Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.02 - Definitions

Current through Register 1525, July 5, 2024
All defined terms in
				957
				CMR 6.00 are capitalized. As used in
				957
				CMR 6.00, unless the context otherwise requires, the
				following words shall have the following meanings:
ADH Provider
. Any person, partnership,
				corporation, or other entity that is authorized in the Commonwealth of
				Massachusetts to engage in the business of furnishing Adult Day Health Services
				to the public and also meets such conditions of participation as may be adopted
				by a governmental unit.
Adult
. Any person 18 years of age or
				older.
Adult Day Health Services
. Programs
				approved by the Office of Medicaid under
				130
				CMR 404.000: Adult Day Health Services and that
				provide for adult recipients an alternative to 24-hour long-term institutional
				care through an organized program of health care and supervision, restorative
				services and socialization.
Adult Foster Care
. Services as defined
				in
				130 CMR
				408.000: Adult Foster Care that are ordered by a
				physician and delivered to a member in a qualified setting as described in
				130 CMR
				408.415: Scope of Adult Foster Care Services
				by a multidisciplinary team and qualified AFC caregiver, that includes
				assistance with activities of daily living, instrumental activities of daily
				living, other personal care as needed, nursing services and oversight, and AFC
				care management.
AFC Provider
. An organization that
				meets the requirements of
				130 CMR
				408.000: Adult Foster Care and that contracts with
				MassHealth to provide Adult Foster Care to eligible MassHealth members.
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 established under M.G.L. c. 12C.
Certified Financial Statement
. A
				certified financial statement is one that has been reviewed and approved by a
				certified, independent auditor.
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 Health Center (CHC)
. A
				clinic which provides comprehensive ambulatory services and which is not
				financially or physically an integral part of a hospital and which meets the
				conditions of participation that have been or may be adopted by a Governmental
				Unit purchasing community health center services. Minimally, a Community Health
				Center must meet the following criteria:
(a)
In State
:
1.Be licensed as a freestanding clinic by the Massachusetts
				Department of Public Health pursuant to M.G.L. c. 111, § 51, and
2.meet the qualifications for certification (or provisional
				certification) by and enter into a provider agreement with MassHealth pursuant
				to
				130
				CMR 405.000: Community Health Center Services.
(b)
Out of State
: Meet criteria for
				CHC Provider eligibility and enter into a provider agreement with MassHealth
				pursuant to
				130
				CMR 405.000: Community Health Center Services.
Continuous Skilled Nursing Care
. The
				provision of skilled nursing services for at least two consecutive hours in
				duration in the home by eligible providers.
Cost Report
. The document used to
				report cost and other financial and statistical data in a format requested by
				and approved by the Center.
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.
Eligible Provider of Ambulance and Chair Car
				Services
. A person, partnership, corporation, Governmental Unit or
				other entity that provides authorized emergency ambulance, transfer ambulance,
				and/or chair car services and that also meets such conditions of participation
				that have been or may be adopted by a Governmental Unit purchasing ambulance
				services.
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.
Field Audit
. An audit performed at the
				Provider's office or site 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 Provider by evaluating internal controls, observing
				the physical plant, and interviewing the Provider's 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.
Fixed-term Travel Employees
. Employees
				who:
(a) work exclusively at a particular health-care facility for a
				specified period of at least 90 days pursuant to a contract between the
				provider and a Temporary Nursing Agency;
(b) must relocate a distance of at least 200 miles and
				establish a temporary residence for the contract term to work at the
				contracting provider; and
(c) incur expenses for temporary accommodations paid by the
				Agency. Providers are required to maintain documentation concerning fixed-term
				travel employees for a period of two years following the expiration of the
				contract.
Governmental Unit
. The Commonwealth,
				any board, commission, department, division, or agency of the Commonwealth and
				any political subdivision of the Commonwealth.
