As used in this part 2, unless the context otherwise requires:
(1) Acquisition cost means the actual allowable cost to the owners of a
capital-related asset or any improvement thereto as determined in accordance with
generally accepted accounting principles.
(2) Actual cost or cost means the audited cost of providing services.
(3) Administration and general services costs means costs in the following
categories:
(a) Advertising, recruitment, and public relations, to the extent that such
costs are necessary, reasonable, and patient-related;
(b) Travel and training of facility staff, unless the travel includes residents of
the facility or the training is for the facility staff described in paragraph (a) of
subsection (15) of this section; and
(c) All other costs that are not direct or indirect health-care services, raw
food costs, or capital-related assets.
(4) Appraised value means the determination by a qualified appraiser who
is a member of an institute of real estate appraisers, or its equivalent, of the
depreciated cost of replacement of a capital-related asset to its current owner. The
depreciated replacement appraisal must be based on a nationally recognized
valuation system determined by the state department. The depreciated cost of
replacement appraisal must be redetermined at least every four years by new
appraisals of the nursing facilities. The new appraisals must be based upon rules
promulgated by the state board.
(5) Array of facility providers means a listing in order from lowest per diem
cost facility to highest for that category of costs or rates, as may be applicable, of
all medicaid-participating nursing facility providers in the state.
(6) (a) Base value means:
(I) For the fiscal year 1986-87 and every fourth year thereafter, the
appraised value of a capital-related asset;
(II) For each year in which an appraisal is not done pursuant to subparagraph
(I) of this paragraph (a), the most recent appraisal together with fifty percent of any
increase or decrease each year since the last appraisal, as reflected in the index.
(b) For the fiscal year 1985-86, the base value shall not exceed twenty-five
thousand dollars per licensed bed at any participating facility, and, for each
succeeding fiscal year, the base value shall not exceed the previous year's
limitation adjusted by any increase or decrease in the index.
(c) An improvement to a capital-related asset, which is an addition to that
asset, as defined by rules adopted by the state board, shall increase the base value
by the acquisition cost of the improvement.
(7) Capital-related asset means the land, buildings, and fixed equipment of
a participating facility.
(8) Case-mix means a relative score or weight assigned for a given group
of residents based upon their levels of resources, consumption, and needs.
(9) Case-mix adjusted direct health-care services costs means those costs
comprising the compensation, salaries, bonuses, workers' compensation, employer-contributed taxes, and other employment benefits attributable to a nursing facility
provider's direct care nursing staff whether employed directly or as contract
employees, including but not limited to registered nurses, licensed practical nurses,
and nurses' aides.
(9.5) Case-mix group means the system determined by the state
department for grouping a nursing facility's residents according to their clinical and
functional status as identified from data supplied by the facility's minimum data set
as published by the United States department of health and human services.
(10) Case-mix index means a numeric score assigned to each nursing
facility resident based upon a resident's physical and mental condition that reflects
the amount of relative resources required to provide care to that resident.
(11) Case-mix neutral means the direct health-care costs of all facilities
adjusted to a common case-mix.
(12) Case-mix reimbursement means a payment system that reimburses
each facility according to the resource consumption in treating its case-mix of
medicaid residents, which case-mix may include such factors as the age, health
status, resource utilization, and diagnoses of the facility's medicaid residents as
further specified in this section.
(13) Class I facility means a private for-profit or not-for-profit nursing
facility provider or a facility provider operated by the state of Colorado, a county, a
city and county, or special district that provides general skilled nursing facility care
to residents who require twenty-four-hour nursing care and services due to their
ages, infirmity, or health-care conditions, including residents who are behaviorally
challenged by virtue of a severe behavioral or mental health disorder.
(14) Direct health-care services costs means those costs subject to case-mix adjusted direct health-care services costs.
