Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 206.00 - Standard Payments to Nursing Facilities › Section 206.02 - General Definitions

Current through Register 1525, July 5, 2024
As used in
				101 CMR
				206.00, unless the context requires otherwise, terms
				have the following meanings.
Administrative and General Costs
.
				Administrative and general costs include the amounts reported in the following
				accounts: administrator salaries; payroll taxes - administrator; worker's
				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 advertisement; 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:
Board of
				Registration of Nursing Home Administrators
.
Advanced Dementia Exclusion
. A
				determination by the Department of Mental Health or its designee, the
				Massachusetts Medical School Pre-admission Screening and Resident Review
				(PASRR) Unit, that a diagnosis of serious mental illness does not apply to an
				individual, for the purposes of PASRR, when that individual has a diagnosis of
				dementia or Alzheimer's disease and/or related disorder (ADRD) that co-occurs
				with a mental illness/disorder diagnosis, and the dementia/ADRD is both primary
				and so severe that the individual would be unable to benefit from
				treatment.
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.
Base Year
. The calendar year used to
				compute the standard payments.
Body Mass Index (BMI)
. A person's
				weight divided by their height.
Capital Costs
. Capital costs include
				depreciation expenses on building, improvements, equipment, software, and other
				limited life assets; long-term interest expense; building insurance; real
				estate tax; non-income portion of Massachusetts Corporate Excise Taxes;
				personal property taxes on nursing facility equipment; other rental expenses
				for fixed costs; and other fixed costs.
Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
Centers for Medicare and Medicaid Services
				(CMS)
. The federal agency under the U.S. Department of Health and
				Human Services that is responsible for administering the Medicare and Medicaid
				programs.
Department of Public Health (DPH)
. An
				agency of the Commonwealth of Massachusetts, established under M.G.L. c. 17,
				§ 1.
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 preadmission 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.
Equipment
. A fixed asset, usually
				moveable, accessory or supplemental to the building, including such items as
				beds, tables, and wheelchairs.
Executive Office of Health and Human Services
				(EOHHS)
. The executive department of the Commonwealth of
				Massachusetts established under M.G.L. c. 6A, § 2 that, through the
				Executive Office of Elder Affairs, the MassHealth program, and other agencies
				within EOHHS, as appropriate, operates and administers the programs of medical
				assistance and medical benefits under M.G.L. c. 118E and that serves as the
				single state agency under § 1902(a)(5) of the Social Security Act.
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 freestanding 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; preadmission 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 resident is not present.
Induction Period
. Days that a nursing
				facility patient is transported to an Opioid Treatment Program by a nursing
				facility direct care staff for the purpose of induction on medication assisted
				treatment at the Opioid Treatment Program.
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.
Management Minute Questionnaire (MMQ)
.
				A method of measuring resident care intensity, or case mix, by discrete care
				giving activities or the characteristics of residents found to require a given
				amount 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.
Minimum Data Set (MDS)
. A CMS-provided
				standardized assessment tool for nursing facilities to determine a nursing
				facility patient's Patient Driven Payment Model (PDPM) case mix
				category.
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 of Public Health pursuant to
				M.G.L. c. 111, and certified by the Department of Public Health for
				participation in MassHealth. It includes facilities that operate a licensed
				residential care unit within the nursing facility.
Operating Costs
. 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 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.
Patient Driven Payment Model (PDPM)
.
				The case mix classification system provided by CMS to classify nursing facility
				patients into payment groups.
Patient Driven Payment Model (PDPM) Nursing Case
				Mix
. One of the five case-mix adjusted components of the CMS
				Patient Driven Payment Model.
Private Nursing Facility
. A nursing
				facility that formerly served only non-Medicaid residents and does not have a
				provider agreement with the MassHealth agency to provide services to public
				residents.
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.
Rate Year
. The 12-month period from
				October 1st through September
				30th.
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 §§ 267(b) and (c) of
				the Internal Revenue Code of 1954 provided, however, that 10% is 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.
Replacement Facility
. A nursing
				facility that replaces its entire building with a newly constructed facility
				pursuant to an approved determination of need under
				105 CMR
				100.000:
Determination of Need
. A
				facility that renovates a building previously licensed as a nursing facility is
				not a replacement facility.
Reported Costs
. All costs reported in
				the cost report.
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 of
				Public Health 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 of Public Health to provide
				residential care.
State Fiscal Year (SFY)
. The 12-month
				period from July 1st through June
				30th.
Unit
. A unit is an identifiable
				section of a nursing facility such as a wing, floor, or ward as defined in
				105 CMR
				150.000:
Licensing of Long-term Care
				Facilities
.