Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20001 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Definitions
Active Assessment
-a resident MDS
					 assessment is considered active when it has been accepted by the U.S.
					 Department of Health and Human Services, Centers for Medicare and Medicaid
					 Services (CMS). The assessment will remain active until a subsequent minimum
					 data set (MDS) assessment for the same resident has been accepted by CMS, the
					 maximum number of days (121) for the assessment has been reached, or the
					 resident has been discharged.
Administrative and Operating Cost
					 Component
-the portion of the Medicaid daily rate that is attributable
					 to the general administration and operation of a nursing facility.
Assessment Reference Date
-the date on the
					 minimum data set (MDS) used to determine the due date and delinquency of
					 assessments.
Base Resident
-
Weighted Median
					 Costs and Prices
-the resident-weighted median costs and prices
					 calculated in accordance with
					 §20005 of this rule during rebase
					 years.
Calendar Quarter
-a three-month period
					 beginning January 1, April 1, July 1, or October 1.
Capital Cost Component
-the portion of the
					 Medicaid daily rate that is:
a.
				  attributable to depreciation;
b.
				  capital related interest;
c. rent;
				  and/or
d. lease and amortization
				  expenses.
Care Related Cost Component
-the portion of
					 the Medicaid daily rate that is attributable to those costs indirectly related
					 to providing clinical resident care services to Medicaid recipients.
Case Mix
-a measure of the intensity of
					 care and services used by similar residents in a facility.
Case-Mix Documentation Review (CMDR)
-a
					 review of original legal medical record documentation and other documentation
					 as designated by the department in the MDS supportive documentation
					 requirements, supplied by a nursing facility provider to support certain
					 reported values that resulted in a specific RUG classification on a randomly
					 selected MDS assessment sample. The review of the documentation provided by the
					 nursing facility will result in the RUG classification being supported or
					 unsupported.
Case-Mix Index (CMI)
-a numerical value
					 that describes the residents relative resource use within the groups under the
					 resource utilization group (RUG-III) classification system, or its successor,
					 prescribed by the department based on the residents MDS assessments. CMIs will
					 be determined for each nursing facility on a quarterly basis using all
					 residents.
Cost Neutralization
-refers to the process
					 of removing cost variations associated with different levels of resident case
					 mix. Neutralized cost is determined by dividing a facility's per diem direct
					 care costs by the facility cost report period case-mix index.
Delinquent MDS Resident Assessment
-an MDS
					 assessment that is more than 121 days old, as measured by the assessment
					 reference date (ARD) field on the MDS.
Department
-the Louisiana Department of
					 Health (LDH), or its successor, and the associated work product of its
					 designated contractors and agents.
Direct Care Cost Component
-the portion of
					 the Medicaid daily rate that is attributable to:
a. registered nurse (RN), licensed practical
				  nurse (LPN) and nurse aide salaries and wages;
b. a proportionate allocation of allowable
				  employee benefits; and
c. the
				  direct allowable cost of acquiring RN, LPN and nurse aide staff from outside
				  staffing companies.
Facility Cost Report Period Case-Mix
					 Index
-Repealed.
Example. Repealed.
Facility-Wide Average Case-Mix
					 Index
-Repealed.
Final Case-Mix Index Report (FCIR)
-the
					 final report that reflects the acuity of the residents in the nursing
					 facility.
a. Prior to the January 1,
				  2017 rate setting, resident acuity is measured utilizing the point-in-time
				  acuity measurement system.
b.
				  Effective with the January 1, 2017 rate setting, resident acuity will be
				  measured utilizing the time-weighted acuity measurement system.
Index Factor
-based on the
Skilled
					 Nursing Home without Capital Market Basket Index
published by IHS
					 Global Insight (IHS Economics), or a comparable index if this index ceases to
					 be published.
MDS Supportive Documentation
					 Requirements
-the departments publication of the minimum documentation
					 and review standard requirements for the MDS items associated with the RUG-III
					 or its successor classification system. These requirements shall be maintained
					 by the department and updated and published as necessary.
Minimum Data Set (MDS)
-a core set of
					 screening and assessment data, including common definitions and coding
					 categories that form the foundation of the comprehensive assessment for all
					 residents of long-term care nursing facility providers certified to participate
					 in the Medicaid Program. The items in the MDS standardize communication about
					 resident problems, strengths, and conditions within nursing facility providers,
					 between nursing facility providers, and between nursing facility providers and
					 outside agencies. The Louisiana system will employ the current required MDS
					 assessment as approved by the Centers for Medicare and Medicaid Services (CMS),
					 or as mandated by the Department of Health through the use of the optional
					 state assessment (OSA).
Nursing Facility Cost Report Period Case Mix
					 Index
-the average of quarterly nursing facility-wide average case mix
					 indices, carried to four decimal places. The quarters used in this average will
					 be the quarters that most closely coincide with the nursing facility providers
					 cost reporting period that is used to determine the medians. This average
					 includes any revisions made due to an on-site CMDR.
a. For the cost reporting periods utilized in
				  the next rebase of rates on or after July 1, 2017, the calendar quarter case
				  mix index averages will be calculated using the time-weighted acuity
				  measurement system, and be inclusive of MDS assessments available as of the
				  date of the applicable quarterly FCIRs. This average includes any revisions
				  made due to an on-site CMDR.
