§ 47-1261 — Definitions.

For the purposes of this chapter, the term:

(1) “Case mix reimbursement methodology” means a prospective Medicaid payment rate system for nursing facilities that includes:

(A) A point-of-sale prescription system;

(B) A resident classification system based on resident acuity and needs; and

(C) The following 3 peer groupings for rate purposes:

(i) All freestanding nursing facilities, except those owned by the District of Columbia;

(ii) All hospital-based nursing facilities; and

(iii) All nursing facilities owned by the District of Columbia.

(2) “Fiscal year” means the 12-month accounting period of the District of Columbia beginning on October 1 and ending on September 30 of the next year.

(3) “Fund” means the Nursing Facility Quality of Care Fund established by this chapter.

(4) “Gross resident revenue” means the sum of resident charges, ancillary service charges, and other charges related to the provision of services to residents.

(5) “Medicaid” means the medical assistance programs authorized by title XIX of the Social Security Act, approved July 30, 1965 (79 Stat. 343; 42 U.S.C. § 1396 et seq.), and by [ § 1-307.02 ], and administered by the Department of Health.

(6) “Net resident revenue” means gross resident revenue less deductions resulting from a nursing facility’s inability to collect full payment of its established charges to residents. The deductions include:

(A) Bad debts;

(B) Contractual adjustments, including the difference between the amount that would be realized at the nursing facility’s established charges and the amount actually received pursuant to contractual agreements entered into to receive Medicare payments, Medicaid payments, Blue Cross or Blue Shield plan payments, or other third-party payments;

(C) Uncompensated or charity care; and

(D) Administrative, courtesy, and policy discounts and adjustments.

(7) “Nursing facility” means a health care facility as defined in and codified at § 44-501(a)(3) , but does not include a health care facility operated by the federal government.

(8) “Quality of care initiatives” means initiatives that include a case mix reimbursement methodology, reimbursement of the costs of the audit required by § 47-1262(d) , and, to the extent that amounts in the Fund remain, other programs designed to promote and foster the improved care, safety, and health of residents in Medicaid-certified nursing facilities.

(9) “Resident” means a person receiving services in a nursing facility.

(10) “Superior Court” means the Superior Court of the District of Columbia.

Legislative History

Dec. 7, 2004, D.C. Law 15-205, § 5202(c), 51 DCR 8441