Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 7.00 - Nursing Facilities Cost Reporting Requirements › Section 7.02 - Definitions

Current through Register 1525, July 5, 2024
All defined terms in
				957 CMR 7.00 are capitalized.
				As used
				957 CMR 7.00, unless the
				context requires otherwise, terms have the following meanings:
Additions
. New Units or enlargements
				of existing Units that may or may not be accompanied by an increase in Licensed
				Bed Capacity.
Administrative and General Costs
.
				Administrative and General Costs include the amounts reported in the following
				accounts: administrator salaries; payroll taxes - administrator; workers'
				compensation - administrator; group life/health - administrator; administrator
				pensions; other administrator benefits; clerical; EDP/payroll/bookkeeping
				services; administrator-in-training; office supplies; phone; conventions and
				meetings; help wanted advertisements; licenses and dues (resident-care
				related); education and training - administration; accounting - other;
				insurance -malpractice; other operating expenses; realty company variable
				costs; management company allocated variable costs; and management company
				allocated fixed costs.
Administrator-in-training
. A person
				registered with the Board of Registration of Nursing Home Administrators and
				involved in a course of training as described in
				245 CMR 2.00: Nursing Home
				Administrators.
Audit
. An examination of the
				Provider's cost report and supporting documentation to evaluate the accuracy of
				the financial statements and identification of Medicaid patient-related
				costs.
Building Costs
. Building Costs include
				the direct cost of construction of the structure that houses residents and
				expenditures for service Equipment and fixtures such as elevators, plumbing and
				electrical fixtures made a permanent part of the structure. Building Costs also
				include the cost of bringing the building to productive use, such as permits,
				engineering and architect's fees, and certain legal fees. Building Costs
				include interest paid during construction to Building Costs but not Mortgage
				Acquisition Costs.
Capital Costs
. Capital Costs include
				building depreciation, Financing Contribution, building insurance, real estate
				taxes, non-income portion of Massachusetts Corporate Excise Taxes, other rent
				and Other Fixed Costs.
Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
Change of Ownership
. A bona fide
				transfer, for reasonable consideration, of all the powers and indicia of
				ownership. A Change of Ownership may not occur between Related Parties. A
				Change of Ownership must be a sale of assets of the Provider rather than a
				method of financing. A change in the legal form of the Provider does not
				constitute a Change of Ownership unless the other criteria are met.
CMS
.The federal Centers for Medicare
				& Medicaid Services.
Department
. The Massachusetts
				Department of Public Health.
Direct Restorative Therapy
. Services
				of physical therapists, occupational therapists, and speech, hearing, and
				language therapists provided directly to individual residents to reduce
				physical or mental disability and to restore the resident to maximum functional
				level. Direct Restorative Therapy Services are provided only upon written order
				of a physician, physician assistant or nurse practitioner who has indicated
				anticipated goals and frequency of treatment to the individual resident. Direct
				Restorative Therapy Services include supervisory, administrative, and
				consulting time associated with provision of the services. These include, but
				are not limited to, reviewing pre-admission referrals, informally communicating
				with families, scheduling treatments, completing resident care documentation
				including MDS documentation, screening of patients, writing orders, meeting
				with aides to discuss patients, consulting with physicians and nurse
				practitioners, managing equipment and assessing equipment needs of
				patients.
EOHHS
.The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Equipment
. A fixed asset, usually
				moveable, accessory or supplemental to the Building, including such items as
				beds, tables, and wheelchairs.
Financing Contribution
. Payment for
				the use of necessary capital assets whether internally or externally
				funded.
Generally Available Employee Benefits
.
				Employee benefits that are nondiscriminatory and available to all full-time
				employees.
Hospital-based Nursing Facility
. A
				separate Nursing Facility Unit or Units located in a hospital building licensed
				for both hospital and Nursing Facility services in which the Nursing Facility
				licensed beds are less than a majority of the facility's total licensed beds
				and the Nursing Facility patient days are less than a majority of the
				facility's total patient days. It does not include free-standing Nursing
				Facilities owned by hospitals.
Improvements
. Expenditures that
				increase the quality of the Building by rearranging the Building layout or
				substituting improved components for old components so that the Provider is in
				some way better than it was before the renovation. Improvements do not add to
				or expand the square footage of the Building. An improvement is measured by the
				Provider's increased productivity, greater capacity, or longer life.
Indirect Restorative Therapy
. Indirect
				Restorative Therapy Services consist only of services of physical therapists,
				occupational therapists, and speech, hearing and language therapists to provide
				the following: orientation programs for aides and assistants; in-service
				training to staff; consultation and planning for continuing care after
				discharge; pre-admission meetings with families; quality improvement activities
				such as record reviews, analysis of information and writing reports; personnel
				activities including hiring, firing, and interviewing; rehabilitation staff
				scheduling; and attending team meetings including quality improvement, falls,
				skin team, daily admissions, interdisciplinary, departmental staff, discharge
				planning, and family meetings when the resident is not present.
Industrial Accident Resident
. A person
				receiving Nursing Facility services for which an employer or an insurer is
				liable under the Workers' Compensation Act, M.G.L. c. 152.
