For purposes of this subpart, the following definitions apply:

1. (1) "Average direct care hours per resident day" means the total number of hours of direct care services provided by direct care staff in a month, divided by the number of calendar days in that month, and the facility's average daily resident census for that month;

2. (2) "Certified nursing facility" means a nursing facility licensed by the Department of Human Services that is certified to participate in:

   1. (A) The federal Medicare program as a skilled nursing facility;
   2. (B) The Arkansas Medicaid Program as a nursing facility; or
   3. (C) Both;

3. (3)

   1. (A) "Direct care services" means:

      1. (i) Nursing and nursing-related services;
      2. (ii) Clinical, diagnostic, therapeutic, and rehabilitative services;
      3. (iii) Physical, occupational, respiratory, and speech therapy services;
      4. (iv) Delegated physician tasks;
      5. (v) Behavioral health services;
      6. (vi) Care management, care coordination, and care transition activities;
      7. (vii) Medication administration;
      8. (viii) Assistance with activities of daily living;
      9. (ix) Assessment, evaluation, planning, and implementation of care plans;
      10. (x) Coordination and consultation with residents' physicians and other healthcare providers; and
      11. (xi) Other services and supports provided for nursing facility residents in response to individual resident needs.
   2. (B) However, the meaning of "direct care services" does not include food preparation, laundry, housekeeping, or other maintenance of a nursing facility's physical environment;

4. (4) "Direct care staff" means a person who provides any direct care services to a nursing facility resident through interpersonal contact with residents or resident care management, including without limitation a:

   1. (A) Licensed nurse;
   2. (B) Nurse aide;
   3. (C) Medication assistant;
   4. (D) Physician;
   5. (E) Physician assistant;
   6. (F) Licensed physical or occupational therapist or licensed therapy assistant;
   7. (G) Registered respiratory therapist;
   8. (H) Licensed speech-language pathologist;
   9. (I) Infection preventionist; and
   10. (J) Other healthcare professionals licensed or certified in the State of Arkansas;
5. (5) "Division" means the Division of Provider Services and Quality Assurance;
6. (6) "Federal direct care data system" means the national online data reporting system operated by the Centers for Medicare and Medicaid Services and used by nursing facilities participating in the federal Medicare program, or the Arkansas Medicaid Program, or both to electronically report detailed and standardized direct care and other staffing information;
7. (7) "Licensed nurse" means any registered nurse, licensed practical nurse, advanced practice registered nurse, or registered nurse practitioner licensed in the State of Arkansas;
8. (8) "Medicare and Medicaid requirements of participation" means the federal requirements established by the Centers for Medicare and Medicaid Services under 42 U.S.C. § 1320a-7j, 42 U.S.C. § 1395i-3, and 42 U.S.C. § 1396r, that a licensed nursing facility is required to follow to be certified as compliant with and participate in the federal Medicare program as a skilled nursing facility, or the Medicaid program as a nursing facility, or both, as existing on January 1, 2021;

9. (9)

   1. (A) "Medication assistant" means a medication assistive person who is qualified and certified under Arkansas Code § 17-87-701 et seq.
   2. (B) Alternatively referred to as medication assistant-certified in rules of the Arkansas State Board of Nursing;

10. (10) "Private pay-only nursing facility" means a licensed nursing facility that is not certified to participate in the:

    1. (A) Federal Medicare program as a skilled nursing facility; or
    2. (B) Arkansas Medicaid Program as a nursing facility;
11. (11) "Universal worker" means a certified nurse aide (CNA) who is designated by a skilled nursing facility as a universal worker and who performs both CNA direct care service duties and nondirect care tasks such as food service, laundry, and housekeeping, and other nondirect care services to meet the needs of residents;
12. (12) "Variance" means granting an alternate requirement or modifying a requirement in place of a requirement established in rule; and
13. (13) "Waiver" means the grant of an exemption from a requirement established in rule.