Rule 15-9-91-1.14 - Definition of Termsa.Affected Person means:2. a person residing within the geographic area served or to be served by the applicant's proposal;3. a person who regularly uses health care facilities or Health Maintenance Organizations (HMO) located in the geographic area of the proposal which provide similar service to that which is proposed;4. health care facilities and HMOs which, before receipt of the application under review, formally indicated an intention to provide services similar to that of the proposal being considered at a future date;5. third party payors who reimburse health care facilities located in the geographical area of the proposal; or6. any agency that establishes rates for health care services or HMOs located in the geographic area of the proposal.b.Aggrieved Party includes the Mississippi Department of Health, the applicant, and any person who actively participated in the proceedings before the Mississippi Department of Health. Active participation in the proceedings includes requesting a hearing during the course of review, and the timely filing of written comments which completely and formally set out objections to the application and the reasons for those objections.c.Applicant means an individual, a partnership, a corporation (including associations, joint stock companies and insurance companies), a state or political subdivision or instrumentality (including a municipal corporation) of a state.d.Bed Capacity means the number of beds by licensure category within the facility as determined by the Department's Health Facilities Licensure and Certification Division.e.By or On Behalf Of means a capital expenditure by a health care facility which meets a review threshold, or a capital expenditure by another entity which will result in a direct or indirect benefit to a health care facility, including capital expenditures by parent corporations for the benefit of their health facility holdings and guarantor arrangements on loans and/or leases. A capital expenditure "by or on behalf of a health care facility" includes but is not limited to the following:
1. Medical office building (MOB) or other structure is constructed on land adjacent to a health care facility;2. Land is leased from a health care facility for the construction of a MOB or other structure to benefit the health care facility;3. The health care facility has an option to purchase the MOB or other structure;4. The health care facility maintains the authority to approve tenants of the MOB or other structure; and/or5. The health care facility retains the option to assume control of the MOB or other structure and collect rent.f.Capital Expenditure:1. When pertaining to defined major medical equipment, shall mean an expenditure which, under generally accepted accounting principles consistently applied, is not properly chargeable as an expense of operation and maintenance and which exceeds one million five hundred thousand dollars ($1,500,000.00)2. When pertaining to a clinical health service, other than major medical equipment shall mean any expenditure which, under generally accepted accounting principles consistently applied, is not properly chargeable as an expense of operation and maintenance and which exceeds five million dollars ($5,000,000.00), adjusted for inflation by the State Department of Health. The Department will use the inflation index, as published by the State Economist annually, to calculate this adjustment. The Department will publish the new amounts each year on its website.3. When pertaining to non-clinical health service, other than major medical equipment, shall mean any expenditure which, under generally accepted accounting principles consistently applied, is not properly chargeable as an expense of operation and maintenance and which exceeds ten million dollars ($10,000,000.00) adjusted for inflation by the State Department of Health. The Department will use the inflation index, as published by the State Economist annually, to calculate this adjustment. The Department will publish the new amounts each year on its website.4. Shall include the acquisition, whether by lease, sufferance, gift, devise, legacy, settlement of a trust or other means, of any facility or part thereof, or equipment for a facility, the expenditure for which would have been considered a capital expenditure if acquired by purchase. Transactions which are separated in time but are planned to be undertaken within 12 months of each other and are components of an overall plan for meeting patient care objectives shall, for purposes of this definition, be viewed in their entirety without regard to their timing.5. In those instances where a health care facility or other provider of health services proposes to provide a service in which the capital expenditure for major medical equipment or other than major medical equipment or a combination of the two may have been split between separate parties, the total capital expenditure required to provide the proposed service shall be considered in determining the necessity of CON review and in determining the appropriate CON review fee to be paid. The capital expenditure associated with facilities and equipment to provide services in Mississippi shall be considered regardless of where the capital expenditure was made, in state or out of state, and regardless of the domicile of the party making the capital expenditure, in state or out of state.g.Capital Lease means a lease which meets one or more of the following conditions: 1. Title is transferred to the lessee by the end of the lease term.2. The lease contains a bargain purchase option at less than the fair value at the time of the option.3. The lease term is at least 75 percent of the leased property's estimated economic life.4. The present value of the minimum lease payments is 90 percent or more of the fair value of the leased property. Operating Leases do not meet any of the four criteria listed above.
