Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 147 - REIMBURSEMENT FOR NURSING COSTS FOR GERIATRIC FACILITIES › Section 147.320 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
For purposes of this Part, the following terms shall be defined
				as follows:
"Active Disease Diagnosis" means a physician documented
				diagnosis (or by a nurse practitioner, physician assistance, or clinical nurse
				specialist if allowable under State licensure laws) that have a direct
				relationship to the resident's current functional status, cognitive status,
				mood or behavior, medical treatments, nursing monitoring or risk of
				death.
"Assessment Reference Date" means the last day of the Minimum
				Data Set (MDS) look-back period. The date sets the designated endpoint of the
				look-back period in the MDS process, and all MDS items refer back in time from
				that point. This period of time is also called the observation or assessment
				period.
"Case Mix" means a method of classifying care that is based on
				the intensity of care and services provided to the resident.
"Case Mix Index" means the weighting factors assigned to each
				RUG-IV classifications.
"Case Mix Reimbursement System" means a payment system that
				measures the intensity of care and services required for each resident, and
				translates these measures into the amount of reimbursement given to the
				facility for care of a resident.
"Continuous Positive Airway Pressure" or "CPAP" means a
				respiratory support device that prevents the airways from closing by delivering
				slightly pressurized air through a mask continually or via electronic cycling
				throughout the breathing cycle. The mask enables the individual to support his
				or her own respirations by providing enough pressure when the individual
				inhales to keep his or her airway open.
"Department" means the Illinois Department of Healthcare and
				Family Services (HFS).
"Fraud" means an intentional deception or misrepresentation
				made by a person with the knowledge that the deception could result in some
				unauthorized benefit to him or herself or some other person. It includes any
				act that constitutes fraud under applicable federal or State law.
"Index Maximization" means a method to classify a resident who
				could be assigned to more than one category, to the category with the highest
				case mix index.
"Minimum Data Set" or "MDS" means the assessment instrument
				specified by the Centers for Medicare and Medicaid Services (federal CMS) and
				designated by the "Department". A core set of screening, clinical, and
				functional status elements, including common definitions and coding categories,
				forms the foundation of a comprehensive assessment.
"Monitoring" means the ongoing collection and analysis of
				information (such as observations and diagnostic test results) and comparison
				to baseline and current data in order to ascertain the individual's response to
				treatment and care, including progress or lack of progress towards a goal.
				Monitoring can detect any improvements, complications or adverse consequences
				of the condition or of the treatments, and support decisions about adding,
				modifying, continuing or discontinuing any interventions.
"Nursing Monitoring" means clinical monitoring (e.g., serial
				blood pressure evaluations, medication management, etc.) by a licensed
				nurse.
"Resource Utilization Group" or "RUG" means the system for
				grouping a nursing facility's residents according to their clinical and
				functional status identified in MDS data supplied by a facility.
"Significant Error" means an error in an assessment where a
				resident's overall clinical status in not accurately represented and the error
				has not been corrected via submission of a more recent assessment.
"Ventilator or Respirator" means a type of electronically or
				pneumatically powered closed system mechanical ventilator support devices that
				ensures adequate ventilation in the resident who is, or who may become, unable
				to support his or her respirations.