South Carolina Code of Regulations
Chapter 126 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
Article 8 - INTERMEDIATE SANCTIONS FOR MEDICAID CERTIFIED NURSING FACILITIES
Section 126-800 - Definitions

A. Administrator of the State Medicaid Agency means the Executive Director of South Carolina Department of Health and Human Services.

B. Annual Standard Survey means an annual standard survey conducted on each nursing facility, without prior notice to the facility. The survey may occur as early as nine months, but shall not be later than fifteen months after the date of the nursing facility's previous standard survey. The statewide average interval between standard surveys shall not exceed twelve months.

C. Certification means the State Survey Agency's determination that a nursing facility meets the requirements for participation in the Medicaid program.

D. Credible allegation means a statement or documentation which must be submitted to the Centers for Medicare and Medicaid Services (CMS) of the United States Department of Health and Human Services (USDHHS) when a nursing facility has had serious deficiencies resulting in imminent action to terminate the provider's certification. The statement must indicate how deficiencies will be corrected and problems resolved and be realistic in terms of the possibility of correction by specified deadlines.

E. Credible Certified Notice of Correction means a certification letter from the Nursing Facility to the State Survey Agency and the Medicaid Agency, stipulating that deficiencies noted in the most recent survey and due to be corrected by the last date in an accepted credible allegation or in an accepted plan of correction, have been corrected as of the date of the certification letter. Credibility shall be validated upon the next Survey Agency revisit, and penalties shall cease or escalate from the date of the certified notice in accordance with procedures in Section 126-840. The statement, "I certify that" must precede the statement of correction.

F. Deficiency means non-compliance with requirements of participation for nursing facilities as mandated by Federal Regulations.

G. Immediately Jeopardizes the Health or Safety of Residents means that conditions exist which pose a high probability that serious harm or injury to patients could occur at any time, or already has occurred and may well occur again if patients are not protected effectively from the harm (An immediate and serious threat need not result in actual harm to the resident. The threat of probable harm is perceived as being as serious or significant).

The only acceptable corrective action is the immediate elimination of the conditions which immediately jeopardize the resident's health and safety.

H. Medicaid is the common name for Title XIX of the Social Security Act.

I. Nursing Facility means a facility with an organized nursing staff to maintain and operate organized facilities and services to accommodate two or more non-related persons over a period exceeding twenty-four hours, which is operated either in connection with a hospital or as a free standing facility for the express or implied purpose of providing nursing care for persons who are not in need of hospital care, and in which all nursing care is prescribed by or performed under the direction of persons currently licensed to practice medicine in the State of South Carolina. Nursing care consists of nursing services requiring knowledge, judgment, and skill in caring for the sick.

J. Recurring Deficiency means a deficiency, cited by the State Survey Agency during a current survey, that has the exact same tag number but a different reason from the one cited during the previous survey.

K. Repeat Deficiency means a deficiency, cited by the State Survey Agency during a current survey, that has the exact same tag number as cited for the exact same reason in a previous survey.

L. Requirements of Participation means the requirements a nursing facility must meet in order to receive payment under the state's Medicaid program.

M. Substantial Risk to Health and Safety of Residents means conditions exist which over time if not corrected, will likely result in harm or injury to patients.

N. State Medicaid Agency means Department of Health and Human Services (SCDHHS).

O. State Survey Agency means the Department of Health and Environmental Control (DHEC).

P. Tag Number means a reference number which identifies a particular Code of Federal Regulation regulatory statement.

Q. Temporary Management/Receivership means the appointment of a substitute manager or administrator, with powers, as enumerated in the statute, by the court.