New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 8:85-1.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this chapter, shall
				  have the following meanings unless the context clearly indicates otherwise.
"Advance directive" means a written instruction relating to the
				  provision of health care when the individual is incapacitated, such as a living will
				  or durable power of attorney for health care.
"AIDS" means acquired immune deficiency syndrome, a condition
				  affecting an individual who has a reliably diagnosed disease that meets the criteria
				  for AIDS specified by the Centers for Disease Control and Prevention of the United
				  States Public Health Service in the following volumes of the Morbidity and Mortality
				  Weekly Review (MMWR): Volume 41 RR-17 of the MMWR published on December 18, 1992;
				  Volume 43 No. RR-17 of the MMWR published on September 30, 1994; Volume 48 No. RR-13
				  of the MMWR published on December 10, 1999; Volume 57 No. RR-10 of the MMWR
				  published on December 5, 2008; and updates found at
www.cdc.gov/mmwr
.
"AIDS-defining illness" means the 26 clinical conditions that
				  affect people with advanced HIV disease listed in Categories B and C of the 1993
				  Revised Classification System, including, but not limited to, pneumocystis carinii
				  pneumonia or PCP, toxoplasmosis, cytomegalovirus or CMV, oral-esophageal
				  candidiasis, wasting, bacterial pneumonia, lymphoma, cryptococcal meningitis,
				  mycobacterium avium complex or MAC, and Kaposi's sarcoma.
"Air fluidized therapy bed" means a device employing the
				  circulation of filtered air through ceramic spherules (small, round ceramic
				  objects).
"Allowable costs" means those costs of a nursing facility that are
				  allowable for reimbursement pursuant to the Medicare Provider Reimbursement Manual
				  unless modified by specific provisions of N.J.A.C. 8:85-3.
"Bed" or "licensed bed" means "bed" or "licensed bed" as those
				  terms are defined at
				  8:39-1.2.
"Beneficiary" means a qualified applicant receiving benefits under
				  the Medical Assistance and Health Services Act,
				  30:4D-1 et seq.
"Care management" means a process by which professional staff
				  designated by the Department monitor the provision of NF care to:
1. Assure that services are rendered as recommended by the HSDP
				  and in accordance with the NF's evaluation of the individual's health service
				  needs;
2. Assure the delivery of timely and appropriate provider
				  responses to changes in care needs;
3. Provide, direct or secure needed consultations with Medicaid
				  professional or NF staff so that services are delivered in a coordinated, effective,
				  and cost-prudent manner; and
4. Facilitate discharge planning and promote appropriate placement
				  to alternate care settings.
"Case mix" means a system of staffing and reimbursement for
				  nursing services based on variation in patient acuity and care needs that influences
				  the type and amount of service needed.
"Case mix index (CMI)" means a numeric score that identifies the
				  relative resource needs for the average resident classified under the resource
				  utilization group (RUG) based on the assessed needs of the resident, whose values,
				  incorporated herein by reference, as amended and supplemented, are set forth as CMI
				  Set B01 located at https://
www.cms.gov/MDS20SWSpecs/13_CMIVersion5.asp
.
"CD4+ T cell" means a type of white blood cell that plays a major
				  role in the functioning of the immune system and which carries the surface protein
				  CD4.
"CDC" means the Centers for Disease Control and Prevention of the
				  United States Department of Health and Human Services.
"Clinical audits" means a method of utilization control under the
				  enforcement authority of Section 1902(a)(30)(A) of the Social Security Act, in
				  accordance with
				  42 CFR
				  456.1(b)(1), to monitor the
				  utilization of and payment for nursing facility care and services reimbursable under
				  the Medicaid State Plan.
"CMS" means the Centers for Medicare and Medicaid Services,
				  formerly known as the Health Care Financing Administration or HCFA, a Federal agency
				  within the United States Department of Health and Human Services.
"Comprehensive assessment" means a process conducted by each
				  member of the interdisciplinary team which, for each resident, identifies problems;
				  determines care needs; and in conjunction with the resident and his or her
				  significant other or legal representative, results in an interdisciplinary plan of
				  care.
"Construction bed value" means the implied cost of construction of
				  a nursing facility bed using a year 2010 base value of $ 89,000 and adjusting to
				  prior years utilizing the index of All Urban Consumers CPI-U U.S. City Average as
				  compiled by the U.S. Department of Labor, Bureau of Labor Statistics and found at
ftp://ftp.bls.gov/pub/special.requests/cpi/cpiai.txt
.
