Chapter 514 - Nursing Facility Services - DHHR - State of West ...

in the balance as part of the process of arriving at a decision and is able to communicate thedecision in an unambiguous manner.Case Mix Reimbursement System - a payment system that measures the intensity of care andservices required for each resident. This translates into the amount of reimbursement given tothe facility for care provided to each resident.Care Area Assessment (CAAs) - a problem-oriented framework for organizing MDSinformation and additional clinically relevant information about an individual’s health problems orfunctional status.Care Plan - a document based on a comprehensive assessment prepared by theinterdisciplinary team. This is coordinated with the resident/representative and identifiesmeasurable objectives for attaining the highest level of physical, mental and psychosocialfunctioning.Centers for Medicare and Medicaid Services (CMS) - the Federal Agency which administersthe Health Care Programs within the United States Department of Health and Human Services(USDHHS).Certificate of Need (CON) - a process often associated with cost containment measures.Additionally, the Legislative findings in the CON law declare the need for health services to beprovided in an orderly, economical manner that discourages unnecessary duplication. The CONis to be submitted to the Health Care Authority.Change of Ownership - any transaction that results in change of control over the capital assetsof a nursing facility including, but not limited to, a conditional sale, a sale, a lease or a transfer oftitle or controlling stock. The two most common types of change of ownership are assetpurchase and stock transfer.Civil Money Penalty (CMP) - a punitive fine imposed on a nursing facility when the nursingfacility has demonstrated deficient practices.Cost Average Point (CAP) – a calculation used in the reimbursement methodology forestablishing rates in nursing facilities.Cost Report - the instrument used in the reimbursement system for nursing facilities with semiannualrate adjustments. It is designed to treat all parties fairly and equitably, i.e., the resident,taxpayer, agency and facility. In order to be equitable, complete and accurate cost data must bemaintained by each facility with cost reports accurately prepared and submitted on a timelybasis and in an approved format.Deficiency - an entry on the federally mandated form provided by the State survey agency, theOffice of Health Facility Licensure and Certification (OHFLAC), which describes the specificrequirements of the regulations with which the nursing facility failed to comply, an explicitDepartment of Health and Human Resources Chapter 514: Nursing Facility Services Page 8January 1, 2013DISCLAIMER: This manual does not address all the complexities of Medicaid policies and procedures,and must be supplemented with all State and Federal Laws and Regulations.