Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 709. Definitions

7 AAC 43.709. Definitions

In 7 AAC 43.670 - 7 AAC 43.709,

(1) "acute care hospital" means a facility that provides inpatient hospitalization for medical and surgical care of acute illness or injury and perinatal care;

(2) repealed 1/1/2004;

(3) "adjusted Medicare cost report" means a base year's Medicare cost report that has been adjusted in accordance with 7 AAC 43.686 or 7 AAC 43.693;

(4) "assets" means all economic resources of a health facility, recognized and measured in conformity with generally accepted accounting principles; "assets" includes certain deferred charges that are not resources but that are recognized and measured in accordance with generally accepted accounting principles;

(5) "base year" means the facility's fiscal year ending 12 months before the fiscal year for which prospective payment rates are to be re-based;

(6) "budget" and "budgeting" mean the financial data for, and the process of, developing a capital budget for annual submission to the department, by a facility that has received a certificate of need for the facility's prospective fiscal year or for a facility that has a rate established under 7 AAC 43.685(g) (3)(B);

(7) "capital" means capital-related costs as determined in accordance with 42 C.F.R. 413.130 - 413.153, governing the Medicare cost report;

(8) "certificate" or "certificate of need" means a certificate of need required by and approved under AS 18.07 and 7 AAC 07;

(9) "charges" means amounts that patients are billed for health care services provided by a facility;

(10) "charity care" means health care services that

(A) a facility does not expect to result in cash payments; and

(B) result from a facility's policy to provide health care services free of charge to an individual who meets certain financial criteria;

(11) repealed 1/1/2004;

(12) "commissioner" means the commissioner of the Department of Health and Social Services or the commissioner's designee;

(13) repealed 7/11/2002;

(14) "department" means the Department of Health and Social Services;

(15) "depreciation" means the systematic distribution of the cost or other base of a tangible asset over the estimated useful life of the asset;

(16) "deputy commissioner" means a deputy commissioner of the Department of Health and Social Services or the deputy commissioner's designee;

(17) repealed 1/1/2004;

(18) "effective date" means the date on which a new or modified prospective payment rate is determined by the department to be effective;

(19) repealed 1/1/2004;

(20) repealed 1/1/2004;

(21) "facility" means an acute care hospital, specialty hospital, nursing facility, intermediate care facility for the mentally retarded, psychiatric hospital, rural health clinic, or outpatient surgical clinic;

(22) "findings and recommendations" means the analysis of a facility prospective payment rate or amendment to the prospective payment rate, the resulting findings, and the department's recommendations relating to the acceptance or modification of a facility's proposed prospective payment rates or effective dates;

(23) "fiscal year" means the operating or business year of a facility; "fiscal year" includes 12 consecutive calendar months;

(24) repealed 1/1/2004;

(25) "generally accepted accounting principles" means accounting principles approved by the Financial Accounting Standards Board (FASB);

(26) "intermediate care facility for the mentally retarded" means a licensed facility certified to deliver services under 7 AAC 12.300 and 7 AAC 12.305;

(27) "long-term care facility" means an intermediate care facility for the mentally retarded or a nursing facility;

(28) "Medicaid nursing facility day" means a nursing facility day that is a Medicaid covered day of service;

(29) "Medicaid patient day" means a patient day that is a Medicaid covered day of service;

(30) "Medicaid utilization rates" means, in acute care, the percentage of Medicaid acute care patient days within a hospital's total acute care patient days for a fiscal year;

(31) repealed 7/11/2002;

(32) "MR-0-14 report" means the cost settlement detail report, generated by the department, of the claims processed and paid for by Medicaid for each facility;

(33) "new facility" means a facility that has not, within the previous 36 months, provided the same or similar level of Medicaid certified patient services within 25 miles of the facility either through present or previous ownership;

(34) "notify" means to place written notice of an action in the United States mail or other independent national post carrier, addressed to the last known address of a person, or to deliver written notice by hand to a person;

(35) "nursery day" means a calendar day related to inpatient nursing care of a newborn infant in a hospital nursery;

(36) "nursing facility" means a licensed facility certified to deliver nursing care services to medical care recipients under 7 AAC 12.250 - 7 AAC 12.290 and a licensed intermediate care facility certified to deliver intermediate care services under 7 AAC 43.170 - 7 AAC 43.280;

(37) "nursing facility day" means a calendar day of care in a nursing facility, including the day of admission and not the day of discharge;

(38) "outpatient surgical clinic" means an ambulatory surgical center, which operates as a distinct entity exclusively for the purpose of providing surgical services to patients not requiring hospitalization;

(39) "patient day" means a calendar day of inpatient care, including the day of admission and not the day of discharge;

(40) "person" has the same meaning as in AS 01.10.060 ; "person" includes a municipality and the state;

(41) "prospective payment rate" means the rate described in 7 AAC 43.676 and authorized by the department to be paid to a facility for services provided to Medicaid recipients;