"Consultant pharmacist" means a pharmacist licensed by the New
				  Jersey State Board of Pharmacy who meets the qualifications in
				  10:51-3.3.
"Conventional nursing facility"--see nursing facility.
"Cost report period case mix index" means the simple average of
				  the day weighted facility case mix indices from the final resident rosters for a
				  nursing facility, carried to four decimal places, for the resident roster periods
				  that most closely match a cost reporting period.
"County welfare agency (CWA)" means that agency of county
				  government with the responsibility to determine income eligibility for public
				  assistance programs including Aid to Families with Dependent Children, the Food
				  Stamp program, and Medicaid. The CWA may be identified as the Board of Social
				  Services, the Welfare Board, the Division of Welfare, or the Division of Social
				  Services.
"DACS" means the Division of Aging and Community Services within
				  the Department of Health and Senior Services.
"Department of Health and Senior Services" (Department or DHSS)
				  means the New Jersey State Department of Health and Senior Services.
"Department of Human Services" (DHS) means the New Jersey State
				  Department of Human Services.
"Division of Developmental Disabilities" (DDD) means the New
				  Jersey State Department of Human Services, Division of Developmental
				  Disabilities.
"Division of Medical Assistance and Health Services" (DMAHS) means
				  the New Jersey State Department of Human Services, Division of Medical Assistance
				  and Health Services.
"Division of Mental Health Services" (DMHS) means the New Jersey
				  State Department of Human Services, Division of Mental Health Services.
"Facility average Medicaid case mix index" means the day weighted
				  average case mix index for all identified Medicaid days from each nursing facility's
				  final resident roster for each resident roster quarter as adjusted in accordance
				  with 8:85-3.10(a)4 
				  iii.
"Fair rental value (FRV) allowance" means a methodology for
				  reimbursing NFs for the use of allowable facilities and equipment based on
				  establishing a rental valuation on a per bed basis of such facilities and equipment
				  and a rental rate in accordance with
				  8:85-3.11.
"Fair Rental Value (FRV) Data Report" means the worksheet attached
				  as N.J.A.C. 8:85 Appendix V, incorporated herein by reference, completed and
				  submitted by the nursing facility that is used to determine the initial effective
				  age for the first FRV allowance for each Class I NF and Class II NF effective on or
				  after July 1, 2010. The worksheet allows the identification of the original year of
				  construction, the original number of licensed beds and any documented allowable
				  capitalized nursing facility additions, deletions and renovations through the period
				  prior to the rate year.
"Fair Rental Value (FRV) Re-age Request" means the worksheet
				  attached as N.J.A.C. 8:85 Appendix W, incorporated herein by reference, completed
				  and submitted by an NF to request modifications to its fair rental value allowance
				  based on allowable capitalized costs of additions, modifications and renovations
				  placed in service during the cost reporting year.
"Federal Medical Assistance Percentage (FMAP)" means the Federal
				  medical assistance percentage applicable for Federal financial participation
				  purposes for medical services pursuant to
				  42
				  U.S.C. §
										1396b(a), which is
				  incorporated by reference, as amended and supplemented.
"Health Services Delivery Plan (HSDP)" means a plan of care
				  prepared by professional staff designated by the Department during the Pre-Admission
				  Screening (PAS) assessment process which reflects the individual's current or
				  potential health problems and required care needs.
"HIV" means Human Immunodeficiency Virus, the virus that causes
				  AIDS and that meets the case definitions of HIV specified by the Centers for Disease
				  Control and Prevention of the United States Public Health Service in the following
				  volumes of the Morbidity and Mortality Weekly Review (MMWR): Volume 41 No. RR-17 of
				  the MMWR published on December 18, 1992; Volume 43 No. RR-17 of the MMWR published
				  on September 30, 1994; Volume 48 No. RR-13 of the MMWR published on December 10,
				  1999; Volume 57 No. RR-10 of the MMWR published on December 5, 2008; and updates
				  found at
www.cdc.gov/mmwr
.
"HIV infection" means a retrovirus infection caused by HIV that
				  destroys CD4+ T cells or interferes with their normal function by triggering other
				  events that weaken an individual's immune function.
