Kan. Admin. Regs. § 30-10-1a - Nursing facility program definitions
(a) The following
words and terms, when used in this article, shall have the following meanings,
unless the context clearly indicates otherwise.
(1) "Accrual basis of accounting" means that
revenue of the provider is reported in the period when it is earned, regardless
of when it is collected, and expenses are reported in the period in which they
are incurred, regardless of when they are paid.
(2) "Active treatment for individuals with
mental retardation or a related condition" means a continuous program for each
client, which shall include aggressive, consistent implementation of a program
of specialized and generic training, treatment, health services, and related
services that is directed toward the following:
(A) The acquisition of the behaviors
necessary for the client to function with as much self-determination and
independence as possible; and
(B)
the prevention or deceleration of regression or loss of current optimal
functional status.
(3)
"Agency" means the department of social and rehabilitation services.
(4) "Ancillary services and other medically
necessary services" means those special services or supplies, in addition to
routine services, for which charges are made.
(5) "Case mix" means a measure of the
intensity of care and services used by a group of residents in a facility.
(6) "Case mix index" means a
numeric score with a specific range that identifies the relative resources used
by a particular group of residents and represents the average resource
consumption across a population or sample. Two average case mix index scores
are considered in setting rates for nursing facility program participants.
These indexes are the following:
(A)
"Medicaid average case mix index," which means the average case mix index
calculated using case mix scores for only the medicaid residents in a
population; and
(B) "facility
average case mix index," which means the average case mix index calculated
using case mix scores for all the residents in a nursing facility.
(7) "Change of ownership" means a
transfer of rights and interests in real and personal property used for nursing
facility services through an arm's-length transaction between unrelated persons
or legal entities.
(8) "Change of
provider" means a change of ownership or lessee specified in the provider
agreement.
(9) "Common ownership"
means that an entity holds a minimum of five percent ownership or equity in the
provider facility or in a company engaged in business with the provider
facility.
(10) "Control" means
that an individual or organization has the power, directly or indirectly, to
significantly influence or direct the actions or policies of an organization or
facility.
(11) "Cost and other
accounting information" means adequate financial data about the nursing
facility operation, including source documentation, that is accurate, current,
and sufficiently detailed to accomplish the purposes for which it is intended.
Source documentation, including petty cash payout memoranda and original
invoices, shall be valid only if the documentation originated at the time and
near the place of the transaction. In order to provide the required cost data,
the provider shall maintain financial and statistical records in a manner that
is consistent from one period to another. This requirement shall not preclude a
beneficial change in accounting procedures when there is a compelling reason to
effect a change of procedures.
(12) "Cost finding" means recasting the data
derived from the accounts ordinarily kept by a provider to ascertain costs of
the various types of services rendered.
(13) "Costs not related to resident care"
means costs that are not appropriate, necessary, or proper in developing and
maintaining the nursing facility operation and activities. These costs shall
not be allowed in computing reimbursable costs.
(14) "Costs related to resident care" means
all necessary and proper costs, arising from arm's-length transactions in
accordance with general accounting rules, that are appropriate and helpful in
developing and maintaining the operation of resident care facilities and
activities. Specific items of expense shall be limited pursuant to K.A.R.
30-10-23a, K.A.R. 30-10-23b, K.A.R. 30-10-23c, K.A.R. 30-10-24, K.A.R.
30-10-25, K.A.R. 30-10-26, K.A.R. 30-10-27, and K.A.R. 30-10-28.
(15) "Cost report" means the nursing facility
financial and statistical report (MS-2004).
(16) "Educational activities" means an
approved, formally organized, or planned program of study usually engaged in by
providers in order to enhance the quality of resident care in an institution.
These activities shall be licensed when required by state law.
(17) "Educational activities net cost" means
the cost of approved educational activities less any grants, specific
donations, or reimbursements of tuition.
(18) "Hospital-based nursing facility" means
a nursing facility, as defined in this regulation, that is attached to or
associated with a hospital.
(19)
"Inadequate care" means any act or failure to act that may be physically or
emotionally harmful to a recipient.
(20) "Level of care" means the type and
intensity of services prescribed in the resident's plan of care as based on the
assessment and reassessment process.
(21) "Mental illness" means a clinically
significant behavioral or psychological syndrome or pattern that is typically
associated with either a distressing symptom or impairment of function.
Relevant diagnoses shall be limited to schizophrenia, recurrent and severe
major affective disorders, atypical psychosis, bipolar disorder, paranoid
disorders, schizoaffective disorder, psychotic disorder, obsessive-compulsive
disorder, or borderline personality disorder.
(22) "Mental retardation" means subaverage
general intellectual functioning that originates in the developmental period
and is associated with an impairment in adaptive behavior.
(23) "Nonworking owners" means any individual
or organization having five percent or more interest in the provider who does
not perform a resident-related function for the nursing facility.
(24) "Nonworking related party or director"
means any related party, as defined in this regulation, who does not perform a
resident-related function for the nursing facility.
(25) "Nursing facility (NF)" means a facility
that conforms to these criteria:
(A) Meets
state licensure standards;
(B)
provides health-related care and services, as prescribed by a physician; and
(C) provides 24-hour-a-day,
seven-day-a-week licensed nursing supervision to residents for ongoing
observation, treatment, or care for long-term illness, disease, or injury.
(26) "Nursing facility
for mental health" means a nursing facility that meets these criteria:
(A) Meets state licensure standards;
(B) provides structured mental
health rehabilitation services, in addition to health-related care, for
individuals with a severe and persistent mental illness; and
(C) provides 24-hour-a-day, seven-day-a-week
licensed nursing supervision. The nursing facility shall have been operating in
accordance with a provider agreement with the agency on June 30, 1994.
