Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1187 - NURSING FACILITY SERVICES › Subchapter L - NURSING FACILITY PARTICIPATION REQUIREMENTS AND REVIEW PROCESS › GENERAL PROVISIONS › Section 1187.162 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this
						subchapter, have the following meanings, unless the context clearly indicates
						otherwise:
Applicant
-A legal entity or a person
						authorized by and acting on behalf of a legal entity who submits a bed request
						to the Department.
Bed request
-A request by an applicant
						for the Department's approval to increase the number of MA-certified beds in a
						subject facility that is a provider or a request by an applicant to increase
						the number of MA-certified beds in the MA Program by enrolling a subject
						facility as a new provider.
Bed transfer request
-A bed request in
						which the following conditions apply:
(i) The applicant seeks the Department's
					 approval to increase the number of MA-certified beds in a provider.
(ii) The applicant represents that, if the
					 Department approves the request, at least the same number of MA-certified beds
					 will be decertified and closed at a different provider.
(iii) The providers are located in the same
					 county, or the driving distance between providers is no greater than 25 miles
					 if both providers are in MSA Level A, as specified by the Federal Office of
					 Management and Budget in the OMB Bulletin No. 99-04, or no greater than 50
					 miles in all other cases.
Legal entity
-One of the
						following:
(i) A person who is a
					 licensee of a licensed nursing facility, as authorized by the Department of
					 Health.
(ii) A person proposing to
					 develop or construct a long-term care nursing facility as defined in Chapter 8
					 of the Health Care Facilities Act (35 P. S. §§
												448.801-448.821).
MA day-one admission rate
-The quotient
						of the number of MA day-one recipients admitted to the subject facility during
						a 12-month period, divided by the total number of individuals admitted to the
						nursing facility during the same 12-month period.
MA day-one recipient
-An individual who
						is eligible for nursing facility services under the MA Program or who becomes
						eligible for nursing facility services under the MA Program within 60 days of
						the date of the individual's admission to a nursing facility.
MA day-one report
-A document displaying
						admission rates of MA day-one recipients for a 12-month period using data
						obtained from Federally-approved PA specific MDS submissions for each nursing
						facility enrolled in the MA Program.
MA occupancy rate
-The quotient of the
						total MA days of care reported in an MA cost report, divided by the total
						actual days of care reported in the same MA cost report.
Nonpublic nursing facility
-A nursing
						facility other than a county nursing facility or a facility owned or operated
						by the State or Federal government.
Overall occupancy rate
-The quotient of
						the total actual days of care reported in an MA cost report, divided by the
						total available days of care reported in the same MA cost report.
Owner
-A person having an ownership or
						control interest, as defined in section 1124(a) of the Social Security Act
						(42 U.S.C.A. §
												1320a-3(a)), in the
						subject facility.
Person
-A natural person, corporation
						(including associations, joint stock companies and insurance companies),
						partnership, trust, estate, association, the Commonwealth, and any local
						government unit, authority and agency thereof.
Primary service area
-One of the
						following:
(i) The county in which the
					 subject facility is or will be physically located.
(ii) The geographic area from which the
					 subject facility draws or is expected to draw at least 75% of its resident
					 population, as determined by the Department.
Proposed project
-Any one of the
						following:
(i) An increase in the
					 number of licensed beds in a provider.
(ii) The construction of a new county or
					 nonpublic nursing facility if there is an expectation that the facility will
					 become a provider.
(iii) The
					 enrollment of a county or nonpublic nursing facility as a provider.
Provider
-A licensed county or nonpublic
						nursing facility that is certified and enrolled as a nursing facility provider
						in the MA Program.
Receiving provider
-The provider
						identified in a bed transfer request which will increase the number of its
						MA-certified beds if the bed transfer request is approved. The receiving
						provider is the subject facility of the bed transfer request.
Related party
-A person who is or would
						be identified as a related party in a subject facility's MA cost report if the
						person were to provide goods, services or property to the subject
						facility.
Specialized medical services
-Services
						that require staffing with advance training and need-specific equipment,
						including services needed by an individual who has severe dementia or traumatic
						brain injury or who requires a respirator for survival, or who receives bed
						side hemodialysis. Specialized medical services are not routinely provided in
						general nursing facilities and do not include the services of a dedicated
						Alzheimer's unit or infection isolation wing, osteopathic treatment or similar
						services.
Subject facility
-An existing or proposed
						county or nonpublic nursing facility identified on a bed request that will
						increase the number of its licensed nursing facility beds or enroll as a
						provider in the MA Program if the bed request is approved.
Surrendering provider
-The provider
						identified on a bed transfer request which will decertify and close at least
						the same number of MA-certified beds as the receiving provider identified in
						the same bed transfer request, if the request is approved.
This section cited in 55 Pa. Code §
													1187.161 (relating to
						  applicability).