Source: https://www.federalregister.gov/documents/2003/05/16/03-11854/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing
Timestamp: 2020-06-06 02:38:36
Document Index: 45549784

Matched Legal Cases: ['§\u2009409', '§\u2009409', '§\u2009409', '§\u2009409', '§\u2009409', '§\u2009409', '§\u2009409', '§\u2009413', '§\u2009413', '§\u2009413', '§\u200940930', '§\u2009413', '§\u2009413', 'art 483', '§\u2009483', 'art 483', 'art 483', '§\u2009483', 'arts 413', '§\u2009483', 'art 483', '§\u2009483', '§\u2009483', '§\u2009483', '§\u2009483', '§\u2009483', '§\u2009483', '§\u2009483', '§\u2009483', '§\u2009483', '§\u2009483', '§\u2009483', '§\u2009483', '§\u2009483', '§\u2009413', '§\u2009413', '§\u2009413', '§\u2009483', '§\u2009483', '§\u2009409', '§\u2009483', 'art 483', 'arts 413', '§\u2009483', '§\u2009409', '§\u2009409', '§\u2009409', '§\u2009409', '§\u2009413', '§\u2009483', '§\u2009440', '§\u2009440', '§\u2009483', 'art 483', '§\u2009440', '§\u2009440', '§\u2009483', '§\u2009483', '§\u2009440', '§\u2009440', '§\u2009440', '§\u2009435', '§\u2009413', '§\u2009483', '§\u2009483', '§\u2009483', 'art.\n4', '§\u2009483', '§\u2009483', '§\u2009483', '§\u2009483']

A Proposed Rule by the Centers for Medicare & Medicaid Services on 05/16/2003
68 FR 26757
26757-26783 (27 pages)
https://www.federalregister.gov/d/03-11854
Mail written comments (one original and three copies) to the following address: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1469-P, PO Box 8013, Baltimore, MD 21244-8013.
Comments mailed to those addresses designated for courier delivery may be delayed and could be considered late. Because of staffing and resource limitations, we cannot accept comments by facsimile (FAX) transmission. Please refer to file code CMS-1469-P on each comment. Comments received timely will be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of this document, in Room C5-12-08 of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland, Monday through Friday of each week from 8:30 a.m. to 4 p.m. Please call (410) 786-7197 to make an appointment to view comments.
ARD Assessment Reference Date
BBA Balanced Budget Act of 1997, Pub.L. 105-33
BBRA Medicare, Medicaid and SCHIP Balanced Budget Refinement Act of 1999, Pub.L. 106-113
BEA (U.S.) Bureau of Economic Analysis
BIPA Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, Pub.L. 106-554
CPT (Physicians') Current Procedural Terminology
ICD-9-CM International Classification of Diseases, Ninth Edition, Clinical Modification
Start Printed Page 26759
IFC Interim Final Rule with Comment Period
NECMA New England County Metropolitan Area
PCE Personal Care Expenditures
PRM Provider Reimbursement Manual
RAVEN Resident Assessment Validation Entry
RFA Regulatory Flexibility Act, Pub. L. 96-354
STM Staff Time Measure
UMRA Unfunded Mandates Reform Act, Pub. L. 104-4
In addition, we are taking this opportunity to make a technical correction in a cross-reference that appears in § 409.20(c) of the regulations. Section 409.20 provides a general introduction to the subsequent sections (§ 409.21 through § 409.36) that set forth the specific requirements pertaining to the SNF benefit. However, in referring to the sections that follow, the cross-reference in § 409.20(c) concerning terminology inadvertently omits a reference to § 409.21, and we would now correct that omission by revising the cross-reference to read “§ 409.21 through § 409.36”.
1. The unadjusted Federal per diem rates to be applied to days of covered SNF services furnished during the FY. Start Printed Page 26760
We included further information on all of the provisions of the BBRA that affect the SNF PPS in Program Memoranda A-99-53 and A-99-61 (December 1999), and Program Memorandum AB-00-18 (March 2000). In addition, for swing-bed hospitals with more than 49 (but less than 100) beds, section 408 of the BBRA provided for the repeal of certain statutory restrictions on length of stay and aggregate payment for patient days, effective with the end of the SNF PPS transition period described in section 1888(e)(2)(E) of the Act. In the July 31, 2001 final rule (66 FR 39562), we made conforming changes to the regulations in § 413.114(d), effective for services furnished in cost reporting periods beginning on or after July 1, 2002.