h.Certificate of Need means a written order by the State Health Officer setting forth the affirmative finding that a proposal in prescribed application form sufficiently satisfies the plans, standards, and criteria prescribed for such service or other project by Sections 41-7-171 et seq., Mississippi Code of 1972 Annotated, as amended, and by rules and regulations promulgated thereunder by the Department.i.Change of Ownership includes, but is not limited to, inter vivos gifts, purchases, transfers, lease arrangements, cash and/or stock transactions or other comparable arrangements whenever another person or entity (not the current owner) acquires or controls the majority interest of an existing health care facility, and/or the change of ownership of major medical equipment, a health service, or an institutional health service. Changes of ownership from partnerships, single proprietorships, or corporations to another form of ownership are specifically included. However, "Change of Ownership" shall not include any inherited interest acquired as a result of a testamentary instrument or under the laws of descent and distribution of the State of Mississippi.j.Change in Project Scope is defined as any substantive change, as determined by the State Department of Health, in plans to construct or renovate a health care facility, in number of beds or services to be offered within the facility, or in capital expenditure authorized by the approved CON.k.Clinical Health Service shall only include those activities which contemplate any change in the existing bed complement of any health care facility through the addition or conversion of any beds, under Section 41-7-191(1)(c) or propose to offer any health services if those services have not been provided on a regular basis by the proposed provider of such services within the period of twelve (12) months prior to the time such services would be offered, under Section 41-7-191(1)(d).l.Construction means the erection, building, or substantial alteration, reconstruction, improvement, renovation, extension, or modification of a health care facility and the studies, surveys, designs, plans, working drawings, specifications, procedures, and other actions necessary thereto.m.Commencement of Construction means that all of the following have been completed with respect to a proposal or project proposing construction, renovation, remodeling, or alteration. 1. A legally binding written contract has been executed and consummated by the proponent and a lawfully licensed contractor to construct and/or complete the intent of the proposal within a specified period of time in accordance with final architectural plans which have been approved by the licensing authority of the Department;2. Any and all permits and/or approvals deemed lawfully necessary by all authorities with responsibility for such have been secured;3. Actual bona fide undertaking of the subject proposal has commenced, and a progress payment of at least one percent of the total cost of the contract has been paid to the contractor by the proponent; and4. Requirements of this paragraph have been met and certified in writing by the Department. Force account expenditures, such as deposits, securities, bonds, etcetera, may, in the discretion of the Department, be excluded from any or all of the provisions of defined commencement of construction.
n.Consumer means an individual who is not a provider of health care or representative of a provider of health care services or who has no financial or indirect interest in any provider of services.o.Determination of Reviewability means findings of the Department setting forth the Department's decision as to the requirement for certificate of need review regarding a proposal pending before it, pursuant to Section 41-7-205.p.Develop, when used in connection with health services, means to undertake those activities which, on their completion, will result in the offering of a new institutional health service or the incurring of a financial obligation as defined under applicable state law in relation to the offering of such services.q.Health Care Facility includes hospitals, long term care hospitals, psychiatric hospitals, chemical dependency hospitals, comprehensive medical rehabilitation facilities, skilled nursing facilities, intermediate care facilities, intermediate care facilities for the mentally retarded, psychiatric residential treatment facilities, pediatric skilled nursing facilities, end stage renal disease facilities (including freestanding hemodialysis units), ambulatory surgical facilities, and/or home health agencies (including facilities owned or operated by the State or political subdivision or instrumentality of the State) but does not include Christian Science sanatoriums operated or licensed and certified by the First Church of Christ, Scientist, Boston, Massachusetts. This definition shall not apply to facilities for the private practice, either independently or by incorporated medical groups, of physicians, dentists, or other health care professionals except where such facilities are an integral part of an institutional health service. The various health care facilities listed in this paragraph shall be defined as follows: 1.Ambulatory Surgical Facility means a facility primarily organized or established for the purpose of performing surgery for outpatients and is a separate identifiable legal entity from any other health care facility. Such term does not include the offices of private physicians or dentists, whether for individual or group practice.2.Chemical Dependency Hospital means an institution which is primarily engaged in providing to inpatients, by or under the supervision of a physician, medical and related services for the diagnosis and treatment of chemical dependency such as alcohol and drug abuse.3.Comprehensive Medical Rehabilitation Facility means a hospital or a hospital unit that is licensed and/or certified as a comprehensive medical rehabilitation facility which provides specialized programs that are accredited by the Commission on Accreditation of Rehabilitation Facilities and supervised by a physician Board-certified or Board-eligible in psychiatry or other doctor of medicine or osteopathy with at least two years of training in the medical direction of a comprehensive rehabilitation program that: a. Includes evaluation and treatment of individuals with physical disabilities;b. Emphasizes education and training of individuals with disabilities;c. Incorporates at least the following core disciplines: iii. Speech and Language Therapyiv. Rehabilitation Nursing; andd. Incorporates at least three of the following disciplines:iv. Therapeutic Recreationviii. Vocational Rehabilitationxi. Rehabilitation Engineering These specialized programs include, but are not limited to, spinal cord injury programs, head injury programs, and infant and early childhood development programs.
