1. (1) "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.
2. (2) "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.
3. (3) "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.
4. (4) "Case mix index" means a score assigned to each facility based on the average of the Medicaid patients' case mix scores for that facility.
5. (5) "Case mix score" means the acuity or frailty of a resident based on medical needs resulting in a weight used to calculate rates.
6. (6) "Exception qualifying major renovation" means for purposes of a moratorium exception, a project in a facility that undergoes major renovations that involve significant structural changes of the physical facility and requires review and approval under Rule 432-4. The renovation includes a cost greater than or equal to $5,000 for total licensed beds and excludes flooring and paint.
7. (7) "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.
8. (8) "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.
9. (9) "FCP" means the facility cost profile report filed by the provider on an annual basis.
10. (10) "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.
11. (11) "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.
12. (12) "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.
13. (13) "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.
14. (14) "Patient day" means the care of one patient during a day of service, excluding the day of discharge.
15. (15) "Patient-driven payment model" (PDPM) means the Medicare prospective payment system for classifying skilled nursing facility patients in a covered Medicare Part A stay.
16. (16) "Property costs" means the fair rental value (FRV) established by this rule.

The definitions in Sections R414-1-2 and R414-501-2 apply to this rule. In addition:

KEY: Medicaid

Date of Last Change: July 2, 2025

Notice of Continuation: October 12, 2022

Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108