Section 29-6599. DEFINITIONS

 

When used in this Chapter, the following terms and phrases shall have the meanings ascribed:

 

Accrual Method of Accounting means a method of accounting pursuant to which revenue is recorded in the period earned, regardless of when collected and expenses are recorded in the period, regardless of when paid.

 

Base Year means the standardized year on which rates for all facilities are calculated to derive a prospective reimbursement rate.

 

BO1 means the case mix index scores developed by the Centers for Medicare and Medicaid Services for the Medicaid 34-group Resource Utilization Groups (RUG-III) classification system.

 

Case Mix Index means a number value score that describes the relative resource use for the average resident in each of the groups under the RUGS III classification system based on the assessed needs of the resident.

 

Case Mix Neutralization means the process of removing cost variations between nursing facilities nursing and resident care costs resulting from different levels of case mix.

 

Ceiling means a pre-determined rate that sets the upper limit of reimbursement.

 

Change of Ownership shall have the same meaning as "acquiring of effective control" as set forth in D.C. Official Code § 44-401(1).

 

Day-Weighted Median means the point in an array from high to low of the per diem costs for all facilities at which half of the days have equal or higher per diem costs and half have equal or lower per diem costs.

 

District-wide Average Case Mix Index means the arithmetic mean of the individual residents case mix indices for all residents, regardless of payer, admitted and present in all nursing facilities located in the District of Columbia on the picture date. The arithmetic mean shall be carried to four decimal places.

 

District-wide Medicaid Average Case Mix Index means the arithmetic mean of the individual residents case mix indices for all residents admitted and present in all nursing facilities on the picture date for whom the Medical Assistance Administration is the payer source. The arithmetic mean shall be carried to four decimal places.

 

F102 (fraction of inspired oxygen) means the ratio of the concentration of oxygen to the total pressure of other gases in inspired air.

 

Facility Medicaid Case Mix Index means the arithmetic mean of the individual resident case mix index for all residents, for whom the Medical Assistance Administration (MAA) is the payer source, admitted and present in the nursing facility on the picture date. The arithmetic mean shall be carried to four decimal places.

 

Fair Market Value means the value at which an asset could be sold in the open market in a transaction between unrelated parties.

 

Leasehold Improvements means the improvements made by the owners of a facility to leased land, buildings or equipment.

 

Mechanical Ventilation means a method for using machines to help an individual to breathe when that individual is unable to breathe sufficiently on his or her own to sustain life.

 

Median means the point in an ordered array from lowest to highest of nursing facility per diem costs at which the facilities are divided into equal halves.

 

Medical Assistance Administration (MAA) means an administration within the Department of Health that is responsible for the day-to-day administration and oversight of the District's Medicaid Program.

 

Minimum Data Set (MDS), Version 2.0 means the resident assessment instrument and data used to determine the RUGS classification of each resident.

 

New Provider means a nursing facility that entered the Medicaid Program after September 30, 2000.

 

Normalized means the process by which the average case mix for the District is set to 1.0. This process shall only be performed at implementation and rebasing.

 

Nursing Facility means a facility that is licensed as a nursing home pursuant to the requirements set forth in the "Health Care and Community Residence License Act of 1983, effective February 24, 1984 (D.C. Law 5-48; D.C. Official Code § 44-501 et seq.) and meets the federal conditions of participation for nursing facilities in the Medicaid program as set forth in 42 CFR 483.1 et seq.

 

Out of State Facility means a nursing facility located outside the District of Columbia which meets the licensure standards in the jurisdiction where services are provided and meets the federal conditions of participation for nursing facilities in the Medicaid program as set forth in 42 CFR 483.1 et seq.

 

Peer Group means a group of nursing facilities sharing the same characteristics.

 

Per Diem Rate means a rate of payment to the nursing facility for covered services in a resident day.

 

Picture Date means one day per quarter in each fiscal year, as selected by the Medical Assistance Administration.

 

Prudent Buyer means the price paid by a prudent buyer in the open market under competitive conditions.

 

Reserved Bed Day means a day for hospitalization or therapeutic leave of absence, when provided for in the resident's plan of care and when there is a reasonable expectation that the resident will return to the nursing facility.

Reserved bed days may not exceed a total of 18 days during any 12-month period that begins on October 1st and ends on September 30th. A therapeutic leave of absence includes visits with relatives and friends and leave to participate in a State-approved therapeutic and rehabilitative program.

 

Resident means an individual who, because of physical, mental, familial or social circumstances, or mental retardation, resides in a nursing facility.

 

Resident Day means one continuous 24-hour period of care furnished by a nursing facility that concludes at midnight each calendar day, including reserved bed days that are paid for by MAA. The day of the resident's admission is counted as a resident day. The day of discharge is not counted as a resident day.

 

Resource Utilization Groups, Version III (RUGS III) means a category-based resident classification system developed by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) used to classify nursing facility residents into groups based on each resident's needs and functional, mental and psychosocial characteristics.

 

Tidal volume means the volume of air inspired and expired during a normal respiratory cycle.

 

Total Facility Average Case Mix Index means the arithmetic mean of the individual resident case mix indices for all residents, regardless of payer, admitted and present in the nursing facility on the picture date. The arithmetic mean shall be carried to four decimal places.

 

Tracheostomy means a surgical opening in the trachea or windpipe through which a tube is channeled to assist breathing.

 

Ventilator dependent means a resident who requires at least sixteen (16) hours per day of mechanically assisted respiration to maintain a stable respiratory status.

 

Weaning means the process of gradually removing an individual from the ventilator and restoring spontaneous breathing after a period of mechanical ventilation.

 

source

Final Rulemaking published at 53 DCR 1370 (February 24, 2006).