Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 204.00 - Rates of Payment to Resident Care Facilities › Section 204.02 - General Definitions

Current through Register 1525, July 5, 2024
As used in 101 CMR 204.00, unless the context requires
				otherwise, terms have the meanings in
				101
				CMR 204.02.
Actual Utilization Rate
. The
				percentage of occupancy of a resident care facility. It is calculated by
				dividing total resident days by maximum available bed days.
Additions
. New units or enlargements
				of existing units that may or may not be accompanied by an increase in licensed
				bed capacity.
Base Year
. The calendar year or
				portion of the calendar year that is used to compute the prospective rates as
				defined in
				101
				CMR 204.04. The base year for rates effective
				January 1, 2024, is 2021.
Building
. The structure that houses
				residents. Building costs include the direct cost of construction of the shell
				and expenditures for service equipment and fixtures such as elevators,
				plumbing, and electrical fixtures that are 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, but not
				mortgage acquisition costs. When the fixed assets of a facility are sold, the
				allowable book value of all improvements will become part of the allowable
				basis of the building for the buyer.
Center
. The Center for Health
				Information and Analysis (CHIA), 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 and must be a sale of assets of the facility 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.
Community Support Facility
. A resident
				care facility licensed by the Department in compliance with 105 CMR 150.000:
Standards for Long-term Care Facilities
that provides or makes
				arrangements to provide appropriate mental health services in addition to the
				minimum basic care and services required by 105 CMR 150.000 for residents who
				do not routinely require nursing or other medically related services.
Community Support Resident
. An
				individual in need of resident care facility services, who is 50 years of age
				or older, and who, upon the written consent of the individual (if he or she is
				competent to give such consent) or guardian (if he or she is not competent),
				and a physical evaluation by a psychiatrist or other physician, and a
				psychiatric evaluation by a psychiatrist, is deemed appropriate by both for
				residency and services provided by a community support facility pursuant to 105
				CMR 150.000:
Licensing of Long Term Care Facilities
or its
				most recent applicable regulation. Any exceptions and additional factors used
				to determine whether a resident is a community support facility resident will
				be in accordance with 105 CMR 150.000.
Community Support Resident Days
. The
				number of days of occupancy by community support residents in a community
				support facility or a resident care facility with community support residents.
				Community support resident days include the day of admission, but not the day
				of discharge. Where admission and discharge occur on the same day, one
				community support resident day will be used. Those days a bed is held vacant
				for a publicly aided community support resident temporarily placed in a
				different care situation, pursuant to an agreement between the provider and the
				Department of Transitional Assistance in accordance with duly established
				policies of said Department, are included as community support resident days.
				Those days a bed is held vacant for a non-publicly aided resident, whether or
				not there is a charge for such reservation by the facility, are included as
				community support resident days.
Constructed Bed Capacity
. A resident
				care facility's bed capacity (or clinical bed capacity) as defined in
				105
				CMR 100.100:
Definitions
,
				which states: the capacity of a building to accommodate a bed and the necessary
				physical appurtenances in accordance with the applicable standards imposed as a
				condition of operation under state law. It includes a room designed or able to
				accommodate a bed and necessary physical appurtenances, whether or not a bed
				and all such appurtenances are actually in place, with any necessary utilities
				(
e.g
., drinking water, sprinkler lines, oxygen, electric
				current, electric signals,
etc
.), with either outlets or
				capped lines within the room.
Deferred Charges
. Expenditures, such
				as prepaid insurance, rent or licenses, not recognized as a cost of operations
				for the period in which they were incurred, but carried forward to be written
				off in one or more future periods. Deferred charges are not expenditures that
				can be identified with and justified as relating to physical assets that will
				contribute services to future operations.
Department
. The Massachusetts
				Department of Public Health.
Department of Transitional Assistance Days (DTA
				Days)
. Days of resident care facility services provided to
				residents who are recipients of Emergency Assistance for the Elderly, Disabled
				and Children (EAEDC) or Supplemental Security Income/State Supplemental
				Payments (SSI/SSP) funded by DTA.
Desk Audit
. A comprehensive audit
				performed at the Center's offices in which the auditor evaluates the accuracy
				of the information in the cost reports and supporting documentation in
				accordance with an audit program.
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.
EOHHS
. The Executive Office of Health
				and Human Services, established under M.G.L. c. 6A.
