
    <text>At the time of admission of a resident, and whenever information changes during the resident's stay, the nursing facility shall notify the resident and, when applicable, a representative or interested family member, in writing and orally, in a language that is easily understood of all terms of admission including, but not limited to the:</text>
    <paragraph num="(1)">
      <text>Residents' Bill of Rights;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Nursing facility's policies and procedures that implement the Residents' Bill of Rights;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Rules of resident responsibility;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Nursing facility's complaint procedure;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Nursing facility's visitation rules;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Procedures for obtaining a determination from the Medical Assistance Program of the amount of the resident's funds available to pay for the cost of the resident's care;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Procedures for establishing eligibility for Medicaid and for receiving refunds for previous private payments covered by these benefits, including the right to request an assessment under 42 U.S.C. §1396r(5)(c) for the purpose of determining the:</text>
      <paragraph num="(a)">
        <text>Extent of a couple's nonexempt resources at the time of institutionalization; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Amount of a couple's resources to be attributed to the community spouse as the spouse's equitable share of resources which are not considered available for payment toward the cost of the institutionalized spouse's medical care or for determining Medicaid eligibility for the institutionalized spouse; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(8)">
      <text>Resident's rights under State law to formulate advance directives.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Upon admission of a resident, a nursing facility shall:</text>
    <paragraph num="(1)">
      <text>Document in the resident's clinical record whether the resident has executed an advance directive and, if an advance directive exists, keep a copy of the advance directive in:</text>
      <paragraph num="(a)">
        <text>The resident's clinical record; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A location within the nursing facility which is accessible to appropriate administrative, nursing, and medical personnel on a 24-hour a day basis;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Prepare an inventory of all property that the resident is bringing into the nursing facility;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Request the resident or representative to identify:</text>
      <paragraph num="(a)">
        <text>Those items with a value of $100 or more;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Any damage to an item existing before admission of the resident; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Whether the resident is retaining possession of each item or is entrusting the item to the nursing facility for safekeeping on behalf of the resident;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Give to the resident and, when applicable, the resident's representative or interested family member, a copy of the inventory prepared under §B(2) of this regulation; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Advise the resident and, when applicable, a representative or interested family member:</text>
      <paragraph num="(a)">
        <text>Whether the nursing facility has purchased insurance to cover a resident's tangible personal property for loss or damage due to the facility's negligence; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Of the limits of insurance coverage.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>With information provided by the resident or representative, a nursing facility shall periodically update the inventory of the resident's personal property with respect to items having a value of $100 or more.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Required Notification. A nursing facility shall notify in writing:</text>
    <paragraph num="(1)">
      <text>A resident who is entitled to Medicaid benefits at the time of admission, or when the resident becomes eligible for benefits, of:</text>
      <paragraph num="(a)">
        <text>Items and services that are included in the per diem rate under Medicaid, and for which the resident may not be charged;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Other items and services that the nursing facility offers and for which the resident may be charged, and the current range of charges for each item and service;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The nursing facility's obligation following admission to notify the resident and, when applicable, the agent or interested family member, of any changes made to the items and services for which the resident may or may not be charged;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The fact that the resident may not be required to pay for an item or service not covered by Medicaid unless the:</text>
        <paragraph num="(i)">
          <text>Resident or, when applicable, the agent, knowingly requests the item or service; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Resident receives the item or service; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>The resident's right, within 90 days of receiving an item or service, to request an itemized statement of charges that:</text>
        <paragraph num="(i)">
          <text>Briefly and clearly describes each item or service, the amount charged for it, and the identity of the payer billed for the service; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Contains a statement in bold and conspicuous print as to when interest may be assessed consistent with Regulation .05B(8) of this chapter;</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A private-pay resident, or the resident's agent, of:</text>
      <paragraph num="(a)">
        <text>The items and services included in the nursing facility's basic per diem rate;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The items and services that are covered by Medicare, and of the amount of any copayments or deductibles;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Other services that the nursing facility offers and for which the resident may be charged, and the current range of charges for the services, including but not limited to charges related to a resident's monthly drug regimen review and other non-drug-related pharmacy costs;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Whether the costs for supplies used in the performance of a service are included in the service charge and the costs of these supplies, within 24 hours of request, when the costs are not included in the service charge; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The resident's right, within 90 days of receiving an item or service or within 30 days of payment, to request an itemized statement of charges that:</text>
        <paragraph num="(i)">
          <text>Briefly and clearly describes each item or service, the amount charged for it, and the identity of the payer billed for the service; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Contains a statement in bold and conspicuous print as to when interest may be assessed consistent with Regulation .05B(8) of this chapter; and</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>A resident of changes to be made to the items and services specified in §D(1) and (2) of this regulation, and increases in any fee or charge, or a new fee or charge, or a change in billing procedures, at least 45 days before the increase, new charge, or change becomes effective.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>A nursing facility shall:</text>
    <paragraph num="(1)">
      <text>Give the resident a copy of the statement of items, services, and charges provided by the facility;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provide information regarding services to be rendered by other health care providers, including:</text>
      <paragraph num="(a)">
        <text>The cost to the resident;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Transportation arrangements; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Direct or indirect financial interests that the nursing facility has in the provider.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>