Tenn. Comp. R. & Regs. 1200-13-09-.01 - DEFINITIONS

The following definitions shall apply to Rules 1200-13-9-.02 through 1200-13-9-.14 inclusive, unless otherwise indicated.

(1) Capital Costs means those costs which are required or allowed by Title XVIII principles to be included in all depreciation columns on worksheet B of HCFA form 2552-85 (12/85). Capital costs shall not include costs associated with non-reimbursable cost centers.

(2) Direct Medical Education Costs means those costs associated with a nursing school or intern-resident services in an approved residency program which are required or allowed by Title XVIII principles to be included on worksheet B of HCFA form 2552-85 (12/85). Medical education costs shall not include costs associated with non-reimbursable cost centers, nor shall they include costs for routine, in-service training.

(3) Utilization Ratio means the ratio of Medicaid covered inpatient days attributable to patients determined eligible for Medicaid by the State of Tennessee to total inpatient days. Education costs are considered as a part of the operating component when educational services are an integral part of a recipient's acute inpatient psychiatric care involving active treatment pursuant to an individual plan of care developed by an interdisciplinary treatment team, and ordered by the recipient's attending physician.

(4) Medicaid Day means any part of a day, including the day of admission in which a person determined eligible for Medicaid by the State of Tennessee is admitted as an inpatient with the intention of remaining overnight. The day of discharge is not counted as a day. If admission and discharge occur on the same day, the day is considered one inpatient day.

(5) Operating Component means those costs, applicable to inpatient services only, which are required or allowed by Title XVIII principles to be included on worksheet E of HCFA form 2552-85 (12/85), including costs relating to hospital-based physicians if applicable, and COSTS for educational services when they are an integral part of a recipient's acute inpatient psychiatric care involving active treatment, pursuant to an individual plan of care developed by an interdisciplinary treatment team, and ordered by the recipient's attending physician, less the portion of capital-related and direct medical education costs attributable to patients determined eligible for Medicaid by the State of Tennessee.

(6) Pass Through Component means the share which is attributable to patients determined eligible for Medicaid by the State of Tennessee of actual capital costs and actual direct medical education costs. Upon the effective date of these rules, the Services Tax will be an allowable cost included in the pass-through component.

(7) Title XVIII principles means, except where indicated otherwise, those Medicare principles which are applicable to hospitals, which were in effect on October 1, 1982, and which are described at 42 CFR Part 405.

(8) Base Year Cost Report for inpatient psychiatric services is the 12 month cost report (for each provider) ending in calendar year 1986. If a provider does not have a 12 month cost report ending within that time period, then the base year shall be the next preceding 12 month cost report. If there is no such cost report, then the base year shall be the most recently filed 12 month cost report. Inpatient psychiatric providers not meeting any of the above conditions shall be handled in accordance with Rule 1200-13-9-.11 NEW PROVIDERS.

(9) Hospital means both those health care facilities defined by T.C.A. § 68-11-201(10), which are licensed by this Department and the Tennessee Board for Licensing Health Care Facilities pursuant to regulatory Chapter 1200-8-1, and those inpatient facilities licensed by the Tennessee Department of Mental Health and Mental Retardation, pursuant to T.C.A. § 33-2-501 et. seq. as defined by regulatory chapter 0940-5-1-.06(l) and (3). "Hospital" also means the whole, or the distinct part, of a health care facility that has been certified by this Department and the Federal Health Care Financing Administration to participate as a provider of Medicaid inpatient hospital services (as defined by the October 1, 1986, edition of 42 CFR 440. 10 and 440.140) or inpatient psychiatric services for individuals under twenty-one (21) (as defined by the October 1, 1986, edition of 42 CFR 440.160) .

Notes

Tenn. Comp. R. & Regs. 1200-13-09-.01

Original rule filed June 2, 1988; effective July 17, 1988. Amendment filed September 25, 1992; effective November 9, 1992.

Authority: T.C.A. §§ 4-5-202, 12-4-301, 71-5-105 and 71-5-109, Public Chapter 913 of the Acts of 1992.