Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 150 - Prospective Payment System; Other Payment
7 AAC 150.990 - Definitions

(1) "adjusted Medicare cost report" means a base year's Medicare cost report that has been adjusted in accordance with 7 AAC 150.170 or 7 AAC 150.200;

(2) "All Patient Refined Diagnosis Related Groups" or "APR DRG" means a type of classification system used to assign inpatient stays to a Diagnosis Related Group (DRG), under which a grouping algorithm utilizes the diagnoses code, procedure code, patient birthdate, patient age, patient gender, admission date, discharge date, and discharge status to assign a DRG code to each claim;

(3) "assets" means all economic resources of a health facility, recognized and measured in conformity with generally accepted accounting principles; in this paragraph, "assets" include certain deferred charges that are not resources but that are recognized and measured in accordance with generally accepted accounting principles;

(4) "audit" means the systematic inspection of accounting records involving analyses, tests, or confirmations;

(5) "base year" means the facility's fiscal year ending 12 months before the fiscal year for which prospective payment rates are to be re-based;

(6) "budget" and "budgeting" mean the financial data for, and the process of, developing a capital budget for annual submission to the department, by a facility that has received a certificate of need for the facility's prospective fiscal year or for a facility that has a rate established under 7 AAC 150.160(i)(3)(B);

(7) "capital" means capital-related costs as determined in accordance with 42 C.F.R. 413.130 - 413.153, governing the Medicare cost report;

(8) "certificate" or "certificate of need" means a certificate of need required by and approved under AS 18.07 and 7 AAC 07;

(9) "charges" means amounts that patients are billed for health care services provided by a facility;

(10) "charity care" means health care services that

(11) "clinical laboratory service" means a biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body, for the purpose of diagnosis, prevention, or treatment of a disease, or assessment of a medical condition of a human being;

(12) "CMC DSH" means a children's medical care DSH;

(13) "commissioner" means the commissioner of health or the commissioner's designee;

(14) "cost center" means a breakout of costs on the Medicare cost report related to a particular type of service or administrative function at the facility;

(15) "department" means the Department of Health;

(16) "depreciation" means the systematic distribution of the cost or other base of a tangible asset over the estimated useful life of the asset;

(17) "deputy commissioner" means a deputy commissioner of the department or the deputy commissioner's designee;

(18) "DET DSH" means a designated evaluation and treatment DSH;

(19) "Diagnosis Related Groups" or "DRG" means a patient classification system that standardizes prospective payments to hospitals by grouping services that consume similar hospital resources;

(20) "DSH" means disproportionate share hospital;

(21) "effective date" means the date on which a new or modified prospective payment rate is determined by the department to be effective;

(22) "findings and recommendations" means the analysis of a facility prospective payment rate or amendment to the prospective payment rate, the resulting findings, and the department's recommendations relating to the acceptance or modification of a facility's proposed prospective payment rates or effective dates;

(23) "fiscal year" means a facility's operating or business year; in this paragraph, "fiscal year" includes 12 consecutive calendar months;

(24) "generally accepted accounting principles" means accounting principles approved by the Financial Accounting Standards Board (FASB);

(25) "government entity" means an entity that qualifies as a unit of government for the purposes of 42 U.S.C. 1396b(w)(6)(A);

(26) "grouper" or "DRG grouper" means a software application used to assign an inpatient hospital claim to a DRG;

(27) "IMD DSH" means an institution for mental disease DSH;

(28) "institution for mental disease" or "IMD" means a facility of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of individuals with mental diseases, including medical attention, nursing care, and related services; whether an institution is an institution for mental disease is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not the facility is licensed as such;

(29) "intergovernmental transfer" means a transfer of money between state or local governments and public facilities;

(30) "licensed capacity days" means the number of beds for which the facility is licensed under 7 AAC 12.900 in the base year, multiplied by 365;

(31) "LI DSH" means a low-income DSH;

(32) "LUR" means the amount over a low-income utilization rate exceeding 25 percent as calculated in 7 AAC 150.180(d)(2);

(33) "Medicaid nursing facility day" means a nursing facility day that is a Medicaid covered day of service;

(34) "Medicaid patient day" means a patient day that is a Medicaid covered day of service;

(35) "Medicaid utilization rates" means, in acute care, the percentage of Medicaid acute care patient days within a hospital's total acute care patient days for a fiscal year;

(36) "MHCA DSH" means a mental health clinic assistance DSH;

(37) "MIU DSH" means a Medicaid inpatient utilization DSH;

(38) "MR-0-14 report" means the cost settlement detail report, generated by the department, of the claims processed and paid for by Medicaid for each facility;

(39) "new facility" means a facility that has not, during the previous 36 months, provided the same or similar level of Medicaid certified patient services within 25 miles of the facility either through present or previous ownership;

(40) "notify" means

(41) "nursery day" means a calendar day related to inpatient nursing care of a newborn infant in a hospital nursery;

(42) "nursing facility day" means a calendar day of care in a nursing facility, including the day of admission and not the day of discharge;

(43) "patient day" means a calendar day of inpatient care, including the day of admission and not the day of discharge;

(44) "prospective payment rate" means the rate described in 7 AAC 150.040 and authorized by the department to be paid to a facility for services provided to Medicaid recipient;

(45) "psychiatric hospital"

(46) "public facility" means a hospital that is, or is owned by, a government entity;

(47) "re-basing" means a change in the base year as described in 7 AAC 150.160(a)(3);

(48) "RHCA DSH" means a rural hospital clinic assistance DSH;

(49) "SATP DSH" means a substance abuse treatment provider DSH;

(50) "SDM" means the amount over a Medicaid inpatient utilization rate at least one standard deviation above the mean of state Medicaid inpatient utilization rates for all hospitals in this state as calculated under 7 AAC 150.180(d)(1);

(51) "specialty hospital" means a rehabilitation hospital that is operated primarily for the purpose of inpatient care assisting in the restoration of persons with physical disabilities;

(52) "SPEP DSH" means a single point of entry psychiatric DSH;

(53) "state" means the State of Alaska;

(54) "swing-bed day" means a calendar day related to a hospitalization for treatment of a patient whose hospital level of care is reduced to nursing facility level without a physical move of the patient;

(55) "swing-bed rate" means a rate set under 7 AAC 150.160(k);

(56) "terms of issuance" means the terms specified by a certificate of need describing the nature and extent of the activities authorized by the certificate;

(57) "uninsured care" means services provided to patients without health insurance or another source of third-party payments that applied to services rendered during the qualifying year;

(58) "year-end report" means the report submitted to the department that contains the following: