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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 27 Chapter 24 Long Term Care

from a nursing facility, a detailed itemization of the services must be provided. The itemization must include: o The date of the service or expense; o The specific medical service; o The reason no payment was received by the facility; and o The amount of the expense. Charges billed to Medicare, Medicaid or private insurance must be accompanied by an Explanation Of Benefits (EOB) to be considered. Only charges denied because they are not covered services may be used. ➢ Additional Limits for Specific Expenses For the items or services listed below, the following limits apply: • Eye examination and eyeglasses: $300 in a 12-month period • Eyeglasses: Two pairs in a 12-month period, unless medical necessity is established. The $300 limit in a 12-month period applies. • Dentures: $3,000 in a 12-month period, unless medical necessity is established • Hearing Aids: $1,500 in a 12-month period, unless medical necessity is established Medical necessity is determined by the Worker and/or Supervisor, based upon the documentation provided. ➢ Expenses which Cannot Be Used The following expenses cannot be used as a deduction for non-reimbursable medical expenses: • Durable Medical Equipment (DME), unless purchased by the client prior to Medicaid payment for nursing facility services, and the cost was not reimbursable from any source; • Bills for non-payment of the client contribution after Medicaid eligibility for nursing facility services is approved; • Medical expenses incurred during a period of Medicaid eligibility which are covered by Medicaid; • Nursing facility expenses incurred during a period of Medicaid ineligibility for excess assets, when the reason for excess assets is non-payment of the client contribution;