"HIV-related medical co-morbidities" means the presence of one or
				  more disorders or diseases in addition to a primary diagnosis of HIV and/or AIDS
				  including, but not limited to, diabetes, cancer, hypertension, hyperlibidemis,
				  asthma, chronic obstructive pulmonary disease, or hepatitis B or C.
"HIV-related psychosocial co-morbidities" means the presence of
				  one or more disorders or diseases in addition to a primary diagnosis of HIV and/or
				  AIDS including, but not limited to, substance abuse, mental illness, or
				  dementia.
"Index factor" means a factor calculated in accordance with
				  8:85-3.6 and based on the Skilled
				  Nursing Home without Capital Market Basket Index published by Global Insight, which
				  is available from CMS at
www.cms.gov
, or a
				  comparable index available from, and used by, CMS, if this index ceases to be
				  published.
"Interdisciplinary care plan" means the care plan developed by the
				  interdisciplinary team which includes measurable objectives and time tables to meet
				  the resident's medical, nursing, dietary and psychosocial needs that are identified
				  through the comprehensive assessment process.
"Interdisciplinary team" means a team consisting of a physician
				  and a registered professional nurse and may also include other health professions
				  relative to the provision of needed services. The interdisciplinary team performs
				  comprehensive assessments and develops the interdisciplinary care plan.
"Level I screen and Level II evaluation and determination" means
				  the Level I and Level II evaluations set forth in
				  42 CFR
				  483.128, which is incorporated by reference, as
				  amended and supplemented.
"Low airloss therapy bed" means a bed frame that is equipped with
				  air sacs which are grouped into zones corresponding to various body areas. The air
				  sacs are inflated by a constant flow of air, some of which is directed through the
				  air sacs to the patient surface.
"Major renovation or replacement project" means allowable
				  capitalized costs, which include improvements, replacements, or additions to land,
				  building and capitalized moveable equipment, that are placed in service during the
				  reported period on the FRV data report or the FRV re-age request during the cost
				  report period and in total are equal to or greater than $ 1,000 per bed.
"Material fact" means any reported costs, statistics, data or
				  supporting documentation submitted to the Medicaid program for the purpose of
				  receiving any benefit, regardless of whether any benefit is ultimately
				  received.
"Medicaid day weighted median" means the point in the array of per
				  diem costs of included nursing facilities ordered from low to high when the
				  cumulative total of all Medicaid days from those nursing facilities' cost reports,
				  excluding bed hold days, first equals or exceeds half the number of the total
				  Medicaid days for all NFs in the array. The per diem cost at this point is the
				  Medicaid day weighted median cost.
"Medicaid occupancy level" means the average number of Medicaid
				  recipients and recipients of public assistance under P.L. 1947, c. 156, as amended
				  (C44.8-107 et seq.) residing in a NF divided by the total number of licensed beds in
				  the facility during the billing month.
"Medical director" means a physician licensed under New Jersey
				  State law who is responsible for the direction and coordination of medical care in a
				  nursing facility.
"Medical staff" means one or more licensed physicians who act as
				  the attending physician(s) to Medicaid recipients in a nursing facility.
"Medicare cost report" means the skilled nursing facility cost
				  report required by the Centers for Medicare & Medicaid Services for Medicare
				  reimbursement. Copies of the Medicare cost report may be obtained by the Centers for
				  Medicare & Medicaid Services, 7500 Security Boulevard Baltimore, MD 21244, or
				  through its website at
www.cms.gov/CostReports/03_SkilledNursingFacility.asp
.
"Mental illness" or "MI" means mental illness as that term is
				  defined at
				  42 CFR §
										483.102, incorporated herein by reference, as
				  amended and supplemented.
"Mental retardation" or "MR" means mental retardation as that term
				  is defined at
				  42 CFR §
										483.102, incorporated herein by reference, as
				  amended and supplemented.
"Minimum Data Set" or "MDS" means the MDS version 3.0, required by
				  42 CFR 483.20 and
				  set forth in the Resident Assessment Instrument (RAI) published by CMS, and
				  available at
www.cms.gov
, incorporated herein by
				  reference, as amended and supplemented, a core set of screening, clinical and
				  functional status elements, including common definitions and coding categories that
				  forms the foundation of the assessment required to be completed on all residents in
				  Medicare- and/or Medicaid-certified long-term care facilities. The MDS identifies an
				  individual NF resident's nursing and care needs.