In developing the rates for the initial period, we updated costs to the first effective year of PPS (the 15-month period beginning July 1, 1998) using a SNF market basket, and then standardized for the costs of facility differences in case-mix and for geographic variations in wages. Providers that received new provider exemptions from the routine cost limits were excluded from the database used to compute the Federal payment rates, as well as costs related to payments for exceptions to the routine cost limits. In accordance with the formula prescribed in the BBA, we set the Federal rates at a level equal to the weighted mean of freestanding costs plus 50 percent of the difference between the freestanding mean and weighted mean of all SNF costs (hospital-based and freestanding) combined. We computed and applied separately the payment rates for facilities located in urban and rural areas. In addition, we adjusted the Start Printed Page 26761portion of the Federal rate attributable to wage-related costs by a wage index.
The Federal rates apply to all costs (routine, ancillary, and capital-related costs) of covered SNF services other than costs associated with approved educational activities as defined in § 413.85. Under section 1888(e)(2) of the Act, covered SNF services include post-hospital SNF services for which benefits are provided under Part A (the hospital insurance program), as well as all items and services (other than those services excluded by statute) that, before July 1, 1998, were paid under Part B (the supplementary medical insurance program) but furnished to Medicare beneficiaries in a SNF during a Part A covered stay. (These excluded service categories are discussed in greater detail in section V.B.2 of the May 12, 1998 interim final rule (63 FR 26295-97)).
Per Diem Amount $125.15 $94.27 $12.42 $63.87
Per Diem Amount $119.57 $108.70 $13.26 $65.06
Start Printed Page 26764
Start Printed Page 26766
Start Printed Page 26767
RUC 438.68 335.31 103.37
RUB 394.87 301.82 93.05
RUA 373.60 285.56 88.04
RVC 338.21 258.51 79.70
RVB 326.95 249.90 77.05
RVA 298.16 227.90 70.26
RHC 310.17 237.08 73.09
RHB 285.14 217.95 67.19
RHA 261.36 199.77 61.59
RMC 305.41 233.44 71.97
RMB 272.87 208.57 64.30
RMA 256.60 196.13 60.47
RLB 243.33 185.99 57.34
RLA 204.53 156.33 48.20
SE3 289.05 220.94 68.11
SE2 250.25 191.28 58.97
SE1 222.72 170.24 52.48
SSC 217.71 166.41 51.30
SSB 207.70 158.76 48.94
SSA 202.69 154.93 47.76
CC2 216.46 165.45 51.01
Start Printed Page 26768
CC1 200.19 153.02 47.17
CB2 190.18 145.36 44.82
CB1 181.42 138.67 42.75
CA2 180.16 137.71 42.45
CA1 170.15 130.05 40.10
IB2 162.64 124.31 38.33
IB1 160.14 122.40 37.74
IA2 147.63 112.84 34.79
IA1 142.62 109.01 33.61
BB2 161.39 123.36 38.03
BB1 157.64 120.49 37.15
BA2 146.37 111.88 34.49
BA1 136.36 104.23 32.13
PE2 175.16 133.88 41.28
PE1 172.66 131.97 40.69
PD2 166.40 127.19 39.21
PD1 163.90 125.28 38.62
PC2 157.64 120.49 37.15
PC1 156.39 119.54 36.85
PB2 140.12 107.10 33.02
PB1 138.87 106.15 32.72
PA2 137.61 105.18 32.43
PA1 133.86 102.32 31.54
RUC 465.08 355.48 109.60
RUB 423.23 323.50 99.73
RUA 402.90 307.96 94.94
RVC 353.44 270.15 83.29
RVB 342.68 261.93 80.75
RVA 315.18 240.91 74.27
RHC 317.90 242.99 74.91
RHB 293.98 224.70 69.28
RHA 271.27 207.35 63.92
RMC 310.18 237.09 73.09
RMB 279.09 213.32 65.77
RMA 263.55 201.44 62.11
RLB 244.52 186.90 57.62
RLA 207.46 158.57 48.89
SE3 281.59 215.23 66.36
SE2 244.52 186.90 57.62