Home Health Aide Service
. The
				provision of personal care in the home, under the supervision of a registered
				professional nurse, or, if appropriate, a physical, speech or occupational
				therapist. Home Health Aide Services are performed by trained personnel who
				assist clients to follow physicians' instructions and established plans of
				care. Additional services include, but are not limited to, assisting the
				patient with activities of daily living, exercising, taking medications ordered
				by a physician that are ordinarily self administered, assisting the patient
				with necessary self help skills, and reporting to the professional supervisor
				any changes in the patient's condition or family situation.
Home Health Agency
. An agency that
				provides health services in a home setting. These services include skilled
				nursing, physical therapy, occupational therapy, speech therapy, medical social
				work and home health aide services.
Home Health Provider
. An individual
				practitioner or an organization certified as a provider of services under the
				Medicare Health Insurance Program for the Aged (Title XVIII) and meets such
				conditions of participation as have been or may be adopted by a governmental
				unit purchasing home health services.
ICF Cost Report
. The Cost Report for
				ICFs beginning with fiscal year 1996.
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 Resident Care Facility's increased
				productivity, greater capacity or longer life.
Intermediate Care Facility (ICF)
. An
				institution whether operated for the purpose of providing diagnostic, medical,
				surgical, or restorative treatment for patients within or centrally based in an
				institution licensed as a hospital by the Department of Public Health under
				M.G.L. c. 111, § 51 and any hospital licensed under M.G.L. c. 19, §
				19.
Licensed Bed Capacity
. A Resident Care
				Facility's "Licensed Bed Capacity" as defined by
				105 CMR 100.020:
				Definitions:
Licensed Bed Capacity
, 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 Resident care
				occupancy, or in the case of a Facility operated by a government agency, the
				number of beds approved by the Department.
Major Additions
. A newly constructed
				addition to a Resident Care Facility that increases the Licensed Bed Capacity
				of the Resident 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 355A, Massachusetts Corporate Excise Tax
				Return.
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.
New CHC
. A community health center
				which has experienced less than one year of operation as a CHC Provider of
				community health care services, or has instituted a significant change in
				service.
Provider
. Any individual, group,
				partnership, trust, corporation or other legal entity that offers services for
				purchase by a Governmental Unit and that meets the conditions of purchase or
				licensure that have been or may be adopted by a purchasing Governmental
				Unit.
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 Individual
. A person
				whose medical care and other services a governmental unit is in whole or in
				part liable for under a statutory program.
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: Rates of
				Payment to Resident Care Facilities 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 sections 267(b), 267(c) and 318 of the Internal Revenue Code of
				1954 as amended provided, however, that 10% must be 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.
Resident Care Facility
. A Facility
				licensed by the Department of Public Health in compliance with
				105 CMR 150.000: Licensing
				of 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: Licensing
				of Long-term Care Facilities, for Publicly-aided Residents who do not routinely
				require nursing or other medically related services.
Sole Proprietor
. A business enterprise
				other than a corporation or partnership in which the net worth belongs entirely
				to one individual.
Temporary Nursing Services Agency
. An
				Agency is defined in accordance with the provisions of
				105 CMR 157.020:
				Definitions:
Temporary Nursing Services Agency
. It
				includes any person, firm, corporation, partnership, or association registered
				with the Department of Public Health that is engaged for hire in the business
				of procuring or providing temporary employment in health-care facilities for
				medical personnel, referred to as "nursing pools" in M.G.L. c. 111, § 72Y.
				Each separate location of the business of an Agency registered with the
				Department of Public Health is an Agency. An Agency shall not include a medical
				personnel staff arrangement set up by a health-care facility solely for its own
				use in which the only costs are the salaries paid to such medical personnel; or
				an individual who engages in providing his or her own services on a temporary
				basis to health-care facilities.
Type I Provider
. Any Provider of the
				type listed in
				957
				CMR 6.00: Appendix A, Part 1.
Type II Provider
. Any Provider of a
				type listed specifically in
				957
				CMR 6.00 which must file a Cost Report specific to
				that type of Provider.
Type III Provider
. Any Provider of the
				type listed in
				957
				CMR 6.00: Appendix A, Part 2.
340B Covered Entities
. Facilities and
				programs eligible to purchase discounted drugs through a program established by
				Section 340B of Public Health Law 102-585, the Veterans Health Act of
				1992.