4.End Stage Renal Disease (ESRD) Facilities means kidney dialysis centers, which includes freestanding hemodialysis units and limited care facilities. The term "limited care facility" generally refers to an off-hospital-premises facility, regardless of whether it is provider or non-provider operated, which is engaged primarily in furnishing maintenance hemodialysis services to stabilized patients.5.Hospital means an institution which is primarily engaged in providing to inpatients, by or under the supervision of physicians, diagnostic services and therapeutic services for medical diagnosis; treatment and care of injured, disabled, or sick persons; or rehabilitation services for the rehabilitation of injured, disabled, or sick persons. Such term does not include psychiatric hospitals.6.Home Health Agency means a public or privately owned agency or organization, or a subdivision of such an agency or organization, properly authorized to conduct business in Mississippi, which is primarily engaged in providing to individuals at the written direction of a licensed physician, in the individual's place of residence, skilled nursing services provided by or under the supervision of a registered nurse licensed to practice in Mississippi, and one or more of the following services or items:a. Physical, occupational, or speech therapy;b. Medical social services;c. Part-time or intermittent services of a home health aide;d. Other services as approved by the licensing agency for home health agencies;e. Medical supplies, other than drugs and biological, and the use of medical appliances; orf. Medical services provided by an intern or resident-in-training at a hospital under a teaching program of such hospital. Further, all skilled nursing services and those services listed in items 1 through 4 of this paragraph (f) must be provided directly by the licensed home health agency. For purposes of this subparagraph, "directly" means either through an agency employee or by an arrangement with another individual not defined as a health care facility. This paragraph shall not apply to health care facilities which had contracts for the above services with a home health agency on January 1, 1990.
7.Intermediate Care Facility means an institution which provides, on a regular basis, health related care and services to individuals who do not require the degree of care and treatment which a hospital or skilled nursing facility is designed to provide, but who, because of their mental or physical condition, require health related care and services (above the level of room and board). NOTE: Under federal guidelines, nursing facilities are no longer licensed as intermediate care facilities. Effective October 1, 1990, nursing facilities are classified, based on reimbursement levels, as nursing facilities or skilled nursing facilities (see skilled nursing facility).
8.Intermediate Care Facility for the Mentally Retarded means an intermediate care facility that provides health or rehabilitative services in a planned program of activities to, persons with intellectual disability, also including but not limited to cerebral palsy and other conditions by the Federal Developmentally Disabled Assistance and Bill of Rights Act, Public Law 94-103.9.Long-Term Care Hospital means a freestanding, Medicare-certified hospital that has an average length of inpatient stay greater than 25 calendar days, which is primarily engaged in providing chronic or long term medical care to patients who do not require more than three hours of rehabilitation or comprehensive rehabilitation per day, and has a transfer agreement with an acute care medical center and a comprehensive medical rehabilitation facility. Long term care hospitals shall not use rehabilitation, comprehensive medical rehabilitation, medical rehabilitation, sub-acute rehabilitation, nursing home, skilled nursing facility, or sub-acute care facility in association with its name.10.Pediatric Skilled Nursing Facility means an institution or a distinct part of an institution that is primarily engaged in providing to inpatients skilled nursing care and related services for persons under 21 years of age who require medical or nursing care or rehabilitation services for the rehabilitation of injured, disabled, or sick persons.11.Psychiatric Hospital means an institution which is primarily engaged in providing to inpatients, by or under the supervision of a physician, psychiatric services for the diagnosis and treatment of persons with mental illness.12.Psychiatric Residential Treatment Facility means any non-hospital establishment with permanent licensed facilities which provides a twenty-four (24) hour program of care by qualified therapists including, but not limited to, duly licensed mental health professionals, psychiatrists, psychologists, psychotherapists and licensed certified social workers, for emotionally disturbed children and adolescents referred to such a facility by a court, local school district, or by the Department of Human Services, who are not in an acute phase of illness requiring the services of a psychiatric hospital, and are in need of such restorative treatment services. For purposes of this paragraph, the term "emotionally disturbed" means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree, which adversely affects educational performance: a. An inability to learn which cannot be explained by intellectual, sensory, or health factors;b. An inability to build or maintain satisfactory relationships with peers and teachers;c. Inappropriate types of behavior or feelings under normal circumstances;d. A general pervasive mood of unhappiness or depression; ore. A tendency to develop physical symptoms or fears