SE1 218.22 166.80 51.42
SSC 213.43 163.14 50.29
SSB 203.87 155.83 48.04
SSA 199.09 152.17 46.92
CC2 212.24 162.23 50.01
CC1 196.69 150.34 46.35
CB2 187.13 143.03 44.10
CB1 178.76 136.64 42.12
CA2 177.56 135.72 41.84
CA1 168.00 128.41 39.59
IB2 160.82 122.92 37.90
IB1 158.43 121.10 37.33
IA2 146.47 111.95 34.52
IA1 141.69 108.30 33.39
BB2 159.63 122.01 37.62
BB1 156.04 119.27 36.77
BA2 145.28 111.04 34.24
BA1 135.71 103.73 31.98
PE2 172.78 132.06 40.72
PE1 170.39 130.24 40.15
PD2 164.41 125.67 38.74
PD1 162.02 123.84 38.18
PC2 156.04 119.27 36.77
PC1 154.84 118.35 36.49
PB2 139.30 106.47 32.83
PB1 138.11 105.56 32.55
PA2 136.91 104.65 32.26
PA1 133.32 101.90 31.42
0470 Arecibo, PR 0.4337
1520 Charlotte-Gastonia-Rock Hill, NC-SC 0.9875
1560 Chattanooga, TN-GA 0.8976
1580 Cheyenne, WY 0.8628
1600 Chicago, IL 1.1044
1720 Colorado Springs, CO 0.9916
Start Printed Page 26770
2680 Ft Lauderdale, FL 1.0297
2710 Fort Pierce-Port St Lucie, FL 0.9823
2800 Fort Worth-Arlington, TX 0.9446
Start Printed Page 26771
3740 Kankakee, IL 1.0790
3810 Killeen-Temple, TX 1.0399
Start Printed Page 26772
5120 Minneapolis-St. Paul, MN-WI 1.0903
5720 Norfolk-Virginia Beach-Newport News, VA-NC 0.8574
5990 Owensboro, KY 0.8344
Start Printed Page 26773
6820 Rochester, MN 1.2139
6840 Rochester, NY 0.9194
6880 Rockford, IL 0.9625
6980 St Cloud, MN 0.9700
7000 St Joseph, MO 0.9544
7040 St Louis, MO-IL 0.8855
7560 Scranton-Wilkes-Barre-Hazleton, PA 0.8599
Start Printed Page 26774
8280 Tampa-St Petersburg-Clearwater, FL 0.9065
8360 Texarkana, AR-Texarkana, TX 0.8088
As discussed in § 413.345, we include in each update of the Federal payment rates in the Federal Register the designation of those specific RUGs under the classification system that represent the required SNF level of care, as provided in § 40930. This designation reflects an administrative presumption under the current 44-group RUG-III classification system. Our presumption is that any beneficiary who is correctly assigned to one of the upper 26 RUG-III groups in the initial 5-day, Medicare-required assessment is automatically classified as meeting the SNF level of care definition up to the assessment reference date for that assessment.
RVC $258.51 0.8941 $231.13 $79.70 $310.83 1 $331.66 14 $4,643
RHA 199.77 0.8941 178.61 61.59 240.20 1 256.29 16 4,101
SSC 166.41 0.8941 148.79 51.30 200.09 2 240.11 30 7,203
IA2 112.84 0.8941 100.89 34.79 135.68 135.68 30 4,070
Total 90 20,017
Section 1888(e)(5)(A) of the Act requires us to establish an SNF market basket index (input price index) that reflects changes over time in the prices of an appropriate mix of goods and services included in the SNF PPS. This proposed rule incorporates the latest available projections of the SNF market basket index. The final rule will incorporate updated projections based on the latest available projections at that time. Accordingly, we have developed an SNF market basket index that encompasses the most commonly used cost categories for SNF routine services, ancillary services, and capital-related expenses. In the July 31, 2001 Federal Register (66 FR 39562), we included a complete discussion on the rebasing of the SNF market basket to FY 1997. There are 21 separate cost categories and respective price proxies. These cost Start Printed Page 26776categories were illustrated in Table 10.A, Table 10.B, and Appendix A, along with other relevant information, in the July 31, 2001 Federal Register.
