All defined terms in 957 CMR 7.00 are capitalized. As used 957
CMR 7.00, unless the context requires otherwise, terms have the following
meanings:
Additions
. New Units or enlargements
of existing Units that may or may not be accompanied by an increase in Licensed
Bed Capacity.
Adjudicatory Proceeding
. A proceeding
before an agency in which the legal rights, duties or privileges of
specifically named persons or entities are required by constitutional right or
by any provision of the General Laws to be determined after an opportunity for
an agency hearing.
Administrative and General Costs
.
Administrative and General Costs include the amounts reported in the following
accounts: administrator salaries; payroll taxes - administrator; workers'
compensation - administrator; group life/health - administrator; administrator
pensions; other administrator benefits; clerical; EDP/payroll/bookkeeping
services; administrator-in-training; office supplies; phone; conventions and
meetings; help wanted advertisements; licenses and dues (resident-care
related); education and training - administration; accounting - other;
insurance -malpractice; other operating expenses; realty company variable
costs; management company allocated variable costs; and management company
allocated fixed costs.
Administrator-in-training
. A person
registered with the Board of Registration of Nursing Home Administrators and
involved in a course of training as described in 245 CMR 2.00: Nursing
Home Administrators.
Audit
. An examination of the
Provider's cost report and supporting documentation to evaluate the accuracy of
the financial statements and identification of Medicaid patient-related
costs.
Building Costs
. Building Costs include
the direct cost of construction of the structure that houses residents and
expenditures for service Equipment and fixtures such as elevators, plumbing and
electrical fixtures 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 to Building Costs but not Mortgage
Acquisition Costs.
Capital Costs
. Capital Costs include
building depreciation, Financing Contribution, building insurance, real estate
taxes, non-income portion of Massachusetts Corporate Excise Taxes, other rent
and Other Fixed Costs.
Center
. The Center for Health
Information and Analysis established under M.G.L. c. 12C.
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. A Change of Ownership must be a sale of assets of the
Provider 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.
CMS
. The federal Centers for Medicare
& Medicaid Services.
Department
. The Massachusetts
Department of Public Health.
Direct Restorative Therapy
. Services
of physical therapists, occupational therapists, and speech, hearing, and
language therapists provided directly to individual residents to reduce
physical or mental disability and to restore the resident to maximum functional
level. Direct Restorative Therapy Services are provided only upon written order
of a physician, physician assistant or nurse practitioner who has indicated
anticipated goals and frequency of treatment to the individual resident. Direct
Restorative Therapy Services include supervisory, administrative, and
consulting time associated with provision of the services. These include, but
are not limited to, reviewing pre-admission referrals, informally communicating
with families, scheduling treatments, completing resident care documentation
including MDS documentation, screening of patients, writing orders, meeting
with aides to discuss patients, consulting with physicians and nurse
practitioners, managing equipment and assessing equipment needs of
patients.
EOHHS
. The Executive Office of Health
and Human Services established under M.G.L. c. 6A.
Equipment
. A fixed asset, usually
moveable, accessory or supplemental to the Building, including such items as
beds, tables, and wheelchairs.
Financing Contribution
. Payment for
the use of necessary capital assets whether internally or externally
funded.
Generally Available Employee Benefits
.
Employee benefits that are nondiscriminatory and available to all full-time
employees.
Hospital-based Nursing Facility
. A
separate Nursing Facility Unit or Units located in a hospital building licensed
for both hospital and Nursing Facility services in which the Nursing Facility
licensed beds are less than a majority of the facility's total licensed beds
and the Nursing Facility patient days are less than a majority of the
facility's total patient days. It does not include free-standing Nursing
Facilities owned by hospitals.
Improvements
. Expenditures that
increase the quality of the Building by rearranging the Building layout or
substituting improved components for old components so that the Provider is in
some way better than it was before the renovation. Improvements do not add to
or expand the square footage of the Building. An improvement is measured by the
Provider's increased productivity, greater capacity, or longer life.
Indirect Restorative Therapy
. Indirect
Restorative Therapy Services consist only of services of physical therapists,
occupational therapists, and speech, hearing and language therapists to provide
the following: orientation programs for aides and assistants; in-service
training to staff; consultation and planning for continuing care after
discharge; pre-admission meetings with families; quality improvement activities
such as record reviews, analysis of information and writing reports; personnel
activities including hiring, firing, and interviewing; rehabilitation staff
scheduling; and attending team meetings including quality improvement, falls,
skin team, daily admissions, interdisciplinary, departmental staff, discharge
planning, and family meetings when the resident is not present.
Industrial Accident Resident
. A person
receiving Nursing Facility services for which an employer or an insurer is
liable under the Workers' Compensation Act, M.G.L. c. 152.
