957 CMR 6.02 - Definitions

All defined terms in 957 CMR 6.00 are capitalized. As used in 957 CMR 6.00, unless the context otherwise requires, the following words shall have the following meanings:

ADH Provider. Any person, partnership, corporation, or other entity that is authorized in the Commonwealth of Massachusetts to engage in the business of furnishing Adult Day Health Services to the public and also meets such conditions of participation as may be adopted by a governmental unit.

Adult. Any person 18 years of age or older.

Adult Day Health Services. Programs approved by the Office of Medicaid under 130 CMR 404.000: Adult Day Health Services and that provide for adult recipients an alternative to 24-hour long-term institutional care through an organized program of health care and supervision, restorative services and socialization.

Adult Foster Care. Services as defined in 130 CMR 408.000: Adult Foster Care that are ordered by a physician and delivered to a member in a qualified setting as described in 130 CMR 408.415: Scope of Adult Foster Care Services by a multidisciplinary team and qualified AFC caregiver, that includes assistance with activities of daily living, instrumental activities of daily living, other personal care as needed, nursing services and oversight, and AFC care management.

AFC Provider. An organization that meets the requirements of 130 CMR 408.000: Adult Foster Care and that contracts with MassHealth to provide Adult Foster Care to eligible MassHealth members.

Building. The structure that houses Residents. Building costs include the direct cost of construction of the shell and expenditures for service Equipment and fixtures such as elevators, plumbing, and electrical fixtures that are made a permanent part of the structure. Building Costs also include the cost of bringing the Building to productive use, such as permits, engineering and architect's fees, and certain legal fees. Building Costs include interest paid during construction but not Mortgage Acquisition Costs. When the fixed assets of a Facility are sold, the allowable book value of all Improvements will become part of the allowable basis of the Building for the buyer.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Certified Financial Statement. A certified financial statement is one that has been reviewed and approved by a certified, independent auditor.

Change of Ownership. A bona fide transfer, for reasonable consideration, of all the powers and indicia of ownership. A Change of Ownership may not occur between Related Parties and must be a sale of assets of the Facility rather than a method of financing. A change in the legal form of the Provider does not constitute a Change of Ownership unless the other criteria are met.

Community Health Center (CHC). A clinic which provides comprehensive ambulatory services and which is not financially or physically an integral part of a hospital and which meets the conditions of participation that have been or may be adopted by a Governmental Unit purchasing community health center services. Minimally, a Community Health Center must meet the following criteria:

(a) In State:

1.Be licensed as a freestanding clinic by the Massachusetts Department of Public Health pursuant to M.G.L. c. 111, § 51, and

2.meet the qualifications for certification (or provisional certification) by and enter into a provider agreement with MassHealth pursuant to 130 CMR 405.000: Community Health Center Services.

(b) Out of State: Meet criteria for CHC Provider eligibility and enter into a provider agreement with MassHealth pursuant to 130 CMR 405.000: Community Health Center Services.

Continuous Skilled Nursing Care. The provision of skilled nursing services for at least two consecutive hours in duration in the home by eligible providers.

Cost Report. The document used to report cost and other financial and statistical data in a format requested by and approved by the Center.

Desk Audit. A comprehensive audit performed at the Center's offices in which the auditor evaluates the accuracy of the information in the Cost Reports and supporting documentation in accordance with an audit program.

Eligible Provider of Ambulance and Chair Car Services. A person, partnership, corporation, Governmental Unit or other entity that provides authorized emergency ambulance, transfer ambulance, and/or chair car services and that also meets such conditions of participation that have been or may be adopted by a Governmental Unit purchasing ambulance services.

EOHHS.The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Equipment. Tangible fixed assets, usually moveable, that are accessory or supplemental to such larger items as Buildings and structures.

Field Audit. An audit performed at the Provider's office or site in which the auditor evaluates the accuracy of the information in the Cost Reports and claim for reimbursement by examining the books and records of the Provider by evaluating internal controls, observing the physical plant, and interviewing the Provider's staff.

Fixed Costs. Indirect Resident care costs, independent of the level of occupancy, including interest associated with long term debt; depreciation of Buildings; Building Improvements, Equipment and software; Equipment; insurance on Buildings and Equipment; real estate taxes; rent; the non income related portion of the Massachusetts Corporate Excise Tax; personal property tax; and Equipment rental.

Fixed-term Travel Employees. Employees who:

(a) work exclusively at a particular health-care facility for a specified period of at least 90 days pursuant to a contract between the provider and a Temporary Nursing Agency;

(b) must relocate a distance of at least 200 miles and establish a temporary residence for the contract term to work at the contracting provider; and

(c) incur expenses for temporary accommodations paid by the Agency. Providers are required to maintain documentation concerning fixed-term travel employees for a period of two years following the expiration of the contract.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Home Health Aide Service. The provision of personal care in the home, under the supervision of a registered professional nurse, or, if appropriate, a physical, speech or occupational therapist. Home Health Aide Services are performed by trained personnel who assist clients to follow physicians' instructions and established plans of care. Additional services include, but are not limited to, assisting the patient with activities of daily living, exercising, taking medications ordered by a physician that are ordinarily self administered, assisting the patient with necessary self help skills, and reporting to the professional supervisor any changes in the patient's condition or family situation.

