Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter A - NURSING FACILITY CARE › GENERAL PROVISIONS › Section 1181.2 - 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:
Certified registered nurse
						practitioner
-A registered nurse licensed in this Commonwealth who is
						currently certified by the State Board of Medicine and the State Board of
						Nursing as a certified registered nurse practitioner as defined at
						42 CFR
						481.2(b).
County nursing facility
-A nursing
						facility controlled and totally funded by the County Institution District or by
						the county if no County Institution District exists. "Totally funded," as used
						in this definition, means that the county funds costs which are not reimbursed
						by liable third parties, such as MA, Medicare or other health insurance
						programs. "Controlled," as used in this definition, means that the county
						government directs the actions and policies of the facility. The term does not
						include intermediate care facilities for the mentally retarded controlled or
						totally funded by a County Institution District or county government.
Distinct part
-A designated part or unit
						of a health care facility licensed or approved by the appropriate State agency
						to provide a specific level of care, either skilled nursing, intermediate care
						or intermediate care for the mentally retarded.
General nursing facility
-A skilled
						nursing or intermediate care facility, including special rehabilitation and
						hospital-based facility, that is owned by an individual, partnership,
						association or corporation and may be operated on a profit or nonprofit basis.
						The term does not include intermediate care facilities for the mentally
						retarded, psychiatric transitional facilities, State-owned facilities or county
						nursing facilities.
HIM-15
-The Medicare Provider
						Reimbursement Manual, Health Insurance Manual-15.
Heavy care/intermediate services
-Health
						related care and services, provided to a patient in a dually certified skilled
						bed, which are not as inherently complex as skilled nursing services, which
						meet the criteria in Appendix F (relating to heavy care/intermediate services)
						and which are:
(i) Ordered by and
					 provided under the direction of a physician.
(ii) Needed in the context of a planned
					 program of health care management due to the degree of functional
					 impairment.
(iii) Provided to a
					 patient requiring 24-hour supervision on an inpatient basis.
Hospital-based nursing facility
-A
						distinct part skilled nursing or intermediate care unit that is:
(i) Located physically within or on the
					 immediate grounds of a hospital.
(ii) Operated or controlled by the
					 hospital.
(iii) Licensed or
					 approved by the Department of Health and meets the requirements of 28 Pa. Code
					 §
											101.31 (relating to hospital
					 requirements) and shares support services and administrative costs of the
					 hospital.
Interim per diem rate
-The rate
						established by the Department for the purpose of making interim payments to the
						facility pending a year-end cost settlement. The interim per diem rate is based
						on the facility's latest approved reported costs, and is limited by the upper
						limits of payment specified in §
											1181.68 (relating to upper limits
						of payment).
Intermediate care
-A level of care
						provided by a facility that is licensed by the Department of Health to provide
						intermediate care. Intermediate care shall be ordered by, and provided under
						the direction of a physician. It is available on a continuous 24-hour basis to
						a person who does not require the degree of care and treatment provided in a
						hospital or skilled nursing facility. Because of a mental or physical
						disability, the person does, however, require nursing and related health and
						medical services in the context of a planned program of health care and
						management. The term does not include intermediate care for the mentally
						retarded.
Intermediate care for the mentally
						retarded
-A level of care provided by a State-operated or
						non-State-operated facility licensed as an ICF/MR facility by the Department.
						Care is specially designed to meet the needs of persons who are mentally
						retarded, or persons with related conditions, who require specialized health
						and rehabilitative services; that is, active treatment provided by an
						intermediate care facility for the mentally retarded.
Nursing facility
-A general descriptive
						term that includes general nursing facilities, hospital-based nursing
						facilities, county-operated nursing facilities, intermediate care facilities
						for the mentally retarded, psychiatric transitional facilities and special
						rehabilitation facilities.
Physician assistant
-An individual
						currently certified as a physician assistant by the State Board of Medicine or
						by the State Board of Osteopathic Medicine and who meets the qualifications for
						a physician assistant as defined at
						42 CFR
						481.2(d).
Psychiatric transitional facility
-A
						private or public facility which provides skilled nursing or intermediate care
						services primarily to individuals who have been discharged from institutions
						for mental diseases and who require nursing services for a limited period of
						time to prepare them to function independently in a community setting. The
						psychiatric transitional facility shall exclusively serve this population group
						and must give the Department control over intake decisions.
Skilled nursing facility
						services
-Skilled nursing and rehabilitation services which are
						provided in accordance with the Medicare requirements and which meet the
						criteria in Appendix E (relating to skilled nursing care) by a facility or
						distinct part of a facility that is licensed to provide skilled care and is
						certified to meet the requirements for participation as a provider in the MA
						Program.
Special rehabilitation facility
-A
						facility with skilled or intermediate care patients more than 80% of whom are
						so severely physically disabled that they require intensive services thereby
						necessitating facility staffing at the levels specified in §
											1181.242(b) 
						(relating to nursing staff allowance).
The provisions of this §
													1181.2 amended under sections
						  403(a) and (b) and 443.1(2) and (3) of the Public Welfare Code (62 P. S.
						  §§
														403(a) and (b)
						  and 443.1(2) and (3)); amended
						  under section 443.1(2) and (3) of the Public Welfare Code (62 P. S. §
														443.1(2) and
						  (3)).