Michigan Administrative Code › Department - Health and Human Services › Medical Services Administration › Enforcement System for Long-Term Care Facilities › Part 11 - ENFORCEMENT SYSTEM FOR LONG-TERM CARE FACILITIES › Section R. 330.11001 - Definitions

Current through Vol. 24-12, July 15, 2024
Rule 11001. As used in this part:
(a) "Administrative or clinical advisor"
				  means an additional remedy imposed upon a facility for the purpose of
				  monitoring and mentoring the facility administrative staff or clinical staff or
				  both through the period of corrective action.
(b) "Category" means a grouping of remedies
				  used to address and correct a certain level of deficiency.
(c) "Civil money penalty" means a fiscal
				  assessment amount which is within a range commensurate to the level of
				  noncompliance, for example, immediate jeopardy or non-immediate jeopardy, and
				  which is levied against nursing facilities for certain findings of
				  noncompliance. A civil money penalty is determined by multiplying an amount,
				  based upon the finding of noncompliance, by the number of days of
				  noncompliance. A daily civil money penalty shall be assessed up to and
				  including the day before the state medicaid agency or the health care financing
				  administration determines that the facility is in substantial compliance or up
				  to and including the day that the civil money penalty is no longer
				  warranted.
(d) "Date certain" means
				  the last day of a specified time frame in which a nursing facility is allowed
				  to correct deficiencies, generally without the application of remedies. A date
				  certain may be allowed at the state medicaid agencys discretion. A date certain
				  shall not be allowed in cases involving an immediate-jeopardy situation or
				  involving a poor-performer facility. If substantial compliance is not attained
				  by the date certain, then the state medicaid agency shall impose 1 or more
				  remedies after reviewing the determinations of the state survey
				  agency.
(e) "Deficiency" means a
				  nursing facilitys failure to meet any participation requirement as specified in
				  section 1919 of the social security act of 1935, as amended, being
				  42 U.S.C.
				  §1396 r et seq. or in
				  42
				  C.F.R. §§483.5 to
				  485.75(1992).
(f) "Department"
				  means the Michigan department of community health (MDCH).
(g) "HCFA" means the federal health care
				  financing administration.
(h)
				  "Immediate jeopardy" means a situation in which the nursing facilitys
				  noncompliance with 1 or more requirements of participation has caused, or is
				  likely to cause, serious injury, harm, impairment, or death to a
				  resident.
(i) "Menu" means a
				  grouping of remedy categories that takes into account facility history and the
				  current level of nursing facility noncompliance or deficient
				  practices.
(j) "Needing early
				  review" means a facility identified for possible immediate imposition or
				  recommendation of enforcement remedies by the state survey agency under its
				  licensure authority.
(k)
				  "Noncompliance" means the presence of any deficiency that causes a nursing
				  facility to not be in substantial compliance.
(l) "Nursing facility" means a facility which
				  provides long-term nursing care, which is enrolled in the states medicaid
				  program, and which is not enrolled in the medicare program. The term excludes a
				  facility owned by the state. The term includes a county medical care facility
				  and a hospital long-term care unit if not enrolled in the medicare
				  program.
(m) "OBRA" means the
				  omnibus budget reconciliation act of 1987, as amended, being Public Law
				  100-203, 101 Stat. 1.
(n) "Plan of
				  correction" means a plan accepted by the state survey agency that is mandatory
				  for all deficiencies of scope and severity levels B through L on the remedy
				  determination grid table 1 of this part, referred to in this part as the "quick
				  reference chart." If a facility fails to obtain an accepted plan of correction,
				  then the state medicaid agency shall impose remedies immediately.
(o) "Poor performer" means a federally
				  identified poor-performing nursing facility. The state medicaid agency shall
				  not afford a poor performer an opportunity to correct deficiencies before
				  remedies are imposed.
(p) "Remedy"
				  means a corrective action which is specified in federal or state law or these
				  rules and which is taken by the state survey agency or the state medicaid
				  agency against a nursing facility for findings of deficiencies.
(q) "Repeat deficiency" means a deficiency
				  which is in the same regulatory grouping of requirements and which is found
				  again at the next survey.
(r)
				  "Repeated noncompliance" means a finding of substandard quality of care based
				  on 3 consecutive standard surveys [standard survey as stated in section
				  1919(g)(2)(A) of the social security act of 1935,
				  42
				  U.S.C.§1396 r(g)(2)(A)] regardless of
				  whether the exact tag number of deficiency was repeated or that the substance
				  of a deficiency was repeated.
(s)
				  "State medicaid agency" means the Michigan department of community health,
				  medical services administration.
(t) "State survey agency" means the Michigan
				  department of consumer and industry services (MDCIS).
(u) "Substandard quality of care" or "SQC"
				  means 1 or more deficiencies on the remedy determination grid in square f, h,
				  i, j, k, or l of table 1 of this part that constitute any of the following
				  related to participation requirements under
				  42 C.F.R.
				  §483.13, resident behavior and facility
				  practices,
				  42 C.F.R.
				  §483.15, quality of life, or
				  42 C.F.R.
				  §483.25, quality of care:
(i) Immediate jeopardy to resident health or
				  safety.
(ii) A pattern of actual
				  harm or widespread actual harm that is not immediate jeopardy.
(iii) A widespread potential for more than
				  minimal harm, but less than immediate jeopardy, with no actual harm.