Utah Admin. Code R414-504-2 - Definitions
The definitions in Sections R414-1-2 and R414-501-2 apply to this rule. In addition:
(1) "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.
(2) "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.
(3) "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 medically based mental health disorder or diagnosis and has a high level
resource use in the nursing facility not currently recognized in the case
mix.
(4) "Case mix index" means a
score assigned to each facility based on the average of the Medicaid patients'
case mix scores for that facility.
(5) "Case mix score" means the acuity or
frailty of a resident based on medical needs resulting in a weight used to
calculate rates.
(6) "Exception
qualifying major renovation" means for purposes of a moratorium exception, a
project in a facility that undergoes major renovations that involve significant
structural changes of the physical facility and requires review and approval
under Rule 432-4. The renovation includes a cost greater than or equal to
$5,000 for total licensed beds and excludes flooring and paint.
(7) "Facility case mix rate" means the rate
the Department issues to a facility for a specified period. This rate utilizes
the case mix index for a provider, labor wage index application, and other case
mix-related costs.
(8) "Fair rental
value (FRV) data report" means a report that provides the Department with
information related to capital improvements to be included in the FRV
calculation.
(9) "FCP" means the
facility cost profile report filed by the provider on an annual
basis.
(10) "Major renovation"
means, as used in the fair rental value calculation, a capitalized project with
a cost equal to or greater than $500 for a 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.
(11) "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.
(12) "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.
(13)
"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 Section 26B-2-201.
(14) "Patient day" means the care of one
patient during a day of service, excluding the day of discharge.
(15) "Patient-driven payment model" (PDPM)
means the Medicare prospective payment system for classifying skilled nursing
facility patients in a covered Medicare Part A stay.
(16) "Property costs" means the fair rental
value (FRV) established by this rule.
Notes
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