Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 10 - HOSPITAL SERVICES › Section 471-10-002 - DEFINITIONS

Current through June 17, 2024
The following definitions apply:
002.01
ALLOWABLE
  COSTS.
Those costs as provided in the Medicare statutes and
  regulations for routine service costs, inpatient ancillary costs,
  capital-related costs, medical education costs, and malpractice insurance
  cost.
002.02
ALL-PATIENT REFINED DIAGNOSIS-RELATED GROUP.
The
  All-Patient Refined Diagnosis-Related Group software application that assigns
  patients into categories based on severity of illness and risk of
  mortality.
002.03
BASE
  YEAR.
The period covered by the most recent settled Medicare cost
  report, which will be used for purposes of calculating prospective
  rates.
002.04
CAPITAL-RELATED COSTS.
Those costs, excluding
  tax-related costs, as provided in the Medicare regulations and statutes in
  effect for each facility's base year.
002.05
CASE-MIX
  INDEX.
An arithmetical index measuring the relative average
  resource use of discharges treated in a hospital compared to the statewide
  average.
002.06
COMORBIDITY.
The simultaneous presence of two chronic
  diseases, or conditions, in a patient.
002.07
COORDINATION
  PLAN.
An overall program outline for the delivery of a specific
  service; it is not an individual patient care plan.
002.08
COST OUTLIER.
Cases which have an extraordinarily high cost as established in 471 Nebraska
  Administrative Code (NAC) 10-004.03 as eligible for additional payments above
  and beyond the initial diagnosis-related group payment.
002.09
CRITICAL ACCESS
  HOSPITAL.
A hospital licensed as a critical access hospital by the
  Department of Health and Human Services under 175 NAC 9, and certified for
  participation by Medicare as a critical access hospital.
002.10
DIAGNOSIS-RELATED GROUP
  (DRG).
A group of similar diagnoses combined based on patient age,
  birth weight, procedure coding, comorbidity, and complications.
002.11
DIAGNOSIS-RELATED GROUP
  (DRG) WEIGHT.
A number that reflects relative resource consumption
  as measured by the relative costs by hospitals for discharges associated with
  each diagnosis-related group and severity of illness (SOI).
002.12
DIAGNOSTIC
  SERVICE.
An examination or procedure performed either on the
  patient, or materials obtained from the patient, to provide information for the
  diagnosis or treatment of a disease or to assess a medical condition. This may
  include radiological and pathological services.
002.13
DIALYSIS.
A
  process by which waste products are removed from the body by diffusion from one
  fluid compartment to another across a semi-permeable membrane.
002.14
DIRECT MEDICAL EDUCATION
  COST PAYMENT.
An add-on to the operating cost payment amount to
  compensate for direct medical education costs associated with approved intern
  and resident programs. Costs associated with direct medical education are
  determined from the hospital base year cost reports, and are limited to the
  maximum per intern and resident amount allowed by Medicare in the base
  year.
002.15
DISPROPORTIONATE SHARE HOSPITAL (DSH).
A hospital
  located in Nebraska is deemed to be a disproportionate share hospital by having
  either:
(A) A Nebraska Medicaid inpatient
  utilization rate equal to or above the mean Nebraska Medicaid inpatient
  utilization rate for hospitals receiving Nebraska Medicaid payments in
  Nebraska; or
(B) A low-income
  utilization rate of 25 percent or more.