North Dakota Code 50-24.4-01 – Definitions
For the purposes of this chapter:
Terms Used In North Dakota Code 50-24.4-01
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
- Organization: includes a foreign or domestic association, business trust, corporation, enterprise, estate, joint venture, limited liability company, limited liability partnership, limited partnership, partnership, trust, or any legal or commercial entity. See North Dakota Code 1-01-49
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See North Dakota Code 1-01-49
- year: means twelve consecutive months. See North Dakota Code 1-01-33
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 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.