"New nursing facility" means a facility which satisfies the
				  following criteria:
1. Does not replace a pre-existing facility which was licensed in
				  accordance with N.J.A.C. 8:39;
2. Does not assume the per diem rate of a pre-existing facility;
				  and
3. Does not have a specific pre-existing patient base.
"NHA-100" means the form used by the Division of Taxation in the
				  New Jersey Department of the Treasury for collecting the quarterly provider tax
				  assessment from certain long-term care facilities.
"Normalization ratio" means the Statewide average case mix index
				  divided by the facility's cost report period case mix index, the result of which is
				  used for the purpose of removing cost variations associated with different levels of
				  resident case mix.
"Normalized direct care case mix cost" means a facility's total
				  allowable direct care case mix cost per diem multiplied by its normalization ratio
				  for the purpose of making the per diem cost comparable among facilities based upon a
				  common case mix in order to determine the direct care limit.
"Nursing facility (NF)" means an institution (or distinct part of
				  an institution) certified by the New Jersey State Department of Health and Senior
				  Services for participation in Title XIX Medicaid and primarily engaged in providing
				  health-related care and services on a 24-hour basis to Medicaid beneficiaries
				  (children and adults) who, due to medical disorders, developmental disabilities
				  and/or related cognitive impairments, exhibit the need for medical, nursing,
				  rehabilitative, and psychosocial management above the level of room and board.
				  However, the nursing facility is not primarily for care and treatment of mental
				  diseases which require continuous 24-hour supervision by qualified mental health
				  professionals or the provision of parenting needs related to growth and
				  development.
"Occupational therapist" means a person who is registered by the
				  American Occupational Therapy Association, 1383 Piccard Drive, P.O. Box 1725,
				  Rockville, MD 20849-1725, or is a graduate of a program in occupational therapy
				  approved by the Council of Medical Education of the American Medical Association,
				  515 N. State St., Chicago, IL 60610, and engaged in the supplemental clinical
				  experience required before registration by the American Occupational Therapy
				  Association.
"Office of Community Choice Options" or "OCCO" means a regional
				  office of the Office of Community Choice Options of the Division of Aging and
				  Community Services of the Senior Services and Health Systems Branch of the
				  Department, which is responsible for the management of the pre-admission screening
				  process.
"Ombudsman" means the Office of the Ombudsman for the
				  Institutionalized Elderly.
"Physical therapist" means a person who is a graduate of a program
				  of physical therapy approved by both the Council on Medical Education of the
				  American Medical Association, 515 N. State St., Chicago, IL 60610, and the American
				  Physical Therapy Association, 1111 N. Fairfax St., Alexandria, VA 22314 or its
				  equivalent; and if practicing in the State of New Jersey, is licensed by the State
				  of New Jersey, or if treatment and/or services are provided in a state other than
				  New Jersey, meets the requirements of that state, including licensure, if
				  applicable, and also meets all applicable Federal requirements.
"Physician's services" means those services provided within the
				  scope of medical practice as defined by the laws of New Jersey and those services
				  which are performed by or under the direct personal supervision of the
				  physician.
1. "Physician" means a doctor of medicine or osteopathy licensed
				  to practice medicine and surgery by the New Jersey State Board of Medical
				  Examiners.
2. "Direct personal supervision" means services which are rendered
				  in the physician's presence.
"Pre-admission screening (PAS)" means that process by which all
				  Medicaid eligible beneficiaries seeking admission to a Medicaid certified NF and
				  individuals who may become Medicaid eligible within six months following admission
				  to a Medicaid certified NF receive a comprehensive needs assessment by professional
				  staff designated by the Department to determine their long-term care needs and the
				  most appropriate setting for those needs to be met, pursuant to
				  30:4D-17.1 0. ( P.L. 1988,
				  c.97).
"Pre-admission screening and resident review" or "PASRR" means
				  that process by which an individual meeting the clinical criteria for mental illness
				  (MI) or mental retardation (MR/RC), regardless of payment source, is screened prior
				  to admission to an NF to determine the individual's appropriateness for NF services,
				  and whether the individual requires specialized services for that individual's
				  condition and, therefore, is ineligible for NF services. PASRR includes two distinct
				  processes, Level I screen and Level II evaluation and determination.
"Prior authorization" means approval granted by the Department
				  through the appropriate Office of Community Choice Options (OCCO) for payment for NF
				  services rendered to a Medicaid beneficiary, in accordance with this chapter.
