Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES
Subchapter 37.40.3 - Reimbursement for Skilled Nursing and Intermediate Care Services
Rule 37.40.302 - DEFINITIONS

(1) "Administrator" means the person licensed by the state, including an owner, salaried employee, or other provider, with daily responsibility for operation of the facility. In the case of a facility with a central management group, the administrator, for the purpose of these rules, may be a person other than the titled administrator of the facility if such person has daily responsibility for operation of the nursing facility and is currently licensed by the state as a nursing home administrator.

(2) "Case mix index (CMI) " means an assigned weight or numeric score assigned to each RUG-III grouping which reflects the relative resources predicted to provide care to nursing facility residents.

(3) "Department" means the Montana Department of Public Health and Human Services or its agents, including but not limited to parties under contract to perform audit services, claim processing and utilization review.

(4) "Department audit staff" and "audit staff" mean personnel directly employed by the department or any of the department's contracted audit personnel or organizations.

(5) "Estimated economic life" means the estimated remaining period during which property is expected to be economically usable by one or more users, with normal repairs and maintenance, for the purpose for which it was intended when built.

(6) "Fiscal year" and "fiscal reporting period" both mean the provider's internal revenue tax year.

(7) "Maintenance therapy and rehabilitation services" mean repetitive services required to maintain functions which do not involve complex and sophisticated therapy procedures or the judgment and skill of a qualified therapist and without the expectation of significant progress.

(8) "Medicaid recipient" means a person who is eligible and receiving assistance under Title XIX of the Social Security Act for nursing facility services.

(9) "Minimum data set (MDS) " means the assessment form approved by the centers for Medicare and Medicaid services (CMS), and designated by the department to satisfy conditions of participation in the Medicaid and Medicare programs.

(10) "Minimum data set RUG-III quarterly assessment form" means the three page quarterly, optional version for RUG-III 1997 update.

(11) "Nonemergency routine transportation" means transportation for routine activities, such as outings scheduled by the facility, nonemergency visits to physicians, dentists, optometrists, or other medical providers. This definition includes such transportation when it is provided within 20 miles of the facility.

(12) "Nursing facility fee schedule" means the list of separately billable ancillary services provided in ARM 37.40.330.

(13) "Nursing facility services" means nursing facility services as provided in ARM 37.40.304 and 37.40.305.

(14) "Patient contribution" means the total of all of a resident's income from any source available to pay the cost of care, less the resident's personal needs allowance. The patient contribution includes a resident's incurment determined in accordance with applicable eligibility rules.

(15) "Patient day" means a whole 24-hour period that a person is present and receiving nursing facility services, regardless of the payment source. Even though a person may not be present for a whole 24-hour period on the day of admission or day of death, such day will be considered a patient day. When department rules provide for the reservation of a bed for a resident who takes a temporary leave from a provider to be hospitalized or make a home visit, such whole 24-hour periods of absence will be considered patient days.

(16) "Provider" means any person, agency, corporation, partnership or other entity that, under a written agreement with the department, furnishes nursing facility services to Medicaid recipients.

(17) "Rate year" means a 12-month period beginning July 1. For example, rate year 2006 means a period corresponding to the state fiscal year July 1, 2005 through June 30, 2006.

(18) "Resident" means a person admitted to a nursing facility who has been present in the facility for at least one 24-hour period.

(19) "RUG-III" means resource utilization group, version III.

(20) "RUG-III grouper version" means the resource utilization group version III algorithm that classifies residents based upon diagnosis, services provided and functional status using MDS assessment information for each resident.