Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.3 - Reimbursement for Skilled Nursing and Intermediate Care Services › Rule 37.40.302 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
Unless the context requires otherwise in this subchapter, the
				  following definitions apply:
(1)
				"Administrator" means the person licensed by the state, including an owner,
				salaried employee, or other provider, with daily responsibility for operation
				of the facility. In the case of a facility with a central management group, the
				administrator, for the purpose of these rules, may be a person other than the
				titled administrator of the facility if such person has daily responsibility
				for operation of the nursing facility and is currently licensed by the state as
				a nursing home administrator.
(2)
				"Case mix index (CMI) " means an assigned weight or numeric score assigned to
				each RUG-III grouping which reflects the relative resources predicted to
				provide care to nursing facility residents.
(3) "Department" means the Montana Department
				of Public Health and Human Services or its agents, including but not limited to
				parties under contract to perform audit services, claim processing and
				utilization review.
(4) "Department
				audit staff" and "audit staff" mean personnel directly employed by the
				department or any of the department's contracted audit personnel or
				organizations.
(5) "Estimated
				economic life" means the estimated remaining period during which property is
				expected to be economically usable by one or more users, with normal repairs
				and maintenance, for the purpose for which it was intended when
				built.
(6) "Fiscal year" and "fiscal
				reporting period" both mean the provider's internal revenue tax year.
(7) "Maintenance therapy and rehabilitation
				services" mean repetitive services required to maintain functions which do not
				involve complex and sophisticated therapy procedures or the judgment and skill
				of a qualified therapist and without the expectation of significant
				progress.
(8) "Medicaid recipient"
				means a person who is eligible and receiving assistance under Title XIX of the
				Social Security Act for nursing facility services.
(9) "Minimum data set (MDS) " means the
				assessment form approved by the centers for Medicare and Medicaid services
				(CMS), and designated by the department to satisfy conditions of participation
				in the Medicaid and Medicare programs.
(10) "Minimum data set RUG-III quarterly
				assessment form" means the three page quarterly, optional version for RUG-III
				1997 update.
(11) "Nonemergency
				routine transportation" means transportation for routine activities, such as
				outings scheduled by the facility, nonemergency visits to physicians, dentists,
				optometrists, or other medical providers. This definition includes such
				transportation when it is provided within 20 miles of the facility.
(12) "Nursing facility fee schedule" means
				the list of separately billable ancillary services provided in ARM
				37.40.330.
(13) "Nursing facility services" means
				nursing facility services as provided in ARM
				37.40.304 and
				37.40.305.
(14) "Patient contribution" means the total
				of all of a resident's income from any source available to pay the cost of
				care, less the resident's personal needs allowance. The patient contribution
				includes a resident's incurment determined in accordance with applicable
				eligibility rules.
(15) "Patient
				day" means a whole 24-hour period that a person is present and receiving
				nursing facility services, regardless of the payment source. Even though a
				person may not be present for a whole 24-hour period on the day of admission or
				day of death, such day will be considered a patient day. When department rules
				provide for the reservation of a bed for a resident who takes a temporary leave
				from a provider to be hospitalized or make a home visit, such whole 24-hour
				periods of absence will be considered patient days.
(16) "Provider" means any person, agency,
				corporation, partnership or other entity that, under a written agreement with
				the department, furnishes nursing facility services to Medicaid
				recipients.
(17) "Rate year" means
				a 12-month period beginning July 1. For example, rate year 2006 means a period
				corresponding to the state fiscal year July 1, 2005 through June 30,
				2006.
(18) "Resident" means a
				person admitted to a nursing facility who has been present in the facility for
				at least one 24-hour period.
(19)
				"RUG-III" means resource utilization group, version III.
(20) "RUG-III grouper version" means the
				resource utilization group version III algorithm that classifies residents
				based upon diagnosis, services provided and functional status using MDS
				assessment information for each resident.
53-2-201,
					 53-6-113,
					 MCA; IMP,
					 53-2-201,
					 53-6-101,
					 53-6-111,
					 53-6-113,
					 MCA;