1. In some situations, there can be limited healthcare options and access specifically for individuals with Medicaid. Explain one of those reasons. 1 point

1. In some situations, there can be limited healthcare options and access specifically for individuals with Medicaid. Explain one of those reasons. 1 point

2. If you are caring for someone with dementia, it is important to know their life story. Explain what that means. 1 points

3. You are helping a resident and his son fill out paperwork for admission to the nursing home when they begin asking you questions about Advance Directives. In particular, they are asking questions about the Kentucky Living Will and the EMS Do Not Resuscitate (DNR) forms. Write below how you would explain each of these documents to the resident and his son. You must, at minimum, include their primary purpose, differences and any similarities. 3 points

a. Primary purpose of each:

b. Differences:

c. Similarities:

4. Nursing facility care is typically “need” driven and not “want” driven. Explain what is meant by this. 2 points

For questions 5, 6, 7 and 8, utilize the three (3) supplemental documents as needed.

5. What is the Medicaid case mix rate for St. Joseph’s Home for the Aged? 1 point ____________

6. Mr. Wright was discharged from the hospital and admitted as a resident at McCreary Health and Rehabilitation Center. He has both Medicare and Medicaid. His stay is currently covered under Medicare Part A as a skilled resident because he is receiving occupational therapy 5 days a week for a total of 500 minutes per week (rehabilitation very high) Plus tracheostomy care (an extensive service). He has an ADL score of 8. 6 points

Fill in the following information for Mr. Wright’s current reimbursement:

a. RUG Category: _______________________________

b. RUG IV: ________

c. Daily Rate:

7. Mr. Wright is no longer receiving any type of therapy but continues to receive tracheostomy care. His ADL score is the same. 3 points

Fill in the following information for Mr. Wright’s new reimbursement:

a. RUG Category: _________________________________

b. RUG IV: _______

c. Daily Rate: _______

8. Mr. Wright has exhausted his Medicare Part A benefits and will now have his nursing facility stay paid by Medicaid. 6 points

a. What rate, per day, will the facility now receive for Mr. Wright’s stay?

b. What is the DIFFERENCE in reimbursement rate for Mr. Wright, PER DAY, from his first daily rate (5c, when first admitted to the nursing facility) to today (7a, as a Medicaid stay)? _______

c. What will be the LOSS/GAIN in revenue for the next 30 DAYS? ________

9. Explain in detail what you have learned about Medicare and payment or coverage for longterm care

services. Examples of information I am looking for are eligibility, Title, some services covered in longterm care continuum, services that are not covered, components of the plans, where funding comes from, oversight, requirements for provider eligibility, etc. You must provide at least 5 of these. They must be specific to a component of longterm care. 5 points

a.

b.

c.

d.

e

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