D.C. Mun. Regs. tit. 29, r. 29-6599
When used in this chapter, the following terms shall have the meanings ascribed:
Accrual Method of Accounting - 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.
Arm's Length Transaction - a transaction between the nursing facility and another party where both parties are acting in their own best interests and there is no established relationship except the mutual involvement of the parties in the transaction itself.
Base Year - the standardized year on which rates for all facilities are calculated to derive a prospective reimbursement rate.
Case Mix Index - a number value score that describes the relative resource use for the average resident in each of the groups under the RUGS IV classification system based on the assessed needs of the resident.
Case Mix Neutralization - the process of removing cost variations between nursing facilities nursing and resident care costs resulting from different levels of case mix.
Change of Ownership shall have the same meaning as "acquiring of effective control" as set forth in D.C. Official Code § 44-401(1).
Clinically Eligible - means that the beneficiary meets the criteria for a nursing facility level of care, as determined by an assessment completed by DHCF or its assign. The assessment includes a determination from clinicians that the beneficiary requires a nursing facility level of care.
Day-Weighted Median - 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.
Department of Health Care Finance (DHCF) - the single state agency responsible for the administration and oversight of the District's Medicaid program.
Expanded Facility - a facility that puts additional Medicaid certified beds into service.
F01 - the case mix index scores developed by the Centers for Medicare and Medicaid Services for the Medicaid 48-group Resource Utilization Groups (RUGS-IV) classification system.
FiO2 - (fraction of inspired oxygen) - the ratio of the concentration of oxygen to the total pressure of other gases in inspired air.
Facility Medicaid Case Mix - the arithmetic mean of the individual resident case mix index for all residents, for whom DHCF is the payer source, admitted and present in the nursing facility on one (1) day per quarter in each fiscal year, as selected by DHCF. The arithmetic mean shall be carried to four (4) decimal places.
Fair Market Value - the value at which an asset could be sold in the open market in a transaction between unrelated parties.
Long-Stay Resident - A resident who resides in nursing facility for one hundred and one (101) resident days or more.
Mechanical Ventilation - 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 - 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.
Medicaid Resident Day - one (1) continuous twenty- four (24)-hour period of care furnished by a nursing facility that concludes at midnight each calendar day, where DHCF is the primary payor. Calendar days include reserved bed days that are paid for by DHCF. The day of the resident's admission is counted as a resident day. The day of discharge is not counted as a resident day.
Minimum Data Set (MDS), Version 3.0 means the resident assessment instrument and data used to determine the RUGS classification of each resident.
New Provider - a nursing facility that, at the time of application to enroll as a Medicaid provider, has not been a provider during the previous twelve (12)-month period or, for rates effective February 1, 2018 and after, does not have a cost report as set forth in § 6521 of this chapter; and a nursing facility not defined as a reorganized facility or a facility that has changed ownership.
Nursing Facility - a facility that is licensed as a nursing home pursuant to the requirement s 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 §§ 44-501et seq.) and meets the federal conditions of participation for nursing facilities in the Medicaid program as set forth in 42 CFR part 483.
Nursing Facility Quality of Care Fund - District fund established in accordance with the "Fiscal Year 2005 Budget Support Act of 2004," effective December 7, 2004 (D.C. Law 15-205; 51 DCR 8441 (September 3, 2004)), as amended by the "Fiscal Year 2006 Budget Support Act of 2006," effective March 2, 2007 (D.C. Law 16-192; 53 DCR 6899 (August 25, 2006)) and the "Technical Amendments Act of 2008," effective March 25, 2009 (D.C. Law 17-687; 56 DCR 1117 (February 4, 2009)).
Out of State Facility - 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 part 483.
Peer Group - a group of nursing facilities sharing the same characteristics.
Per Diem Rate - a rate of payment to the nursing facility for cove red services in a resident day.
Reorganized Facility - a nursing facility that has filed for bankruptcy in accordance with the requirements set forth by Chapter 11 (Reorganization) of Title 11 of the United State Bankruptcy Code and is managing debts and operations pursuant to a confirmed reorganization plan.
Resident - an individual who resides in a nursing facility due to physical, mental, familial or social circumstances, or intellectual disability.
Resident Day - one (1) continuous twenty- four (24) hour period of care furnished by a nursing facility and reimbursed by any payor that concludes at midnight each calendar day. Calendar days include reserved bed days that are paid for by DHCF. 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 (RUGS IV) - 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 - the volume of air inspired and expired during a normal respiratory cycle.
Total Facility Average Case Mix - the arithmetic mean of the individual resident case mix indices for all residents, regardless of payer, admitted and present in the nursing facility on one (1) day per quarter in each fiscal year, as selected by DHCF. The arithmetic mean shall be carried to four (4) decimal places.
Tracheostomy - a surgical opening in the trachea or windpipe through which a tube is channeled to assist breathing.
Ventilator Dependent - a resident who requires at least sixteen (16) hours per day of mechanically assisted respiration to maintain a stable respiratory status.
Weaning - the process of gradually removing an individual from the ventilator and restoring spontaneous breathing after a period of mechanical ventilation.
D.C. Mun. Regs. tit. 29, r. 29-6599