50-24.4-01. Definitions

50-24.4-01. Definitions

For the purposes of this chapter:

1. "Actual allowable historical operating cost per diem" means the per diem operating

costs allowed by the department for the most recent reporting year.

2. "Actual resident day" means a billable, countable day as defined by the department.

3. "Department" means the department of health and human services.

4. "Direct care costs" means the cost category for allowable nursing and therapy costs.

5. "Fair rental value" means the depreciated replacement value of the building, fixed

equipment, moveable equipment, and land based on the facility's effective age. The

calculation of the fair rental value of the building and fixed equipment must include a

location factor, annual depreciation, and an annual replacement cost inflation factor.

6. "Fair rental value rate" means the per diem rate calculated using the fair rental value

and rental rate.

7. "Final rate" means the rate established after any adjustment by the department,

including adjustments resulting from cost report reviews and audits.

8. "Fringe benefits" means workforce safety and insurance, group health or dental

insurance, group life insurance, retirement benefits or plans, and uniform allowances,

and medical services furnished at nursing home expense.

9. "General and administrative costs" means all allowable costs for administering the

facility, including salaries of administrators, assistant administrators, accounting

personnel, data processing personnel, security personnel, and all clerical personnel;

board of directors' fees; business office functions and supplies; travel, except as

necessary for training programs for dietitians, nursing personnel, and direct resident

care related personnel required to maintain licensure, certification, or professional

standards requirements; telephone and telegraph; advertising; membership dues and

subscriptions; postage; insurance, except as included as a fringe benefit; professional

services such as legal, accounting, and data processing services; central or home

office costs; management fees; management consultants; employee training, for any

top management personnel and for other than direct resident care related personnel;

and business meetings and seminars.

10. "Historical operating costs" means the allowable operating costs incurred by the facility

during the reporting year immediately preceding the rate year for which the payment

rate becomes effective, after the department has reviewed those costs and determined

them to be allowable costs under the medical assistance program, and after the

department has applied appropriate limitations such as the limit on administrative

costs.

11. "Indirect care costs" means the cost category for allowable administration, plant,

housekeeping, medical records, chaplain, pharmacy, and dietary, exclusive of food

costs.

12. "Managed care organization" means a Medicaid managed care organization as that

term is defined in section 1903(m) of the Social Security Act [42 U.S.C. 1396b(m)].

13. "Margin cap" means a percentage of the price limit which represents the maximum

per diem amount a nursing home may receive if the facility has historical operating

costs below the price limit.

14. "Nursing home" means a facility, not owned or administered by the state government,

defined in section 43-34-01 or a facility owned or administered by the state, which

agrees to accept a rate established under this chapter.

15. "Operating costs" means the day-to-day costs of operating the facility in compliance

with licensure and certification standards.

16. "Other direct care costs" means the cost category for allowable activities, social

services, laundry, and food costs.

17. "Payment rate" means the rate determined under section 50-24.4-06.

18. "Payroll taxes" means the employer's share of Federal Insurance Contributions Act

taxes, governmentally required retirement contributions, and state and federal

icensure and certification standards.

16. "Other direct care costs" means the cost category for allowable activities, social

services, laundry, and food costs.

17. "Payment rate" means the rate determined under section 50-24.4-06.

18. "Payroll taxes" means the employer's share of Federal Insurance Contributions Act

taxes, governmentally required retirement contributions, and state and federal

unemployment compensation taxes.

19. "Private-paying resident" means a nursing home resident on whose behalf the nursing

home is not receiving medical assistance payments and whose payment rate is not

established by any governmental entity with ratesetting authority, including the

veterans' administration or Medicare, or whose payment rate is not negotiated by any

managed care organization contracting with a facility to provide services for the

resident.

20. "Rate year" means the fiscal year for which a payment rate determined under this

chapter is effective, from January first to the next December thirty-first.

21. "Reporting year" means the period from July first to June thirtieth, immediately

preceding the rate year, for which the nursing home submits reports required under

this chapter.

22. "Top management personnel" means owners, board members, corporate officers,

general, regional, and district managers, administrators, nursing home administrators,

and other persons performing functions ordinarily performed by such personnel.