Home Health Agency. An agency that provides health services in a home setting. These services include skilled nursing, physical therapy, occupational therapy, speech therapy, medical social work and home health aide services.

Home Health Provider. An individual practitioner or an organization certified as a provider of services under the Medicare Health Insurance Program for the Aged (Title XVIII) and meets such conditions of participation as have been or may be adopted by a governmental unit purchasing home health services.

ICF Cost Report. The Cost Report for ICFs beginning with fiscal year 1996.

Improvements. Expenditures that increase the quality of the existing Building by rearranging the Building layout or substituting improved components for old components so that facilities are in some way better than before the renovation. Improvements do not add to the existing Building nor do they expand the square footage of the Building. An improvement is measured by the Resident Care Facility's increased productivity, greater capacity or longer life.

Intermediate Care Facility (ICF). An institution whether operated for the purpose of providing diagnostic, medical, surgical, or restorative treatment for patients within or centrally based in an institution licensed as a hospital by the Department of Public Health under M.G.L. c. 111, § 51 and any hospital licensed under M.G.L. c. 19, § 19.

Licensed Bed Capacity. A Resident Care Facility's "Licensed Bed Capacity" as defined by 105 CMR 100.020: Definitions: Licensed Bed Capacity, which states: the portion of bed capacity, by number of beds, which a Provider under its license, as issued or subsequently modified, is authorized to use for Resident care occupancy, or in the case of a Facility operated by a government agency, the number of beds approved by the Department.

Major Additions. A newly constructed addition to a Resident Care Facility that increases the Licensed Bed Capacity of the Resident Facility by 50% or more.

Massachusetts Corporate Excise Tax. Those taxes that have been paid to the Massachusetts Department of Revenue in connection with the filing of Form 355A, Massachusetts Corporate Excise Tax Return.

Mortgage Acquisition Costs. Those costs, including finder's fees, points, certain legal fees, and filing fees, that are necessary to obtain long term financing through a mortgage, bond or other long term debt instrument.

New CHC. A community health center which has experienced less than one year of operation as a CHC Provider of community health care services, or has instituted a significant change in service.

Provider. Any individual, group, partnership, trust, corporation or other legal entity that offers services for purchase by a Governmental Unit and that meets the conditions of purchase or licensure that have been or may be adopted by a purchasing Governmental Unit.

Prudent Buyer Concept. The assumption that a purchase price that exceeds the market price for a supply or service is an unreasonable cost.

Publicly-aided Individual. A person whose medical care and other services a governmental unit is in whole or in part liable for under a statutory program.

Publicly-aided Resident. A person as to whose care in a Resident Care Facility the Commonwealth or a political subdivision of the Commonwealth is in whole or in part financially liable.

Rate Year. The period in which the rate determined under 101 CMR 204.00: Rates of Payment to Resident Care Facilities is effective.

Related Party. An individual or organization associated or affiliated with, or that has control of, or is controlled by, the Provider; or any director, stockholder, trustee, partner or administrator of the Provider by common ownership or control or in a manner specified in sections 267(b), 267(c) and 318 of the Internal Revenue Code of 1954 as amended provided, however, that 10% must be the operative factor as set out in sections 267(b)(2) and (3). Related individuals include spouses, parents, children, spouses of children, grandchildren, siblings, fathers-in-law, mothers-in-law, brothers-in-law, and sisters-in-law.

Resident Care Facility. A Facility licensed by the Department of Public Health in compliance with 105 CMR 150.000: Licensing of Long-term Care Facilities or exempt from licensure under M.G.L. c. 111, § 73B providing protective supervision in addition to the minimum basic care required by 105 CMR 150.000: Licensing of Long-term Care Facilities, for Publicly-aided Residents who do not routinely require nursing or other medically related services.

Sole Proprietor. A business enterprise other than a corporation or partnership in which the net worth belongs entirely to one individual.

Temporary Nursing Services Agency. An Agency is defined in accordance with the provisions of 105 CMR 157.020: Definitions: Temporary Nursing Services Agency. It includes any person, firm, corporation, partnership, or association registered with the Department of Public Health that is engaged for hire in the business of procuring or providing temporary employment in health-care facilities for medical personnel, referred to as "nursing pools" in M.G.L. c. 111, § 72Y. Each separate location of the business of an Agency registered with the Department of Public Health is an Agency. An Agency shall not include a medical personnel staff arrangement set up by a health-care facility solely for its own use in which the only costs are the salaries paid to such medical personnel; or an individual who engages in providing his or her own services on a temporary basis to health-care facilities.

Type I Provider. Any Provider of the type listed in 957 CMR 6.00: Appendix A, Part 1.

Type II Provider. Any Provider of a type listed specifically in 957 CMR 6.00 which must file a Cost Report specific to that type of Provider.

Type III Provider. Any Provider of the type listed in 957 CMR 6.00: Appendix A, Part 2.

340B Covered Entities. Facilities and programs eligible to purchase discounted drugs through a program established by Section 340B of Public Health Law 102-585, the Veterans Health Act of 1992.

Notes

957 CMR 6.02

Adopted, Mass Register Issue 1259, eff. 4/25/2014.