Equipment
. Tangible fixed assets,
				usually moveable, that are accessory or supplemental to such larger items as
				buildings and structures.
Exit Conference
. A conference
				conducted at the close of an on-site field audit at which the Center auditors
				present audit findings and recommendations to the provider. The provider may
				respond to the Center's findings and may present additional information for
				review. The conference may take place at a scheduled meeting or by
				telephone.
Field Audit
. An audit performed
				on-site at the resident care facility in which the auditor evaluates the
				accuracy of the information in the cost reports and claim for reimbursement by
				examining the books and records of the facility by evaluating internal
				controls, observing the physical plant, and interviewing resident care facility
				staff.
Fixed Costs
. Indirect resident care
				costs, independent of the level of occupancy, including interest associated
				with long-term debt; depreciation of buildings; building improvements;
				equipment and software; equipment; insurance on buildings and equipment; real
				estate taxes; rent; the non-income related portion of the Massachusetts
				corporate excise tax; personal property tax; and equipment rental.
Generally Available Employee Benefits
.
				The employee benefits that are reasonable and necessary for the efficient
				operation of the facility including, but not limited to, insurance, pensions,
				bonuses, child care, and non-required but job-related education. Such benefits
				must be nondiscriminatory and available to all full-time employees.
Improvements
. Expenditures that
				increase the quality of the existing building by rearranging the building
				layout or substituting improved components for old components so that
				facilities are in some way better than before the renovation. Improvements do
				not add to the existing building nor do they expand the square footage of the
				building. An improvement is measured by the facility's increased productivity,
				greater capacity, or longer life.
Imputed Value
. An alternative cost
				based on a standard amount to be used by EOHHS in
lieu
of
				other costs.
Indirect Restorative Therapy
. Services
				of physical therapists, occupational therapists, and speech, hearing, and
				language therapists to provide orientation programs for aides and assistants,
				in-service training to staff, and consultation and planning for continuing care
				after discharge.
Industrial Accident Resident
. A person
				receiving resident care facility services for which an employer or an insurer
				is liable under M.G.L. c. 152 (the Workers' Compensation Act).
Land Costs
. The purchase price plus
				the cost of bringing land to productive use including, but not limited to,
				commissions to agents, attorney's fees, demolition of buildings, clearing and
				grading the land, site-survey, soil investigation, streets, off-site sewer and
				water lines, and public utility charges necessary to service the land. Land
				must be necessary for the care of publicly aided residents.
Licensed Bed Capacity
. A resident care
				facility's licensed bed capacity as defined by
				105 CMR 100.100:
Definitions
, which states: the portion of bed capacity, by
				number of beds, which a provider under its license, as issued or subsequently
				modified, is authorized to use for patient occupancy, or in the case of a
				facility operated by a government agency, the number of beds approved by the
				Department.
Limited Life Assets
. Limited life
				assets include software, wallpaper, and painting.
Long-term Interest Expense
. Reasonable
				and necessary expense that is incurred for the use of legitimate loans related
				to the care of publicly aided residents and that is supported by allowable,
				depreciable fixed assets. It includes all of the costs of borrowing money
				including, but not limited to, interest, allowable mortgage acquisition costs,
				and mortgage insurance premiums.
Major Additions
. A newly constructed
				addition to a facility that increases the licensed bed capacity of the facility
				by 50% or more.
Massachusetts Corporate Excise Tax
.
				Those taxes that have been paid to the Massachusetts Department of Revenue in
				connection with the filing of Form 355, Business/Manufacturing Corporate Excise
				Return.
Maximum Available Bed-days
. The total
				number of licensed bed-days 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
				facility's weighted average licensed bed capacity for the calendar year. The
				value is calculated by multiplying the licensed bed capacity by the number of
				days in the calendar year for which the facility was licensed to determine the
				maximum available bed-days. The maximum available bed-days is divided by the
				number of days in the calendar year to determine the mean licensed bed
				capacity.
Mortgage Acquisition Costs
. Those
				costs, including finder's fees, points, certain legal fees, and filing fees,
				that are necessary to obtain long-term financing through a mortgage, bond, or
				other long-term debt instrument.