Licensed Bed Capacity
. The number of
beds for which the Nursing Facility is either licensed by the Department of
Public Health pursuant to 105 CMR 100.020: Definitions, or for
a Nursing Facility operated by a government agency, the number of beds approved
by the Department of Public Health. The Department of Public Health issues a
license for a particular level of care.
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.
Maximum Available Bed Days
. The total
number of licensed beds for the calendar year, determined by multiplying the
Mean Licensed Bed Capacity for the calendar year by the days in the calendar
year.
Mean Licensed Bed Capacity
. A
Provider's weighted average Licensed Bed Capacity for the calendar year,
determined by:
(a) multiplying Maximum
Available Bed Days for each level of care by the number of days in the calendar
year for which the Nursing Facility was licensed for each level;
(b) adding the Maximum Available Bed Days for
each level; and
(c) dividing the
total Maximum Available Bed Days by the number of days in the calendar
year.
Mortgage Acquisition Costs
. Those
costs (such as finder's fees, certain legal fees, and filing fees) necessary to
obtain long-term financing through a mortgage, bond, or other long-term debt
instrument.
Nursing Costs
. Nursing costs include
the Reported Costs for Director of Nurses, Registered Nurses, Licensed
Practical Nurses, Nursing Aides, Nursing Assistants, Orderlies, Nursing
Purchased Services, and the Workers' Compensation expense, Payroll Tax expense,
and Fringe Benefits, including Pension Expense, associated with those
salaries.
Nursing Facility
. A nursing or
convalescent home; an infirmary maintained in a town; a charitable home for the
aged, as defined in M.G.L. c. 111, § 71; or a Nursing Facility operating
under a hospital license issued by the Department pursuant to M.G.L. c. 111,
and certified by the Department for participation in MassHealth. It includes
facilities that operate a licensed Residential Care Unit within the Nursing
Facility.
Other Fixed Costs
. Other Fixed Costs
include real estate taxes, personal property taxes on the Nursing Facility
Equipment, the non-income portion of the Massachusetts Corporate Excise Tax,
Building insurance, and rental of Equipment located at the facility.
Other Operating Costs
. Other Operating
Costs include, but are not limited to the following reported costs: plant,
operations and maintenance; dietary; laundry; housekeeping; ward clerks and
medical records librarian; medical director; advisory physician; utilization
review committee; employee physical exams; other physician services; house
medical supplies not resold; pharmacy consultant; social service worker;
Indirect Restorative Therapy and recreation therapy expense; other required
education; job related education; quality assurance professionals; management
minute questionnaire nurses; staff development coordinator; motor vehicle
expenses including, but not limited to depreciation, mileage payments, repairs,
insurance, excise taxes, finance charges, and sales tax; and Administrative and
General Costs.
Patient Days
. The total number of days
of occupancy by residents in the facility. The day of admission is included in
the computation of Patient Days; the day of discharge is not included. If
admission and discharge occur on the same day, one resident day is included in
the computation. It includes days for which a Provider reserves a vacant bed
for a Publicly-aided Resident temporarily placed in a different care situation,
pursuant to an agreement between the Provider and the MassHealth agency. It
also includes days for which a bed is held vacant and reserved for a non
publicly aided resident.
Presiding Officer
. The individual(s)
authorized by law or designated by the Center to conduct an Adjudicatory
Proceeding.
Provider
. A Nursing Facility providing
care to Publicly-aided Residents or Industrial Accident Residents.
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 Resident
. A person for
whom care in a Nursing Facility is in whole or in part subsidized by the
Commonwealth or a political subdivision of the Commonwealth. Publicly-aided
Residents do not include residents whose care is in whole or in part subsidized
by Medicare.
Related Party
. An individual or
organization associated or affiliated with, or that has control of, or is
controlled by, the Provider; or is related to 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) and (c) of the
Internal Revenue Code of 1954 as amended provided, however, that 10% is 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.
Reported Costs
. All costs reported in
the cost report, less costs adjusted and/or self-disallowed.
Required Education
. Educational
activities, conducted by a recognized school or authorized organization,
required to maintain a professional license of employees that provide care to
Publicly-aided Residents. Required education also includes training for nurses'
aides.
Residential Care
. The minimum basic
care and services and protective supervision required by the Department in
accordance with 105 CMR 150.000:
Licensing of Long-term Care
Facilities for residents who do not routinely require nursing or other
medically-related services.
Residential Care Unit
. A Unit within a
Nursing Facility licensed by the Department to provide residential care.
Unit
. A Unit is an identifiable
section of a Nursing Facility such as a wing, floor, or ward as defined by the
Department in 105 CMR 150.000:
Licensing of Long-term Care
Facilities.
