La. Admin. Code tit. 50 § II-20001
Active Assessment-a resident MDS assessment is considered active when it has been accepted by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS). The assessment will remain active until a subsequent minimum data set (MDS) assessment for the same resident has been accepted by CMS, the maximum number of days (121) for the assessment has been reached, or the resident has been discharged.
Administrative and Operating Cost Component-the portion of the Medicaid daily rate that is attributable to the general administration and operation of a nursing facility.
Assessment Reference Date-the date on the minimum data set (MDS) used to determine the due date and delinquency of assessments.
Base Resident-Weighted Median Costs and Prices-the resident-weighted median costs and prices calculated in accordance with §20005 of this rule during rebase years.
Calendar Quarter-a three-month period beginning January 1, April 1, July 1, or October 1.
Capital Cost Component-the portion of the Medicaid daily rate that is:
Care Related Cost Component-the portion of the Medicaid daily rate that is attributable to those costs indirectly related to providing clinical resident care services to Medicaid recipients.
Case Mix-a measure of the intensity of care and services used by similar residents in a facility.
Case-Mix Documentation Review (CMDR)-a review of original legal medical record documentation and other documentation as designated by the department in the MDS supportive documentation requirements, supplied by a nursing facility provider to support certain reported values that resulted in a specific RUG classification on a randomly selected MDS assessment sample. The review of the documentation provided by the nursing facility will result in the RUG classification being supported or unsupported.
Case-Mix Index (CMI)-a numerical value that describes the residents relative resource use within the groups under the resource utilization group (RUG-III) classification system, or its successor, prescribed by the department based on the residents MDS assessments. CMIs will be determined for each nursing facility on a quarterly basis using all residents.
Cost Neutralization-refers to the process of removing cost variations associated with different levels of resident case mix. Neutralized cost is determined by dividing a facility's per diem direct care costs by the facility cost report period case-mix index.
Delinquent MDS Resident Assessment-an MDS assessment that is more than 121 days old, as measured by the assessment reference date (ARD) field on the MDS.
Department-the Louisiana Department of Health (LDH), or its successor, and the associated work product of its designated contractors and agents.
Direct Care Cost Component-the portion of the Medicaid daily rate that is attributable to:
Facility Cost Report Period Case-Mix Index-Repealed.
Example. Repealed.
Facility-Wide Average Case-Mix Index-Repealed.
Final Case-Mix Index Report (FCIR)-the final report that reflects the acuity of the residents in the nursing facility.
Index Factor-based on the Skilled Nursing Home without Capital Market Basket Index published by IHS Global Insight (IHS Economics), or a comparable index if this index ceases to be published.
MDS Supportive Documentation Requirements-the departments publication of the minimum documentation and review standard requirements for the MDS items associated with the RUG-III or its successor classification system. These requirements shall be maintained by the department and updated and published as necessary.
Minimum Data Set (MDS)-a core set of screening and assessment data, including common definitions and coding categories that form the foundation of the comprehensive assessment for all residents of long-term care nursing facility providers certified to participate in the Medicaid Program. The items in the MDS standardize communication about resident problems, strengths, and conditions within nursing facility providers, between nursing facility providers, and between nursing facility providers and outside agencies. The Louisiana system will employ the current required MDS assessment as approved by the Centers for Medicare and Medicaid Services (CMS), or as mandated by the Department of Health through the use of the optional state assessment (OSA).
Nursing Facility Cost Report Period Case Mix Index-the average of quarterly nursing facility-wide average case mix indices, carried to four decimal places. The quarters used in this average will be the quarters that most closely coincide with the nursing facility providers cost reporting period that is used to determine the medians. This average includes any revisions made due to an on-site CMDR.
Example: A January 1, 2015-December 31, 2015 cost report period would use the time-weighted facility-wide average case mix indices calculated for the four quarters ending March 31, 2015, June 30, 2015, September 30, 2015 and December 31, 2015.
Nursing Facility-Wide Average Case Mix Index-the simple average, carried to four decimal places, of all resident case mix indices.