Licensed Bed Capacity
. The number of
				beds for which the Nursing Facility is either licensed by the Department of
				Public Health pursuant to
				105 CMR 100.020:
				Definitions, or for a Nursing Facility operated by a government agency, the
				number of beds approved by the Department of Public Health. The Department of
				Public Health issues a license for a particular level of care.
Massachusetts Corporate Excise Tax
.
				Those taxes that have been paid to the Massachusetts Department of Revenue in
				connection with the filing of Form 355A, Massachusetts Corporate Excise Tax
				Return.
Maximum Available Bed Days
. The total
				number of licensed beds for the calendar year, determined by multiplying the
				Mean Licensed Bed Capacity for the calendar year by the days in the calendar
				year.
Mean Licensed Bed Capacity
. A
				Provider's weighted average Licensed Bed Capacity for the calendar year,
				determined by:
(a) multiplying Maximum Available Bed Days for each level of
				care by the number of days in the calendar year for which the Nursing Facility
				was licensed for each level;
(b) adding the Maximum Available Bed Days for each level;
				and
(c) dividing the total Maximum Available Bed Days by the number
				of days in the calendar year.
Mortgage Acquisition Costs
. Those
				costs (such as finder's fees, certain legal fees, and filing fees) necessary to
				obtain long-term financing through a mortgage, bond, or other long-term debt
				instrument.
Nursing Costs
. Nursing costs include
				the Reported Costs for Director of Nurses, Registered Nurses, Licensed
				Practical Nurses, Nursing Aides, Nursing Assistants, Orderlies, Nursing
				Purchased Services, and the Workers' Compensation expense, Payroll Tax expense,
				and Fringe Benefits, including Pension Expense, associated with those
				salaries.
Nursing Facility
. A nursing or
				convalescent home; an infirmary maintained in a town; a charitable home for the
				aged, as defined in M.G.L. c. 111, § 71; or a Nursing Facility operating
				under a hospital license issued by the Department pursuant to M.G.L. c. 111,
				and certified by the Department for participation in MassHealth. It includes
				facilities that operate a licensed Residential Care Unit within the Nursing
				Facility.
Other Fixed Costs
. Other Fixed Costs
				include real estate taxes, personal property taxes on the Nursing Facility
				Equipment, the non-income portion of the Massachusetts Corporate Excise Tax,
				Building insurance, and rental of Equipment located at the facility.
Other Operating Costs
. Other Operating
				Costs include, but are not limited to the following reported costs: plant,
				operations and maintenance; dietary; laundry; housekeeping; ward clerks and
				medical records librarian; medical director; advisory physician; utilization
				review committee; employee physical exams; other physician services; house
				medical supplies not resold; pharmacy consultant; social service worker;
				Indirect Restorative Therapy and recreation therapy expense; other required
				education; job related education; quality assurance professionals; management
				minute questionnaire nurses; staff development coordinator; motor vehicle
				expenses including, but not limited to depreciation, mileage payments, repairs,
				insurance, excise taxes, finance charges, and sales tax; and Administrative and
				General Costs.
Patient Days
. The total number of days
				of occupancy by residents in the facility. The day of admission is included in
				the computation of Patient Days; the day of discharge is not included. If
				admission and discharge occur on the same day, one resident day is included in
				the computation. It includes days for which a Provider reserves a vacant bed
				for a Publicly-aided Resident temporarily placed in a different care situation,
				pursuant to an agreement between the Provider and the MassHealth agency. It
				also includes days for which a bed is held vacant and reserved for a non
				publicly aided resident.
Provider
. A Nursing Facility providing
				care to Publicly-aided Residents or Industrial Accident Residents.
Prudent Buyer Concept
. The assumption
				that a purchase price that exceeds the market price for a supply or service is
				an unreasonable cost.
Publicly-aided Resident
. A person for
				whom care in a Nursing Facility is in whole or in part subsidized by the
				Commonwealth or a political subdivision of the Commonwealth. Publicly-aided
				Residents do not include residents whose care is in whole or in part subsidized
				by Medicare.
Related Party
. An individual or
				organization associated or affiliated with, or that has control of, or is
				controlled by, the Provider; or is related to the Provider, or any director,
				stockholder, trustee, partner or administrator of the Provider by common
				ownership or control or in a manner specified in sections 267(b) and (c) of the
				Internal Revenue Code of 1954 as amended provided, however, that 10% is the
				operative factor as set out in sections 267(b)(2) and (3). Related individuals
				include spouses, parents, children, spouses of children, grandchildren,
				siblings, fathers-in-law, mothers-in-law, brothers-in-law, and
				sisters-in-law.
Reported Costs
. All costs reported in
				the cost report, less costs adjusted and/or self-disallowed.
Required Education
. Educational
				activities, conducted by a recognized school or authorized organization,
				required to maintain a professional license of employees that provide care to
				Publicly-aided Residents. Required education also includes training for nurses'
				aides.
Residential Care
. The minimum basic
				care and services and protective supervision required by the Department in
				accordance with
				105 CMR 150.000: Licensing
				of Long-term Care Facilities for residents who do not routinely require nursing
				or other medically-related services.
Residential Care Unit
. A Unit within a
				Nursing Facility licensed by the Department to provide residential care.
Unit
. A Unit is an identifiable
				section of a Nursing Facility such as a wing, floor, or ward as defined by the
				Department in
				105 CMR 150.000: Licensing
				of Long-term Care Facilities.