Wages and Salaries 54.796 55.143
Employee Benefits 11.232 11.269
Nonmedical Professional Fees 2.652 2.661
Labor-intensive Services 4.124 4.137
Capital-related 3.324 3.226
Total 76.128 76.435
October 1997, FY 1998 2.8
October 1999, FY 2000 4.0
October 2000, FY 2001 4.9
October 2001, FY 2002 3.4
October 2002, FY 2003 3.1
October 2003, FY 2004 2.9
We note that the original BBRA legislation (as well as the implementing regulations) identified a set of excluded services by means of specifying HCPCS codes that were in effect as of a particular date (that is, July 1, 1999). Start Printed Page 26777Identifying the excluded services in this manner made it possible for us to utilize a Program Memorandum as the vehicle for accomplishing routine updates of the excluded codes, in order to reflect any minor revisions that might subsequently occur in the coding system itself (for example, the assignment of a different code number to the same service). Accordingly, for any new services that would actually represent a substantive change in the scope of services that are excluded from the SNF consolidated billing provision, we would identify these additional excluded services by means of the HCPCS codes that are in effect as of a specific date (in this case, October 1, 2002). By making any new exclusions in this manner, we could similarly accomplish routine future updates of these additional codes through the issuance of a Program Memorandum.
By July 31, 2003, the SNF PPS will cover all swing-bed hospitals. Therefore, all rates and wage indexes outlined in earlier sections of this notice for SNF PPS also apply to all swing-bed hospitals. A complete discussion of assessment schedules, the MDS and the transmission software, Raven-SB for Swing Beds can be found in the July 31, 2001 final rule (66 FR 39562). The latest changes in the MDS for swing-bed hospitals are listed on our SNF PPS Web site, http://.www.cms.hhs.gov/​providers/​snfpps/​default.asp.
As noted in section I.A of this preamble, services are covered under the Part A SNF benefit only when furnished in a SNF that Medicare has certified as meeting the requirements for program participation contained in section 1819 of the Act. This section of the Act defines a SNF in terms of being “* * * an institution (or a distinct part of an institution) * * *. ” The committee report that accompanied the original Medicare legislation (cited below) contained the following explanation of the distinct part concept as applied to “posthospital extended care facilities,” or SNFs: “* * * A posthospital extended care facility could be an institution, such as a skilled nursing home, or a distinct part of an institution, such as a ward or wing of a hospital or a section of a facility another part of which might serve as an old-age home.” (Senate Finance Committee Rep. No. 404, 89th Cong., 1st Sess. 31-32 (1965)).
The SNF and hospital are financially integrated as evidenced by the cost report, which must reflect the certified or noncertified SNF beds of the hospital, the allocation of hospital overhead to the SNF through the required stepdown methodology, and common billing for all services of both facilities.Start Printed Page 26778
While colocation is not an essential factor, the distance between the two facilities must be reasonable.
We recognize that the April 7, 2000 final rule for the PPS for outpatient hospital services promulgated a set of criteria for use in determining whether an entity is “provider-based” (65 FR 18504), including several criteria that were similar to the 1980 hospital-based criteria for SNFs. However, SNFs are not subject to the provider-based regulations (see § 413.65(a)(1)(ii)(D)).
It has been noted that the regulations at § 413.65 already set forth detailed criteria for determining provider-based status in other settings, but that no similar regulations exist with regard to SNFs. The need to clarify the criteria for identifying distinct parts is especially pronounced in the context of survey and certification procedures.
In addition, the concept of a distinct part is actually broader than that of a “hospital-based” facility, in that the former can encompass situations in which a SNF is a part of a larger institution that is not a hospital (for example, a domiciliary or “board and care” facility). Further, the distinct part concept applies to Medicaid nursing facilities (NFs) as well as to SNFs, and involves not only payment issues, but also the requirements specified in the regulations at part 483, subpart B (the requirements for program participation for long-term care facilities (that is, SNFs and NFs)). Further, while the regulations at § 483.5 (which define a long-term care facility in this context) refer to the existence of “distinct part” SNFs and NFs, they do not currently contain a specific definition of this term.
Accordingly, in this proposed rule, we propose to add a number of specific criteria that would serve to determine whether a SNF or NF can be designated as a distinct part of a hospital or other entity, in the requirements for participation for long-term care facilities in subpart B of part 483. These proposed revisions would essentially reflect the 1980 “hospital-based” criteria discussed previously (which focus primarily on such elements as common ownership and control, financial integration, and location), and would also incorporate existing criteria included in the State Operations Manual and in Survey and Certification Letters into a single regulation. We also propose to make a number of conforming changes elsewhere in subpart B of part 483 of the regulations (specifically §§ 483.10 and 483.12), as well as to other distinct part references that appear in parts 413 and 440.