Optional State Assessment (OSA)-assessment required by Louisiana Medicaid to report on Medicaid-covered stays. Allows nursing facility providers using RUG-III or RUG-IV models as the basis for Medicaid payment to do so until the legacy payment model (RUG-III) ends.
Allows nursing facility providers using RUG-III or RUG-IV models as the basis for Medicaid payment to do so until the legacy payment model (RUG-III) ends.
Patient Driven Payment Model (PDPM)-the proposed new Medicare payment rule for skilled nursing facilities. The PDPM identifies and adjusts different case-mix components for the varied needs and characteristics of a resident's care and then combines these with a non-case-mix component to determine the full skilled nursing facilities (SNF) prospective payment system (PPS) per diem rate for that resident.
Pass-Through Cost Component-includes the cost of property taxes and property insurance. It also includes the provider fee as established by the Department of Health.
Point-In-Time Acuity Measurement System (PIT)-the case mix index calculation methodology that is compiled utilizing the active resident MDS assessments as of the last day of the calendar quarter, referred to as the point-in-time.
Preliminary Case-Mix Index Report (PCIR)-the preliminary report that reflects the acuity of the residents in the nursing facility.
Rate Year-a one-year period from July 1 through June 30 of the next calendar year during which a particular set of rates are in effect. It corresponds to a state fiscal year.
Resident-Day-Weighted Median Cost-a numerical value determined by arraying the per diem costs and total actual resident days of each nursing facility from low to high and identifying the point in the array at which the cumulative total of all resident days first equals or exceeds half the number of the total resident days for all nursing facilities. The per diem cost at this point is the resident-day-weighted median cost.
RUG-III Resident Classification System-the resource utilization group used to classify residents. When a resident classifies into more than one RUG-III, or its successors group, the RUG-III or its successors group with the greatest CMI will be utilized to calculate the nursing facility providers total residents average CMI and Medicaid residents average CMI.
Summary Review Results Letter-a letter sent to the nursing facility that reports the final results of the case-mix documentation review and concludes the review.
Supervised Automatic Sprinkler System-a system that operates in accordance with the latest adopted edition of the National Fire Protection Associations Life Safety Code. It is referred to hereafter as a fire sprinkler system.
Time-Weighted Acuity Measurement System (TW)-the case mix index calculation methodology that is compiled from the collection of all resident MDS assessments transmitted and accepted by CMS that are considered active within a given calendar quarter. The resident MDS assessments will be weighted based on the number of calendar days that the assessment is considered an active assessment within a given calendar quarter.
Two-Hour Rated Wall-a wall that meets American Society for Testing and Materials International (ASTM) E119 standards for installation and uses two-hour rated sheetrock.
Unsupported MDS Resident Assessment-an assessment where one or more data items that are used to classify a resident pursuant to the RUG-III, 34-group, or its successors resident classification system is not supported according to the MDS supportive documentation requirements and a different RUG-III, or its successor, classification would result; therefore, the MDS assessment would be considered "unsupported."
Base Resident-Repealed.
Calendar Quarter-Repealed.
Capital Cost Component-Repealed.
Care Related Cost Component-Repealed.
Case Mix-Repealed.
Case-Mix MDS Documentation Review (CMDR)-Repealed.
Cost Neutralization-Repealed.
Delinquent MDS Resident Assessment-Repealed.
Direct Care Cost Component-Repealed.
Facility Cost Report Period Case-Mix Index-Repealed.
Example. Repealed.
Facility-Wide Average Case-Mix Index-Repealed.
Final Case-Mix Index Report (FCIR)-Repealed.
Index Factor-Repealed.
Minimum Data Set (MDS)-Repealed.
MDS Supportive Documentation Guidelines-Repealed.
Pass-Through Cost Component-Repealed.
Preliminary Case Mix Index Report (PCIR)-Repealed.
Rate Year-Repealed.
Resident-Day-Weighted Median Cost-Repealed.
RUG-III Resident Classification System-Repealed.
Summary Review Results Letter-Repealed.
Supervised Automatic Sprinkler System-Repealed.
Two-Hour Rated Wall-Repealed.
Unsupported MDS Resident Assessment-Repealed.
La. Admin. Code tit. 50, § II-20001