(27) "Ongoing entity"
means that a change in the provider has not been recognized for Kansas medical
assistance program payment purposes.
(28) "Organization costs" means those costs
directly incidental to the creation of the corporation or other form of legal
business entity. These costs shall be considered to be intangible assets
representing expenditures for rights and privileges that have value to the
business.
(29) "Owner and related
party compensation" means salaries, drawings, consulting fees, or other
payments paid to or on behalf of any owner with a five percent or greater
interest in the provider or any related party, as defined in this regulation,
whether the payment is from a sole proprietorship, partnership, corporation, or
nonprofit organization.
(30)
"Owner" means the person or legal entity that has the rights and interests of
the real and personal property used to provide the nursing facility services.
(31) "Plan of care for nursing
facilities" means a document completed by the nursing facility staff that
states the need for care, the estimated length of the program, the methodology
to be used, and the expected results for each resident.
(32) "Prescription drug" means a simple or
compound substance or mixture of substances prescribed for the cure,
mitigation, or prevention of disease or for health maintenance that is
prescribed by a licensed physician or practitioner and dispensed by a licensed
pharmacist.
(33) "Projected cost
report" means a cost report submitted to the agency by a provider prospectively
for a 12-month period of time. The projected cost report shall be based on an
estimate of the costs, revenues, resident days, and other financial data for
that 12-month period of time.
(34)
"Provider" means the operator of the nursing facility specified in the provider
agreement.
(35) "Recipient" means
a person determined to be eligible for the Kansas medical assistance program in
a nursing facility.
(36) "Related
parties" means two or more parties with a relationship in which one party has
the ability to influence another party to the transaction in the following
manner:
(A) When one or more of the
transacting parties might fail to pursue the party's or parties' own separate
interests fully;
(B) when the
transaction is designed to inflate the Kansas medical assistance program costs;
or
(C) when any party considered a
related party to a previous owner or operator becomes the employee, or
otherwise functions in any capacity on behalf of a subsequent owner or
operator. Related parties shall include parties related by family, business, or
financial association, or by common ownership or control. Transactions between
related parties shall not be considered to have arisen through arm's-length
negotiations.
(37)
"Related to the nursing facility" means that the facility is significantly
associated or affiliated with, has control of, or is controlled by the
organization furnishing the services, facilities, or supplies.
(38) "Representative" means either of the
following:
(A) A legal guardian, conservator,
or representative payee as designated by the social security administration; or
(B) any person who is designated
in writing by the resident to manage the resident's personal funds and who is
willing to accept the designation.
(39) "Resident assessment form" means the
document that meets these requirements:
(A)
Is jointly specified by the Kansas department of health and environment and the
agency;
(B) is approved by the
health care finance administration; and
(C) includes the minimum data set.
(40) "Resident assessment
instrument" means the resident assessment form, resident assessment protocols,
and the plan of care, including reassessments.
(41) "Resident day" means that period of
service rendered to a resident between census-taking hours on two successive
days and all other days for which the provider receives payment, either full or
partial, for any Kansas medical assistance program or non-Kansas medical
assistance program resident who was not in the nursing facility. Census-taking
hours shall consist of 24 hours beginning at midnight.
(42) "Resident status review" means a
reassessment to identify any nursing facility resident who may no longer meet
the level of care criteria.
(43)
"Routine services and supplies" means services and supplies that are commonly
stocked for use by or provided to any resident. The services and supplies shall
be included in the provider's cost report.
(44) "Sale-leaseback" means a transaction in
which an owner sells a facility to a related or nonrelated purchaser and then
leases the facility from the new owner to operate as the provider.
(45) "Severe and persistent mental illness"
means mental illness as defined in this regulation, but shall include both of
the following additional requirements:
(A)
The individual meets one of the following criteria:
(i) Has undergone psychiatric treatment more
intensive than what could have been provided through outpatient care more than
once in a lifetime; or
(ii) has
experienced a single episode of continuous, structured, supportive residential
care other than hospitalization for a duration of at least two months.
(B) The individual
meets at least two of the following criteria, on a continuing or intermittent
basis, for at least two years:
(i) Is
unemployed, is employed in a sheltered setting, or has markedly limited skills
and a poor work history;
(ii)
requires public financial assistance for out-of-hospital maintenance and may be
unable to procure this assistance without help;
(iii) shows a severe inability to establish
or maintain a personal social support system;
(iv) requires help in basic living skills; or
(v) exhibits inappropriate social
behavior that results in a need for intervention by the mental health or
judicial system.
(46) "Specialized mental health
rehabilitation services" means one of the specialized rehabilitative services
that provide ongoing treatment for mental health problems and that are aimed at
attaining or maintaining the highest level of mental and psychosocial
well-being. The specialized rehabilitative services shall include the
following:
(A) Crisis intervention services;
(B) drug therapy or monitoring of
drug therapy;
(C) training in
medication management;
(D)
structured socialization activities to diminish tendencies toward isolation and
withdrawal;
(E) development and
maintenance of necessary daily living skills, including grooming, personal
hygiene, nutrition, health and mental health education, and money management;
and
(F) maintenance and
development of appropriate personal support networks.
(47) "Specialized services" means inpatient
psychiatric care for the treatment of an acute episode of mental illness.
(48) "State licensing agency"
means the department of health and environment for hospital-based nursing
facilities and the department on aging for all other nursing facilities.
(49) "Swing bed" means a hospital
bed that can be used interchangeably as either a hospital bed or nursing
facility bed.
(50)
"Twenty-four-hour nursing care" means the provision of 24-hour licensed nursing
services with the services of a registered nurse for at least eight consecutive
hours a day, seven days a week.
(51) "Working trial balance" means a list of
the account balances in general ledger order that was used in completing the
cost report.
(b) This
regulation shall be effective on and after May 1, 2005.
Notes
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