"Professional staff designated by the Department" means a
				  registered nurse or professional social worker who performs health needs assessments
				  and counseling on alternative options and care management as required by this
				  chapter. Professional social workers employed by the State or a political
				  subdivision thereof are not required to be licensed or certified.
"Provider reimbursement manual or Medicare Provider Reimbursement
				  Manual" means the Medicare Provider Reimbursement Manual published by CMS and
				  commonly known as CMS Publication 15-1 and 15-2, available at
www.cms.gov/manuals
, incorporated
				  herein by reference, as amended and supplemented.
"Rehabilitative and/or restorative nursing care" means nursing
				  care provided by a registered professional nurse, or under the direction of a
				  registered professional nurse, qualified by experience in rehabilitative or
				  restorative nursing care.
"Rehabilitative services" means physical therapy, occupational
				  therapy, speech-language pathology services, and the use of such supplies and
				  equipment as are necessary in the provision of such services.
"Related Condition" or "RC" means a related condition as defined
				  in
				  42 CFR
				  435.1010, which is incorporated herein by
				  reference, as amended and supplemented.
"Related Parties" means those individuals or entities defined as
				  related parties in the provider reimbursement manual.
"Replacement nursing facility" means a facility which satisfies
				  the following criteria:
1. Replaces a pre-existing facility which was licensed in
				  accordance with N.J.A.C. 8:39;
2. Can assume the per diem rate of the pre-existing facility;
				  and
3. Has a specific pre-existing patient base.
"Resident" means a Medicaid eligible or potentially eligible
				  beneficiary residing in an NF.
"Resident roster" means a list of all residents in an NF for a
				  calendar quarter based on MDS assessments and tracking forms, which are transmitted
				  by the NF and accepted by the applicable submission site approved by CMS, used for
				  the calculated day weighted case mix indices for Medicaid, Medicare and other
				  payment sources.
"Resource utilization group" or "RUG" means the version III
				  (RUG-III), 5.12 34-Group, incorporated herein by reference, as amended and
				  supplemented, a system developed by CMS and set forth at https://
www.cms.gov/MDS20SWSpecs/12_RUG-IIIVersion5.asp
for grouping nursing facility residents according to the residents' functional
				  status and anticipated uses of services and resources as identified from data
				  supplied by the NF's MDS.
"Respiratory care practitioner" means an individual credentialed
				  by the State Board of Respiratory Care, to practice respiratory care under the
				  direction or supervision of a physician pursuant to State of New Jersey P.L. 1971,
				  c. 60; P.L. 1974, c. 46; and P.L. 1978, c. 73, amended August 1991.
"Skilled nursing facility (SNF)" means a free-standing institution
				  or an identifiable part of an institution which meets all the State and Federal
				  requirements for participation in the Medicare Program as a skilled nursing
				  facility.
"Social services" means those services provided to meet the
				  emotional and social needs of the Medicaid beneficiary and significant other or
				  guardian at the time of admission, during treatment and care in the facility, and at
				  the time of discharge.
"Special care nursing facility (SCNF)" means a NF or separate and
				  distinct unit within a Medicaid certified conventional NF which has been approved by
				  the Department to provide care to New Jersey Medicaid beneficiaries who require
				  specialized health care services beyond the scope of conventional nursing facility
				  services as defined in N.J.A.C. 8:85-2, Nursing Facility Services.
"Specialized services for MI" mean those services offered, in
				  accordance with
				  42 CFR 483.120,
				  that are determined to be medically indicated when an individual is experiencing an
				  acute episode of serious MI and psychiatric hospitalization is recommended, based on
				  a psychiatric evaluation.
1. Specialized services include implementation of a continuous,
				  aggressive and individualized treatment plan by an interdisciplinary team of
				  qualified and trained mental health personnel.
2. During a period of 24-hour supervision of an individual with
				  MI, specific therapies and activities are prescribed, with the following objectives:
i. To diagnose and reduce behavioral symptoms;
ii. To improve independent functioning; and
iii. As early as possible, to permit functioning at a level where
				  less than specialized services are appropriate.
3. Specialized services for MI exceed the range of services that
				  an NF is authorized to provide and can only be provided in a 24-hour inpatient
				  setting.
"Specialized services for MR/RC" mean those services offered, in
				  accordance with
				  42 CFR 483.120,
				  when an individual is determined to have skill deficits or other specialized
				  training needs that necessitate the availability of trained MR personnel, 24 hours
				  per day, to teach the individual functional skills.
