Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-22 - NURSING FACILITY REIMBURSEMENT › Section 560-X-22-.03 - Definitions

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
Accrual
			 Method of Accounting
- Revenues must be allocated to the accounting
			 period in which they are earned and expenses must be charged to the period in
			 which they are incurred. This must be done regardless of when cash is received
			 or disbursed.
(2)
Adjusted
			 Reported Costs
- The net reported costs from Schedule D, Column 7, of
			 the cost report adjusted, as required, for unallowable costs, and cost recovery
			 items.
(3)
Medicaid
-
			 The Alabama Medicaid Agency.
(4)
Medicaid Reimbursement Principles
- A combination of generally
			 accepted accounting principles, principles included in the State Plan, Medicare
			 (Title XVIII) Principles of Reimbursement, and procedures and principles
			 promulgated by Medicaid to provide reimbursement of provider costs which must
			 be incurred by efficiently and economically operated nursing
			 facilities.
(5)
Allowable
			 Costs
- The costs of a provider of nursing facility services which must
			 be incurred by an efficiently and economically operated facility and which are
			 not otherwise disallowed by the reimbursement principles established under and
			 incorporated into this chapter.
(6)
Approved Bed Rate
- The Medicaid rate paid to nursing facilities
			 for approved beds. (See Section 5 for computation.)
(7)
Category
- Grouping formed
			 according to type of facility. Medicaid categories to which this chapter
			 applies are: NF, NF/IMD, and NF/IDD.
(8)
Chapter
- This chapter
			 (560-X-22) of the
Alabama Medicaid Administrative
			 Code
.
(9)
Cost
			 Recovery Item
- Income generated by an element of allowable
			 cost.
(10)
Facility
-
			 Any structure licensed by the State of Alabama for the purpose of providing
			 long-term care to the aged, ill, or disabled.
(11)
Fair Market Value
- The
			 bona fide price at which an asset would change hands or at which services would
			 be purchased between a willing buyer and a willing seller, neither being under
			 any compulsion to buy or sell and both having reasonable knowledge of the
			 relevant facts.
(12)
Fiscal
			 Year
- The 12 month period upon which providers are required to report
			 their costs, being the period from July 1st through June 30th, also called the
			 "reporting period."
(13)
HCFA
- The Health Care Financing Administration, an agency of the
			 U.S. Department of Health and Human Services.
(14)
HIM-15
- The title of the
			 Medicare Provider Reimbursement Manual, a publication of HCFA. All references
			 to this manual or to Title XVIII Principles of Reimbursement in Chapter 22 are
			 for the "Retrospective" Reasonable Cost Reimbursement Principles and not those
			 of the 10-1-83 Prospective Medicare System.
(15)
Hold Bed Days
- The period
			 during which a provider receives payment from a source other than Medicaid for
			 the reservation of a bed in a long-term care facility for a particular patient
			 who is not in the facility. Hold bed days do not include therapeutic leave
			 covered by Medicaid.
(16)
Home Office Costs
- See Rule
			 560-X-22-.20 for indepth
			 discussion and treatment of home-office costs.
(17)
Imprest System
- A system
			 in which any fund is replenished by writing a check equal to the payments which
			 have been made out of the fund. Examples of such funds are petty cash and
			 payroll.
(18)
Interest
- Cost incurred for the use of borrowed funds.
(a)
Necessary Interest
-
			 Incurred to satisfy a financial need of the provider on a loan made for a
			 purpose directly related to patient care. Necessary interest cannot include
			 loans resulting in excess funds or investments.
(b)
Proper Interest
- Must be
			 necessary as described above, incurred at a rate not in excess of what a
			 prudent borrower would have to pay in the money market at the time the loan was
			 made, and incurred in connection with a loan directly related to patient care
			 or safety.