Current through Register Vol. 44, No. 18, September 25, 2021
Special definitions relating to nursing facility
1. "Acquisition Cost"
means the actual allowable cost to the owners of a capital-related asset or any
improvement thereto as determined in accordance with generally accepted
cost" or "cost" means the audited cost of providing services.
3. "Administration and General Services
Costs" means costs as defined at 10 CCR 2505-10 section 8.443.8.
"Appraised value" means the determination
by a qualified appraiser who is a member of an institute of real estate
appraisers, or its equivalent, of the depreciated cost of replacement of a
capital-related asset to its current owner. The depreciated replacement
appraisal shall be based on the "Boechk Commercial Underwriter's Valuation
System for Nursing Homes."
The depreciated cost of replacement appraisal shall be
redetermined every four years by new appraisals of the nursing facilities. The
new appraisals shall be based upon rules promulgated by the state board.
5. "Array of facility providers"
means a listing in order from lowest per diem cost facility to highest for that
category of costs or rates, as may be applicable, of all Medicaid-participating
nursing facility providers in the state.
i) The appraised value of a
capital-related asset for the fiscal year 1986-87 and every fourth year
ii) The most recent
appraisal together with fifty percent of any increase or decrease each year
since the last appraisal, as reflected in the index, for each year in which an
appraisal is not done pursuant to subparagraph (i) of this paragraph
b. For the fiscal
year 1985-86, the base value shall not exceed twenty-five thousand dollars per
licensed bed at any participating facility, and, for each succeeding fiscal
year, the base value shall not exceed the previous year's limitation adjusted
by any increase or decrease in the index.
c. An improvement to a capital -related
asset, which is an addition to that asset, as defined by rules adopted by the
state board, shall increase the base value by the acquisition cost of the
"Capital-related asset" means the land, buildings, and fixed equipment of a
"Case-mix" means a relative score or weight assigned for a given group of
residents based upon their levels of resources, consumption, and
9. "Case-mix adjusted direct
health care services costs" means those costs comprising the compensation,
salaries, bonuses, workers' compensation, employer -contributed taxes, and
other employment benefits attributable to a nursing facility provider's direct
care nursing staff whether employed directly or as contract employees,
including but not limited to DONs, registered nurses, licensed practical
nurses, certified nurse aides and restorative nurses.
10. "Case-mix index" means a numeric score
assigned to each nursing facility resident based upon a resident's physical and
mental condition that reflects the amount of relative resources required to
provide care to that resident.
"Case-mix neutral" means the direct health care costs of all facilities
adjusted to a common case-mix.
"Case-mix reimbursement" means a payment system that reimburses each facility
according to the resource consumption in treating its case-mix of Medicaid
residents, which case-mix may include such factors as the age, health status,
resource utilization, and diagnoses of the facility's Medicaid residents as
further specified in this section.
13. "Class I facility" means a private for
-profit or not-for-profit nursing facility provider or a facility provider
operated by the state of Colorado, a county, a city and county, or special
district that provides general skilled nursing facility care to residents who
require twenty-four-hour nursing care and services due to their ages,
infirmity, or health care conditions, including residents who are behaviorally
challenged by virtue of severe mental illness or dementia. Swing bed facilities
are not included as class I facilities.
14. "Core Components" means the health care,
administrative and general and fair rental allowance for capital -related
assets prospective per diem rate components.
15. "Direct health care services costs" means
those costs subject to case-mix adjusted direct health care services
16. "Direct or indirect
health care services costs" means the costs incurred for patient support
services as defined at 10 CCR 2505-10 section 8.443.7.
17. "Facility population distribution" means
the number of Colorado nursing facility residents who are classified into each
resource utilization group as of a specific point in time.
18. "Fair rental allowance" means the product
obtained by multiplying the base value of a capital -related asset by the
means the addition to a capital -related asset of land, buildings, or fixed
20. "Index" means the R.
S. Means construction systems cost index or an equivalent index that is based
upon a survey of prices of common building materials and wage rates for nursing
maximization" means classifying a resident who could be assigned to more than
one category to the category with the highest case-mix index.
22. "Median per diem cost" means the daily
cost of care and services per patient for the nursing facility provider that
represents the middle of all of the arrayed facilities participating as
providers or as the number of arrayed facilities may dictate, the mean of the
two middle providers.
data set" means a set of screening, clinical, and functional status elements
that are used in the assessment of a nursing facility provider's residents
under the Medicare and Medicaid programs.
24. "Normalization ratio" means the statewide
average case-mix index divided by the facility's cost report period case-mix
25. "Normalized" means
multiplying the nursing facility provider's per diem case-mix adjusted direct
health care services cost by its case-mix index 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 maximum allowable reimbursement
26. "Nursing facility
provider" means a facility provider that meets the state nursing facility
licensing standards established pursuant to C.R.S. section
, and is maintained primarily for the care and treatment of inpatients under
the direction of a physician.
"Nursing salary ratios" means the relative difference in hourly wages of
registered nurses, licensed practical nurses, and nurse's aides.
28. "Nursing weights" means numeric scores
assigned to each category of the resource utilization groups that measure the
relative amount of resources required to provide nursing care to a nursing
facility provider's residents.
"Occupancy-imputed days" means the use of a predetermined number for patient
days rather than actual patient days in computing per diem cost.
30. "Per diem cost" means the daily cost of
care and services per patient for a nursing facility provider.
31. "Per diem rate" means the daily dollar
amount of reimbursement that the state department shall pay a nursing facility
provider per patient.
fee" means a licensing fee, assessment, or other mandatory payment as specified
42 CFR section
33. "Raw food" means the food products and
substances, including but not limited to nutritional supplements, that are
consumed by residents.
rate" means the average annualized composite rate for United States treasury
bonds issued for periods of ten years and longer plus two percent. The rental
rate shall not exceed ten and three-quarters percent nor fall below eight and
utilization group" (RUG) means the system for grouping a nursing facility's
residents according to their clinical and functional status identified from
data supplied by the facility's minimum data set as published by the United
States Department of Health and Human Services.
36. "Statewide average per diem rate" means
the average daily dollar amount of the per patient payments to all
Medicaid-participating facility providers in the state.
37. "Medicare patient day" means all days
paid for by Medicare. For instance, a Medicare patient day includes those days
where Medicare pays a Managed Care Organization for the resident's
38. "Per diem fee" means the
daily dollar amount of provider fee that the state department shall charge a
nursing facility provider per non-Medicare day.
"Substandard Quality of Care means one or
more deficiencies related to participation requirements under
behavior and facility practices, 42 CFR
, quality of life, or
42 CFR section
, quality of care, that constitute
either immediate jeopardy to resident health or safety (level J, K, or L); a
pattern of widespread actual harm that is not immediate jeopardy (level H or
I); or a widespread potential for more than minimal harm, but less than
immediate jeopardy, with no actual harm (level F)" per State Operations Manual,
Medicaid Payment" means a lump sum payment that is made in addition to a
provider's per diem rate. A supplemental Medicaid payment is calculated on an
annual basis using historical data and paid as a fixed monthly amount with no