Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-504 - Nursing Facility Payments
Section R414-504-2 - Definitions

(1) "Behaviorally complex resident" means a long-term care resident with a severe, medically based behavior disorder, including traumatic brain injury, dementia, Alzheimer's, Huntington's Chorea, which causes diminished capacity for judgment, retention of information or decision-making skills, or a resident, who meets the Medicaid criteria for nursing facility level of care and who has a medically based mental health disorder or diagnosis and has a high level resource use in the nursing facility not currently recognized in the case mix.

(2) "Case mix index" means a score assigned to each facility based on the average of the Medicaid patients' case mix scores for that facility.

(3) "Case mix score" means the acuity or frailty of a resident based on medical needs resulting in a weight used to calculate rates.

(4) "Facility case mix rate" means the rate the Department issues to a facility for a specified period. This rate utilizes the case mix index for a provider, labor wage index application, and other case mix-related costs.

(5) "FCP" means the facility cost profile report filed by the provider on an annual basis.

(6) "Minimum data set" (MDS) means a set of screening, clinical, and functional status elements, including common definitions and coding categories, that form the foundation of the comprehensive assessment for residents of long-term care facilities certified to participate in Medicaid.

(7) "Nursing costs" means the current costs from the annual FCP report reported on lines 070-012 Nursing Admin Salaries and Wages, 070-013 Nursing Admin Tax and Benefits, 070-040 Nursing Direct Care Salaries and Wages, 070-041 Nursing Direct Care Tax and Benefits, and 070-050 Purchased Nursing Services.

(8) "Nursing facility" or "facility" means a Medicaid-participating nursing facility, skilled nursing facility, or a combination thereof, as defined in 42 USC 1396r(a), 42 CFR 440.150, 42 CFR 442.12, and Section 26B-2-201.

(9) "Patient day" means the care of one patient during a day of service, excluding the day of discharge.

(10) "Patient-driven payment model" (PDPM) means the Medicare prospective payment system for classifying skilled nursing facility patients in a covered Medicare Part A stay.

(11) "Property costs" means the fair rental value (FRV) established by this rule.

(12) "Fair rental value (FRV) data report" means a report that provides the Department with information related to capital improvements to be included in the FRV calculation.

(13) "Bed addition" means, as used in the fair rental value calculation, a capitalized project that adds additional beds to the facility. This must be new and complete construction. An increase in total licensed beds and new construction costs support a claim of additional beds.

(14) "Bed replacement" means, as used in the fair rental value calculation, a capitalized project that furnishes a bed in the place of another, previously existing bed. Room remodeling is not a replacement of beds. This must be new and complete construction.

(15) "Major renovation" means, as used in the fair rental value calculation, a capitalized project with a cost equal to or greater than $500 for a licensed bed. A renovation extends the life, increases the productivity, or significantly improves the safety, such as by asbestos removal, of a facility as opposed to repairs and maintenance that either restore the facility to, or maintain it at its normal or expected service life. Vehicle costs are not a major renovation capital expenditure.