Example: A January 1, 2015-December 31, 2015 cost report
					 period would use the time-weighted facility-wide average case mix indices
					 calculated for the four quarters ending March 31, 2015, June 30, 2015,
					 September 30, 2015 and December 31, 2015.
Nursing Facility
-
Wide Average Case
					 Mix Index
-the simple average, carried to four decimal places, of all
					 resident case mix indices.
a. Prior to
				  the January 1, 2017, rate setting resident case mix indices will be calculated
				  utilizing the point-in-time acuity measurement system. If a nursing facility
				  provider does not have any residents as of the last day of a calendar quarter
				  or the average resident case mix indices appear invalid due to temporary
				  closure or other circumstances, as determined by the department, a statewide
				  average case mix index using occupied and valid statewide nursing facility case
				  mix indices may be used.
i. Effective as of
				  the January 1, 2017 rate setting, resident case mix indices will be calculated
				  utilizing the time-weighted acuity measurement. If a nursing facility provider
				  does not have any residents during the course of a calendar quarter, or the
				  average resident case mix indices appear invalid due to temporary closure or
				  other circumstances, as determined by the department, a statewide average case
				  mix index using occupied and valid statewide nursing facility provider case mix
				  indices may be used.
Optional State Assessment (OSA)
-assessment
					 required by Louisiana Medicaid to report on Medicaid-covered stays. Allows
					 nursing facility providers using RUG-III or RUG-IV models as the basis for
					 Medicaid payment to do so until the legacy payment model (RUG-III) ends.
Allows nursing facility providers using RUG-III or RUG-IV
					 models as the basis for Medicaid payment to do so until the legacy payment
					 model (RUG-III) ends.
Patient Driven Payment Model (PDPM)
-the
					 proposed new Medicare payment rule for skilled nursing facilities. The PDPM
					 identifies and adjusts different case-mix components for the varied needs and
					 characteristics of a resident's care and then combines these with a
					 non-case-mix component to determine the full skilled nursing facilities (SNF)
					 prospective payment system (PPS) per diem rate for that resident.
Pass-Through Cost Component
-includes the
					 cost of property taxes and property insurance. It also includes the provider
					 fee as established by the Department of Health.
Point-In-Time Acuity Measurement System
					 (PIT)
-the case mix index calculation methodology that is compiled
					 utilizing the active resident MDS assessments as of the last day of the
					 calendar quarter, referred to as the point-in-time.
Preliminary Case-Mix Index Report
					 (PCIR)
-the preliminary report that reflects the acuity of the
					 residents in the nursing facility.
a.
				  Prior to the January 1, 2017 rate setting, resident acuity is measured
				  utilizing the point-in-time acuity measurement system.
b. Effective as of the January 1, 2017 rate
				  setting, resident acuity will be measured utilizing the time-weighted acuity
				  measurement system.
Rate Year
-a one-year period from July 1
					 through June 30 of the next calendar year during which a particular set of
					 rates are in effect. It corresponds to a state fiscal year.
Resident-Day-Weighted Median Cost
-a
					 numerical value determined by arraying the per diem costs and total actual
					 resident days of each nursing facility from low to high and identifying the
					 point in the array at which the cumulative total of all resident days first
					 equals or exceeds half the number of the total resident days for all nursing
					 facilities. The per diem cost at this point is the resident-day-weighted median
					 cost.
RUG-III Resident Classification System
-the
					 resource utilization group used to classify residents. When a resident
					 classifies into more than one RUG-III, or its successors group, the RUG-III or
					 its successors group with the greatest CMI will be utilized to calculate the
					 nursing facility providers total residents average CMI and Medicaid residents
					 average CMI.
Summary Review Results Letter
-a letter
					 sent to the nursing facility that reports the final results of the case-mix
					 documentation review and concludes the review.
a. The summary review results letter will be
				  sent to the nursing facility provider within 10 business days after the final
				  exit conference date.
Supervised Automatic Sprinkler System
-a
					 system that operates in accordance with the latest adopted edition of the
					 National Fire Protection Associations
Life Safety Code.
It is
					 referred to hereafter as
a fire sprinkler system.
Time-Weighted Acuity Measurement System
					 (TW)
-the case mix index calculation methodology that is compiled from
					 the collection of all resident MDS assessments transmitted and accepted by CMS
					 that are considered active within a given calendar quarter. The resident MDS
					 assessments will be weighted based on the number of calendar days that the
					 assessment is considered an active assessment within a given calendar
					 quarter.
Two-Hour Rated Wall
-a wall that meets
					 American Society for Testing and Materials International (ASTM) E119 standards
					 for installation and uses two-hour rated sheetrock.
Unsupported MDS Resident Assessment
-an
					 assessment where one or more data items that are used to classify a resident
					 pursuant to the RUG-III, 34-group, or its successors resident classification
					 system is not supported according to the MDS supportive documentation
					 requirements and a different RUG-III, or its successor, classification would
					 result; therefore, the MDS assessment would be considered
					 "unsupported."