At § 483.5, we would define a distinct part as a physically identifiable component of an institution (for example, a hospital, or a board and care facility) or institutional complex (for example, a hospital or continuing care retirement community that includes various subprovider units and occupies several buildings) that is certified as meeting the applicable statutory requirements for SNFs or NFs in sections 1819 or 1919 of the Act, respectively, as well as the participation requirements for long-term care facilities set forth in subpart B of part 483. A SNF or NF distinct part may be comprised of one or more buildings or designated parts of buildings (that is, wings, wards, or floors) that are located in the same physical area immediately adjacent to the institution's main buildings, other areas and structures that are not strictly contiguous to the main buildings but are within close proximity of the main buildings, and any other areas that we determine, on an individual basis, to be part of the institution's campus. A distinct part must include all of the beds within the designated area, and cannot consist of a random collection of individual rooms or beds that are scattered throughout the physical plant.
We note that our proposed definition of distinct parts does not represent an additional burden on SNFs; rather, it would simply add increased clarity and specificity to the process of determining distinct part status. We believe that establishing more definitive criteria in this area will actually help reduce the existing burden on SNFs by adding greater clarity and predictability to the process of determining a SNF's distinct part status.Start Printed Page 26779
Further, we note that the numerous requests that we have received for clarification of the distinct part criteria have arisen, in part, from a June 4, 1996, memorandum in which we reiterated our longstanding interpretation that sections 1819(a) and 1919(a) of the Act allow for a maximum of one distinct part SNF (and one distinct part NF) within a single institution. We issued this memorandum in response to an increasing number of situations involving the merger of two hospitals on separate campuses, each of which brings its own distinct part SNF into the merger. Under our policy of allowing only one distinct part SNF per institution, such a merger would result in the creation of a single distinct part SNF consisting of two noncontiguous units in different locations (as opposed, for example, to a distinct part consisting of noncontiguous wards, wings, or floors that are all located within the same building or campus).
Posting of resident's rights (§ 483.10(b));
Posting of names, addresses, and telephone numbers of all pertinent State client advocacy groups (§ 483.10(b)(7)(iii));
Prominently displayed facility information (§ 483.10(b)(10));
Readily available survey results (§ 483.10(g));
Organized resident and family groups (§ 483.15(c));
Equal access by residents to activities and social services (§ 483.15(b), § 483.15(f), and § 483.15(g));
Except where waived, the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week (§ 483.30(b));
Designating a person to serve as director of food services who receives frequently scheduled consultation from a qualified dietitian, unless a qualified dietitian is employed on a full-time basis (§ 483.35(a)); and
The physical environment requirements, including life safety, and provisions for space and equipment in dining, health services, recreation and program areas, to enable staff to provide residents with needed services as required by these standards and as identified in each resident's plan of care (§ 483.15(h) and § 483.70).
We also propose to amend the regulations at § 483.12, to establish a resident's right to remain in (or return to) the same location of the composite distinct part to which he or she was originally admitted. To avoid any confusion regarding the distinct part criteria applicable to SNFs, we would amend the provider-based regulations at § 413.65(a)(1)(ii)(D) to include a cross-reference to the new distinct part criteria. Currently, the regulations at § 413.65(a)(1)(ii)(D) indicate only that provider-based determinations under these regulations do not apply to SNFs. We would amend § 413.65(a)(1)(ii)(D) by adding a parenthetical statement indicating that determinations for SNFs are made under the regulations at § 483.5.
We are also taking this opportunity to correct a typographical error that currently appears in the regulations text at § 483.20(k)(1) (regarding the required comprehensive care plan for long-term care facility residents), in which the word “describe” is misspelled as “describer.”
In § 409.20, we would make a technical correction to the cross-reference that appears in paragraph (c).
We would revise § 483.5 to include specific definitions of the terms “distinct part” and “composite distinct part.” In addition, we would make conforming changes elsewhere in subpart B of part 483 of the regulations, as well as in parts 413 and 440, and we would correct a typographical error that currently appears in the regulations text at § 483.20(k)(1).
We have examined the impacts of this proposed rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review), the Regulatory Flexibility Act (RFA) (September 16, 1980, Pub. L. 96-354), section 1102(b) of the Social Security Act, (the Act) the Unfunded Mandates Reform Act of 1995 (UMRA), (Pub. L. 104-4), and Executive Order 13132.