(42) "psychiatric hospital" means a facility that primarily provides inpatient psychiatric services for the diagnosis and treatment of mental illness; "psychiatric hospital" does not include a residential treatment center;

(43) "re-basing" means a change in the base year as described in 7 AAC 43.685(a) (5);

(44) repealed 7/11/2002;

(45) repealed 7/11/2002;

(46) "specialty hospital" means a rehabilitation hospital that is operated primarily for the purpose of inpatient care assisting in the restoration of persons with physical handicaps;

(47) "state" means the State of Alaska;

(48) "swing-bed day" means a calendar day related to a hospitalization for treatment of a patient whose hospital level of care is reduced to nursing facility level without a physical move of the patient;

(49) "swing-bed rate" means a rate set under 7 AAC 43.685(j) ;

(50) "terms of issuance" means the terms specified by a certificate of need describing the nature and extent of the activities authorized by the certificate;

(51) "year-end report" means the report submitted to the department that contains the following:

(A) the uniform Medicare cost report as submitted to the Medicare intermediary;

(B) the Medicare home office cost statements and any audit performed by Medicare of those statements, if applicable;

(C) the Medicare provider cost report reimbursement questionnaire;

(D) any supporting schedules sent to the Medicare intermediary with the Medicare cost report;

(E) audited financial statements specific to the reporting facility and matching the time period of the Medicare cost report that identify the facility's financial information;

(F) audit adjustments made by the financial statement auditors;

(G) reconciliation of the audited financial statements to the Medicare cost report worksheet A;

(H) post-audit working trial balance;

(I) reconciliation of the post-audit working trial balance to the Medicare cost report worksheets A, A-8, C, and G series;

(J) appropriate Medicaid reporting forms from the Medicaid Hospital and Long-Term Facility Reporting Manual , adopted by reference in 7 AAC 43.679(a) ;

(52) "CMC DSH" means a children's medical care DSH;

(53) "DET DSH" means a designated evaluation and treatment DSH;

(54) "DSH" means disproportionate share hospital;

(55) "government entity" means an entity that qualifies as a unit of government for the purposes of 42 U.S.C. 1396b(w)(6)(A);

(56) "IMD DSH" means an institution for mental disease DSH;

(57) "institution for mental disease" or "IMD" means a facility of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of individuals with mental diseases, including medical attention, nursing care, and related services; whether an institution is an institution for mental disease is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not the facility is licensed as such;

(58) "intergovernmental transfer" means a transfer of money between state or local governments and public facilities;

(59) "LI DSH" means a low-income DSH;

(60) "LUR" means the amount over a low-income utilization rate exceeding 25 percent as calculated in 7 AAC 43.687(d) (2);

(61) "MIU DSH" means a Medicaid inpatient utilization DSH;

(62) repealed 7/11/2002;

(63) "public facility" means a hospital that is, or is owned by, a government entity;

(64) "RHCA DSH" means a rural hospital clinic assistance DSH;

(65) "ROGA DSH" means a remainder of government allocation DSH;

(66) "SDM" means the amount over a Medicaid inpatient utilization rate at least one standard deviation above the mean of state Medicaid inpatient utilization rates for all hospitals in this state as calculated under 7 AAC 43.687(d) (1);

(67) "SPEP DSH" means a single point of entry psychiatric DSH;

(68) "uninsured care" means services provided to patients without health insurance or another source of third party payments that applied to services rendered during the qualifying year;

(69) "MHCA DSH" means a mental health clinic assistance DSH;

(70) "SATP DSH" means a substance abuse treatment provider DSH.

(71) "audit" means the systematic inspection of accounting records involving analyses, tests, or confirmations;

(72) "licensed capacity days" means the number of beds for which the facility is licensed under 7 AAC 12.900 in the base year, multiplied by 365.

History: Eff. 8/9/86, Register 99; am 7/4/87, Register 102; am 5/8/88, Register 106; am 6/19/88, Register 106; am 7/20/88, Register 107; am 3/16/89, Register 109; am 3/13/89, Register 110; am 8/25/89, Register 111; am 10/11/89, Register 112; am 1/18/90, Register 113; am 9/21/90, Register 116; am 8/6/92, Register 123; am 3/26/93, Register 126; am 8/11/95, Register 135; readopt 8/7/96, Register 139; am 12/27/96, Register 140; am 12/30/2000, Register 156; am 9/28/2001, Register 159; am 6/23/2002, Register 162; am 7/11/2002, Register 163; am 1/1/2004, Register 168; am 3/18/2006, Register 177

Authority: AS 47.05.010

AS 47.07.070

AS 47.07.073

Editor's note: Definitions formerly located at 7 AAC 43.709(13), (31), (44), (45), and (62) have been relocated to 7 AAC 43.1990.

Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.709 in its entirety, without change, under AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.