Nonprofit Provider
. A provider either
				organized for charitable purposes or recognized as a nonprofit entity by the
				Internal Revenue Service. This includes Massachusetts corporations organized
				under M.G.L. c. 180; clubs, associations, organizations, or tax-exempt
				entities; corporations organized under M.G.L. c. 156B and granted a tax
				exemption under the Internal Revenue Code, § 501(c)(3); and facilities
				owned or operated by governmental units.
Nursing Facility
. A nursing or
				convalescent home, infirmary maintained in a town, or 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 the MassHealth program, or
				facilities licensed to operate a residential care unit within a nursing
				facility or those exempt from licensure under M.G.L. c. 111, § 73B.
Proprietary Provider
. A provider that
				does not meet the criteria specified in 101 CMR 204.02:
Nonprofit
				Provider
.
Provider
. A resident care facility
				providing care to publicly aided 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 as
				to whose care in a resident care facility the Commonwealth or a political
				subdivision of the Commonwealth is in whole or in part financially
				liable.
Rate Year
. The period in which the
				rate determined under
				101 CMR 204.00 is
				effective.
Related Party
. An individual or
				organization associated or affiliated with, or that has control of, or is
				controlled by, the provider; or any director, stockholder, trustee, partner, or
				administrator of the provider by common ownership or control or in a manner
				specified in the Internal Revenue Code of 1954, §§ 267(b), 267(c),
				and 318; provided, however, that 10% must be the operative factor as set out in
				§§ 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.
Resident Care Facility (Facility)
. A
				facility licensed by the Department in compliance with 105 CMR 150.000:
Standards for Long-term Care Facilities
or exempt from
				licensure under M.G.L. c. 111, § 73B providing protective supervision in
				addition to the minimum basic care required by 105 CMR 150.000 for residents
				who do not routinely require nursing or other medically related
				services.
Resident Days
. The number of days of
				occupancy by residents in a facility. Included in the computation of resident
				days is the day of admission, but not the day of discharge. Where admission and
				discharge occur on the same day, one resident day is used. Those days in which
				a bed is held vacant and reserved for a publicly aided resident temporarily
				placed in a different care situation, are included as resident days. Those days
				on which a bed is held vacant and reserved for a non-publicly aided resident,
				whether or not there is a charge for such reservation by the facility, are
				included as resident days.
Responsible Person
. A person 21 years
				of age or older who has received a high school diploma, is of good moral
				character, and has the ability to communicate orally and in writing in English
				or the primary language used by residents of the facility, and who will make
				mature and accurate judgments regarding the care needs of the residents as
				required by 105 CMR 150.000:
Standards for Long-term Care
				Facilities
.
Sole Proprietor
. A business enterprise
				other than a corporation or partnership in which the net worth belongs entirely
				to one individual.
Support Service Coordinator
. A person
				who has received a BA or BS degree in a human service field of study such as
				psychology, nursing, or social work and who is employed by a community support
				facility to identify, monitor, and meet the support service needs of community
				support residents.
Support Services
. Those services
				provided for the benefit of community support resident(s) in order to enhance
				psycho-social and physical functioning as defined by the Department in 105 CMR
				150.000:
Standards for Long-term Care Facilities
.
Unit
. Unit has the same definition as
				in 105 CMR 150.000:
Standards for Long-term Care
				Facilities
.
Variable Costs
. Costs that change
				depending on the volume of occupancy. Variable costs include the allowable
				amounts reported in the following accounts from the cost report:
				administrator/responsible person salaries and benefits; clerical salaries;
				EDP/payroll/bookkeeping services; office supplies; telephone, except directory
				advertising; motor vehicle expense; conventions and meetings; advertising, help
				wanted; licenses and dues, resident care related; total education and training;
				total employee benefits, except officers, profit sharing and other benefits;
				accounting services not related to appeals; total payroll taxes, except
				officer; nonprofit DES claims; malpractice and general liability insurance;
				total Workers' Compensation, except officer; total group life/health, except
				officer; total plant operations; total dietary; total laundry; total
				housekeeping; total nursing; quality assurance professional; community support
				coordinator; total physician services; house supplies, not resold; pharmacy
				consultant; social service worker; indirect therapy salaries; indirect therapy
				consultants; total recreation, except transportation; realty company variable
				add-back; management company variable and fixed cost add-back, less
				non-allowable self-disallowances; vending machine income; and other operating
				cost recoverable income.