(15) Direct or indirect health-care services costs means the costs incurred
for patient support services, including the following:
(a) Salaries, payroll taxes, workers' compensation payments, training, and
other employee benefits for registered nurses, licensed practical nurses, aides,
medical records librarians, social workers, and activity personnel;
(b) Nonprescription drugs ordered by a physician;
(c) Consultant fees for nursing, medical records, patient activities, social
workers, pharmacies, physicians, and therapies;
(d) Purchases, rentals, and costs incurred to operate, maintain, or repair
health-care equipment;
(e) Supplies for nurses, medical records personnel, social workers, activity
personnel, and therapy personnel;
(f) Medical director fees;
(g) Therapies and other medically related services, including the following:
(I) Utilization review;
(II) Dental care, when required by federal law;
(III) Audiology;
(IV) Psychology;
(V) Physical therapy;
(VI) Recreational therapy;
(VII) Occupational therapy; and
(VIII) Speech therapy;
(h) Other patient support services determined and defined by the state board
pursuant to rule;
(i) Raw food costs that do not include the costs of equipment, staff, or other
costs associated with meal preparation;
(j) Malpractice insurance;
(k) Depreciation and interest for major health-care equipment, such as
equipment purchased for the sole purpose of providing care to facility residents;
and
(l) Photocopying related to health-care purposes such as medical records of
patients.
(15.5) Eligible nursing facility provider means a nursing facility, as defined
in section 25.5-4-103.
(16) Facility population distribution means the number of Colorado nursing
facility residents who are classified into each case-mix group as of a specific point
in time.
(17) Fair rental allowance means the product obtained by multiplying the
base value of a capital-related asset by the rental rate.
(18) Improvement means the addition to a capital-related asset of land,
buildings, or fixed equipment.
(19) Index means the RSMeans construction systems cost index or an
equivalent index that is based upon a survey of prices of common building materials
and wage rates for nursing home construction.
(20) Index maximization means classifying a resident who could be
assigned to more than one category to the category with the highest case-mix
index.
(20.5) Repealed.
(21) Median per diem cost means the average daily cost of care and
services per patient for the nursing facility provider that represents the middle of
all of the arrayed facilities participating as providers or as the number of arrayed
facilities may dictate, the mean of the two middle providers.
(22) Minimum data set means a set of screening, clinical, and functional
status elements that are used in the assessment of a nursing facility provider's
residents under the federal medicare and medicaid programs.
(23) Normalization ratio means the statewide average case-mix index
divided by the facility's cost report period case-mix index.
(24) Normalized means multiplying the nursing facility provider's per diem
case-mix adjusted direct health-care services cost by its case-mix index
normalization ratio for the purpose of making the per diem cost comparable among
facilities based upon a common case-mix in order to determine the maximum
allowable reimbursement limitation.
(25) Nursing facility provider means a facility provider that meets the state
nursing home licensing standards established pursuant to section 25-1.5-103 (1)(a),
C.R.S., and is maintained primarily for the care and treatment of inpatients under
the direction of a physician.
(26) Nursing salary ratios means the relative difference in hourly wages of
registered nurses, licensed practical nurses, and nurses' aides.
(27) Nursing weights means numeric scores assigned to each category of
the case-mix groups that measure the relative amount of resources required to
provide nursing care to a nursing facility provider's residents.
(28) Occupancy-imputed days means the use of a predetermined number
for patient days rather than actual patients days in computing per diem cost.
(29) Per diem cost means the daily cost of care and services per patient for
a nursing facility provider.
(30) Per diem rate means the daily dollar amount of reimbursement that
the state department shall pay a nursing facility provider per patient.
(31) Provider fee means a licensing fee, assessment, or other mandatory
payment that is related to health-care items or services as specified under 42 CFR
433.55.
(32) Raw food means the products and substances, including but not
limited to nutritional supplements, that are consumed by residents.
(33) Rental rate means the average annualized composite rate for United
States treasury bonds issued for periods of ten years and longer plus two percent.
The rental rate shall not exceed ten and three-quarters percent nor fall below eight
and one-quarter percent.
(34) Repealed.
(35) Statewide average per diem rate means the average daily dollar
amount of the per patient payments to all medicaid-participating facility providers
in the state.
(36) Supplemental medicaid payment means a lump sum payment that is
made in addition to a provider's per diem rate. A supplemental medicaid payment is
calculated on an annual basis using historical data and paid as a fixed monthly
amount with no retroactive adjustment.
(37) Wage enhancement supplemental payment means a supplemental
payment to an eligible nursing facility provider that is subject to available
appropriations and not a rate enhancement.