R414-504-2 - Definitions

R414-504-2. Definitions

The definitions in Sections R414-1-2 and R414-501-2 apply to this rule. In addition:

(1) "Behaviorally complex resident" means a long-term care resident with a severe, medically based behavior disorder, including traumatic brain injury, dementia, Alzheimer's, Huntington's Chorea, which causes diminished capacity for judgment, retention of information or decision-making skills, or a resident, who meets the Medicaid criteria for nursing facility level of care and who has a medicallybased mental health disorder or diagnosis and has a high level resource use in the nursing facility not currently recognized in the case mix.

(2) "Case mix index" means a score assigned to each facility based on the average of the Medicaid patients' RUGS scores for that facility.

(3) "Facility case mix rate" means the rate the Department issues to a facility for a specified period of time. This rate utilizes the case mix index for a provider, labor wage index application, and other case mix- related costs.

(4) "FCP" means the facility cost profile report filed by the provider on an annual basis.

(5) "Minimum Data Set" (MDS) means a set of screening, clinical and functional status elements, including common definitions and coding categories, that form the foundation of the comprehensive assessment for residents of long -term care facilities certified to participate in Medicaid.

(6) "Nursing Costs" means the current costs from the annual FCP report reported on lines 070-012 Nursing Admin Salaries and Wages, 070-013 Nursing Admin Tax and Benefits, 070-040 Nursing Direct Care Salaries and Wages, 070-041 Nursing Direct Care Tax and Benefits, and 070-050 Purchased Nursing Services.

(7) "Nursing facility" or "facility" means a Medicaid-participating nursing facility, skilled nursing facility, or a combination thereof, as defined in 42 USC 1396r(a), 42 CFR 440.150, 42 CFR 442.12, and Subsection 26-21-2(15).

(8) "Patient day" means the care of one patient during a day of service, excluding the day of discharge.

(9) "Patient-driven payment model" (PDPM) means the Medicare prospective payment system for classifying skilled nursing facility patients in a covered Medicare Part A stay.

(10) "Property costs" means the fair rental value (FRV) established by this rule.

(11) "RUGS" means the 34 RUG identification system based on the resource utilization group system established by Medicare to measure and ultimately pay for the labor, fixed costs, and other resources necessary to provide care to Medicaid patients. Each RUG is assigned a weight based on an assessment of its relative value as measured by resource utilization.

(12) "RUGS score" means a total number based on the individual RUGS derived from a resident's physical, mental, and clinical condition, which projects the amount of relative resources needed to provide care to the resident. RUGS is calculated from the information obtained through the submission of the MDS data.

(13) "Sole community provider" means a facility that is not an urban provider and is not within 30 paved road miles of another existing facility and is the only facility:

(a) within a city, if the facility is located within the incorporated boundaries of a city; or

(b) within the unincorporated area of the county if it is located in an unincorporated area.

(14)

(a) "Urban provider" means a facility located in a county that has a population greater than 90,000 persons.

(b) "Rural provider" means a facility that is not an urban provider.

(15) "FRV Data Report" means a report that provides the Department with information relating to capital improvements to be included in the FRV calculation.

(16) "Banked beds" means beds that have been taken offline by the provider, through the process defined by the Department of Health, Bureau of Health Facility Licensing, Certification and Resident Assessment, to reduce the operational capacity of the facility, but does not reduce the licensed -bed capacity.

(17) "Bed addition" means, as used in the fair rental value calculation, a capitalized project that adds additional beds to the facility. This must be new and complete construction. An increase in total licensed beds and new construction costs support a claim of additional beds.

(18) "Bed replacement" means, as used in the fair rental value calculation, a capitalized project that furnishes a bed in the place of another, previously existing bed. Room remodeling is not a replacement of beds. This must be new and complete construction.

(19) "Major Renovation" means, as used in the fair rental value calculation, a capitalized project with a cost equal to or greater than $500 per licensed bed. A renovation extends the life, increases the productivity, or significantly improves the safety, such as by asbestos removal, of a facility as opposed to repairs and maintenance that either restore the facility to, or maintain it at its normal or expected service life. Vehicle costs are not a major renovation capital expenditure.

(Amended by Utah State Bulletin Number 2020-19, effective 10/1/2020)

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