Executive Order 12866 (as amended by Executive Order 13258, which merely assigns responsibility of duties) directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). This proposed rule is a major rule, as defined in Title 5, United States Code, section 804(2), because we estimate the Start Printed Page 26780impact of the update will be to increase payments to SNFs by approximately $400 million. The update set forth in this proposed rule applies to payments in FY 2004. Accordingly, the analysis that follows describes the impact of this one fiscal year only. In accordance with the requirements of the Act, we will publish a notice for each subsequent fiscal year that will provide for an update to the payment rates and that will include an associated impact analysis.
For the purpose of this proposed rule, we have used the MEDPAR analog classification, and estimated current SNF PPS reimbursement as if the swing-bed providers were fully phased into the SNF PPS in FY 2002. Then, using the Start Printed Page 26781same MEDPAR analog classifications, we applied the FY 2004 changes for a fully phased-in swing-bed population. We estimate that the overall impact on swing-bed facilities will be an increase in payments of approximately 2.9 percent, or $6.4 million.
2. In § 409.20, the introductory text to paragraph (c) is revised to read as follows:
§ 409.20
Coverage of services.
In § 409.21 through § 409.36—.
2. In § 413.65, paragraph (a)(1)(ii)(D) is revised to read as follows:
Requirements for a determination that a facility or organization has provider-based status.
(D) Skilled nursing facilities (SNFs) (determinations for SNFs are made in accordance with the criteria set forth in § 483.5 of this chapter).
2. In § 440.40, paragraph (a)(1)(ii)(A) is revised to read as follows:
§ 440.40
(A) A facility or distinct part (as defined in § 483.5(b) of this chapter) that is certified to meet the requirements for participation under subpart B of part 483 of this chapter, as evidenced by a valid agreement between the Medicaid agency and the facility for providing nursing facility services and making payments for services under the plan; or
2. In § 440.155(c), the introductory text is revised to read as follows:
§ 440.155
Nursing facility services, other than in institutions for mental diseases.
(c) “Nursing facility services” may include services provided in a distinct part (as defined in § 483.5(b) of this chapter) of a facility other than a nursing facility if the distinct part (as defined in § 483.5(b) of this chapter)—
(a) Facility defined. For purposes of this subpart, facility means a skilled nursing facility (SNF) that meets the requirements of sections 1819 (a), (b), (c), and (d) of the Act, or a nursing facility (NF) that meets the requirements of sections 1919 (a), (b), (c), and (d) of the Act. “Facility” may include a distinct part of an institution (as defined in paragraph (b) of this section and specified in § 440.40 and § 440.155 of this chapter), but does not include an institution for the mentally retarded or persons with related conditions Start Printed Page 26782described in § 440.150 of this chapter. For Medicare and Medicaid purposes (including eligibility, coverage, certification, and payment), the “facility” is always the entity that participates in the program, whether that entity is comprised of all of, or a distinct part of, a larger institution. For Medicare, a SNF (see section 1819(a)(1) of the Act), and for Medicaid, a NF (see section 1919(a)(1) of the Act) may not be an institution for mental diseases as defined in § 435.1009 of this chapter.
(1) Definition. A composite distinct part is a distinct part consisting of two or more noncontiguous components that are not located within the same campus, as defined in § 413.65(a)(2) of this chapter.
3. In § 483.10, the following new paragraph (b)(12) is added to read as follows:
(12) Admission to a composite distinct part. In its admission agreement, a facility that is a composite distinct part (as defined in § 483.5(c) of this subpart) must disclose its physical configuration, including the various locations that comprise the composite distinct part, and must specify the policies that apply to room changes between its different locations under § 483.12(a)(8) of this subpart.
4. In § 483.12, the following changes are made:
Admission, transfer, and discharge rights.
(8) Room changes in a composite distinct part. Room changes in a facility that is a composite distinct part (as defined in § 483.5(c) of this subpart) must be limited to moves within the particular building in which the resident resides, unless the resident voluntarily agrees to move to another of the composite distinct part's locations.
(4) Readmission to a composite distinct part. When the nursing facility Start Printed Page 26783to which a resident is readmitted is a composite distinct part (as defined in § 483.5(c) of this subpart), the resident must be permitted to return to an available bed in the particular location of the composite distinct part in which he or she resided previously. If a bed is not available in that location at the time of readmission, the resident must be given the option to return to that location upon the first availability of a bed there.
3. In § 483.20(k)(1), the word “describer” is revised to read “describe''.