associated with personal or school problems. An establishment furnishing primarily domiciliary care is not within this definition.13.Rehabilitation Hospital means a hospital or established and dedicated unit of a general hospital licensed for rehabilitation, which is organized, staffed, and equipped to render services toward the rehabilitation of disabled persons through an integrated program of medical, psychological, social, and vocational evaluation and provision of services over a continuous period exceeding 24 hours. The average length of stay for such beds shall be 30 calendar days or more.14.Skilled Nursing Facility (SNF) means a health institution planned, organized, operated, and maintained to provide facilities and health services with related social care to inpatients who require medical care and 24-hour nursing services for illness, injury, or disability. Each patient shall be under the care of a physician licensed to practice medicine in the State of Mississippi. The nursing services shall be organized and maintained to provide 24-hour nursing services under the direction of a registered professional nurse employed full-time.r.Health Maintenance Organization or "HMO" means a public or private organization which:1. Provides or otherwise makes available to enrolled participants health care services, including substantially the following basic health care services: usual health care services, hospitalization, laboratory, x-ray, emergency and preventive services, and out-of-area coverage;2. Is compensated (except for co-payments) for the provision of the basic health care services listed in subparagraph (a) of this paragraph to enrolled participants on a predetermined basis; and3. Provides health care services primarily:a. Directly through physicians who are either employees or partners of such organization; orb. Through arrangements with individual physicians or one or more groups of physicians (organized on a group practice or individual practice basis).s.Health Planning Area means that geographic area specified in the State Health Plan that is determined by population data, patient origin data, and area health facilities offering referral services to the area. Health Planning Areas are used for determining bed need and/or service needs within the state.t.Health Service Area means a geographic area of the state designated in the State Health Plan as the area to be used in planning for specified health facilities and services and to be used when considering CON applications to provide health facilities and service.u.Health Services means clinically related (i.e., diagnostic, treatment, or rehabilitative) services and include alcohol, drug abuse, mental health, and home health care servicesv.Hospital and/or Health Facility Based means a health service that is physically located in or legally owned by the hospital or health facility.w.Institutional Health Services shall mean health services provided in or through health care facilities and shall include the entities in or through which such services are provided.x.Major Medical Equipment means medical equipment costs in excess of one million five hundred thousand dollars ($1,500,000.00). However, this definition shall not be applicable to clinical laboratories if they are determined by the Department to be independent of any physician's office, hospital, or other health facility or otherwise not so defined by federal or state law, or rules and regulations promulgated there under.y.Nonclinical Health Services shall be all other health services, which do not involve any change in the existing bed complement or offering health services as described herein.z.Offer means, when used in connection with health services, that the State Department of Health has determined that the health care facility is capable of providing specified health services.aa.Person means an individual, a trust or estate, partnership, corporation (including associations, joint stock companies, and insurance companies), the State, or political subdivision or instrumentality of the State.bb.Provider means any person who is a provider or representative of a provider of health care services requiring a CON or who has any financial or indirect interest in any provider or services.cc.Secretary means the Secretary of Health and Human Services and any officer or employee of the Department of Health and Human Services to whom the authority involved has been delegated.dd.Similar Equipment means pieces of equipment which are similar in function and appearance. For example, a manually operated bed and an electrically operated bed are similar units. A 1,000 power microscope and a 500 power microscope are similar units. A coulter counter and a microscope are not similar units.ee.State Health Plan means the sole and official statewide health plan for Mississippi which identifies priority state health needs and establishes standards and criteria for health related activities which require Certificate of Need review in compliance with Section 41-7-191, Mississippi Code of 1972, as amended.ff.State Department of Health shall mean the state agency created under Section 41-3-15, Mississippi Code of 1972 as amended, which shall be considered to be the State Health Planning and Development Agency, as defined in paragraph 1.46 below.gg.State Health Planning and Development Agency means the agency of state government designated to perform health planning and resource development programs for the State of Mississippi.hh.Swing Bed Program means the interchangeable utilization of hospital beds for the provision of acute or extended care with reimbursement based on the specific level of care provided.15 Miss. Code. R. 9-91-1.14