1. Specialized services are those services needed to address such
				  skill deficits or specialized training needs.
2. Specialized services may be provided in an intermediate care
				  facility for the mentally retarded or ICF/MR as defined at
				  42 CFR
				  440.150 or in a community-based setting that meets
				  ICF/MR standards.
3. Specialized services for MR go beyond the range of services
				  that a NF is required to provide.
"Speech-language pathologist" means a person who has a certificate
				  of clinical competence from the American Speech and Hearing Association; meets all
				  applicable Federal regulations; has completed the equivalent educational
				  requirements and work experience necessary for the certificate, or has completed the
				  academic program and is acquiring supervised work experience to qualify for the
				  certificate, and, if practicing in the State of New Jersey is licensed by the State
				  of New Jersey; or if treatment and/or services are provided in a state other than
				  New Jersey, meets the requirements of that state, including licensure, if
				  applicable.
"Statewide average case mix index" means the simple average of all
				  cost report period, day weighted case mix indices represented in the limit database
				  established pursuant to
				  N.J.A.C.
				  8:85-3.8.
"Statewide average Medicaid case mix index" means the Medicaid day
				  weighted average of all Class I and Class II NFs' case mix indices for the Medicaid
				  days identified on the final resident rosters for each resident roster
				  quarter.
"Track of care" means the designation of the setting and scope of
				  Medicaid services as determined by professional staff designated by the Department
				  following the PAS of an applicant, for Medicaid clinical eligibility, for NF
				  placement or services, as follows:
1. "Track I" means long-term NF care and shall be designated for
				  individuals with respect to whom long-term placement is required because clinical
				  prognosis is poor, and as to whom PAS results in a determination that short-term
				  stays are neither realistic nor predictable and that the individual is eligible for
				  NF level of nursing care in accordance with
				  N.J.A.C.
				  8:85-2.1.
i. A Track I designation shall not preclude the possibility of
				  future discharge. The professional staff designated by the Department will monitor
				  those individuals with discharge potential, reassess the individual, and update the
				  HSDP for a change in the track of care if appropriate.
2. "Track II" means short-term NF care and shall be designated for
				  individuals as to whom PAS results in a determination that the individual requires
				  comprehensive and coordinated NF services, in accordance with
				  8:85-2.1, provided in a therapeutic
				  setting that assures family counseling and teaching in preparation for discharge to
				  the community setting and to achieve at least one of the objectives listed at 2i
				  through iii below; provided that individuals designated for Track II shall also be
				  assigned to short-term NF stays, in spite of technically complex care needs and
				  guarded prognosis, particularly in cases in which the individual is motivated
				  towards NF alternatives and/or in which caregivers, through case management
				  intervention, may obtain services that make return to the community a viable
				  option.
i. To stabilize medical conditions;
ii. To promote rehabilitation; or
iii. To restore maximum functioning levels.
3. "Track III" means long-term care services in the community and
				  shall be designated for individuals as to whom PAS results in a determination of
				  Medicaid clinical eligibility for NF care in accordance with
				  8:85-2.1, but who can be appropriately
				  cared for in the community with supportive health care services. These individuals
				  may be eligible for Medicaid State Plan services or Home and Community-Based
				  Services Waiver Programs.
"Transfer of ownership" means, for reimbursement purposes, a
				  change in the majority ownership that does not involve related parties, related
				  corporations or public corporations. "Majority ownership" is defined as an
				  individual or entity who owns 50 percent or more of the facility, or where no
				  individual or entity owns 50 percent or more, the majority owner is the owner who
				  owns the largest percentage.
"Unclassifiable MDS assessment" means an MDS assessment for which
				  one or more MDS items used to calculate a resource utilization group are not present
				  on the MDS assessment.
"Unsupported MDS assessment" means an assessment where one or more
				  MDS items that are required to classify a resident into a resource utilization group
				  are not supported by documentation in the resident's clinical record.
"Validated cost report" means a complete cost report submission
				  that has undergone a minimum of a desk review by the Department and reflects any
				  adjustments made by the Department in accordance with this chapter.
"Waiting list" means the standardized listing, maintained in
				  chronological order by the NF, of the names of all individuals seeking admission to
				  a Medicaid participating NF who have completed a written
				  application.