Section 16.03.10.010 - DEFINITIONS: A THROUGH D01.Accrual Basis. An accounting system based on the principle that revenues are recorded when they are earned; expenses are recorded in the period incurred.02.Active Treatment. Continuous participation, during all waking hours, by an individual in an aggressive, consistently implemented program of specialized and generic training, treatment, health and related services, and provided under a treatment plan developed by an interdisciplinary team and monitored by a Qualified Intellectual Disabilities Professional (QIDP) directed toward: (1) the acquisition of the behaviors necessary for the resident to function with as much self-determination and independence as possible; or(2) the prevention or deceleration of regression or loss of current functional status.03.Activities of Daily Living (ADL). The performance of basic self-care activities in meeting an individual's needs for sustaining them in a daily living environment, including bathing, washing, dressing, toileting, grooming, eating, communication, continence, mobility, and associated tasks.04.Allowable Cost. Reimbursable cost sufficiently documented to meet the requirements of audit.05.Amortization. The systematic recognition of the declining utility value of certain assets, usually not owned by the organization or intangible in nature.06.Appraisal. The method of determining the value of property as determined by an Appraisal Institute appraisal. The appraisal must specifically identify the values of land, buildings, equipment, and goodwill.07.Assets. Economic resources of the provider recognized and measured in conformity with generally accepted accounting principles.08.Attendant Care. Services provided under a Medicaid Home and Community-Based Services waiver that involve personal and medically-oriented tasks dealing with the functional needs of the participants and accommodating the participant's needs for long-term maintenance, supportive care, or ADL. These services may include personal assistance and medical tasks that can be done by unlicensed persons or delegated to unlicensed persons by a health care professional or the participant. Services are based on the person's abilities and limitations, regardless of age, medical diagnosis, or other category of disability. This assistance may take the form of hands-on assistance (performing a task for the person) or cuing to prompt the participant to perform a task.09.Audit. An examination of provider records based on which an opinion is expressed representing the compliance of a provider's financial statements and records with Medicaid law, regulations, and rules.10.Auditor. The individual or entity designated by the Department to conduct the audit of a provider's records.11.Audit Reports. a. Draft Audit Report. A preliminary report of the audit finding sent to the provider for the provider's review and comments.b. Final Audit Report. A final written report containing the results, findings, and recommendations, if any, from the audit of the provider, as approved by the Department.12.Bad Debts. Amounts due to provider because of services rendered, but are considered uncollectible.13.Bed-Weighted Median. A numerical value determined by arraying the average per diem cost per bed of all facilities from high to low and identifying the bed at the point in the array at which half of the beds have equal or higher per diem costs and half have equal or lower per diem costs. The identified bed is the median bed. The per diem cost of the median bed is the bed-weighted median.14.Budget Adjustment Factor (BAF). A total budget for nursing facility reimbursement will be established by legislative appropriation and will be effective on July 1 of each year. The budget will be compared to the annual expected Medicaid reimbursement rates for the same rate year. A BAF will be established to adjust the expected Medicaid reimbursement rates to meet the approved budget. The BAF may be positive or negative and will apply to all nursing facility rates calculated under the established prospective rate system. The BAF will not be applied to the calculated customary charge for each nursing facility and will not apply to any nursing facility that is retrospectively settled.15.Capitalize. The practice of accumulating expenditures related to long-lived assets that will benefit later periods.16.Case Mix Adjustment Factor. The factor used to adjust a provider's direct care rate component for the difference in the average Medicaid acuity and the average nursing facility-wide acuity. The average Medicaid acuity is from the picture date immediately preceding the rate period. The average nursing facility-wide acuity is the average of the indexes that correspond to the cost reporting period.17.Case Mix Index (CMI). A numeric score assigned to each nursing facility resident, based on the resident's physical and mental condition, that projects the amount of relative resources needed to provide care to the resident. a. Nursing Facility-Wide Case Mix Index. The average of the entire nursing facility's case mix indexes identified at each picture date during the cost reporting period. If case mix indexes are not available for applicable quarters due to lack of data, case mix indexes from available quarters will be used.b. Medicaid Case Mix Index. The average of the weighting factors assigned to each Medicaid resident in the facility on the picture date, based on their RUG classification. Medicaid or non-Medicaid status is based upon information contained in the MDS databases. To the extent that Medicaid identifiers are found to be incorrect, the Department may adjust the Medicaid case mix index and reestablish the reimbursement rate.c. State-Wide Average Case Mix Index. The simple average of all nursing facilities "facility-wide" case mix indexes used in establishing the reimbursement limitation July 1st of each year. The state-wide case mix index will be calculated annually during each July 1st rate setting.18.Certified Family Home (CFH). A home that meets the requirements under IDAPA 16.03.19, "Certified Family Homes.".19.Chain Organization. A proprietorship, partnership, or corporation that leases, manages, or owns two (2) or more facilities that are separately licensed.20.Claim. An itemized bill for services rendered to one (1) participant by a provider and submitted to the Department for payment.21.Clinical Nurse Specialist. An RN who meets all the applicable requirements to practice as a clinical nurse specialist under Title 54, Chapter 14, Idaho Code, and IDAPA 24.34.01, "Rules of the Idaho Board of Nursing."22.Common Ownership. An individual(s), or other entities who have equity or ownership in two (2) or more organizations that conduct business transactions with each other. Common ownership exists if an individual(s) possesses significant ownership or equity in the provider and the institution or organization serving the provider.23.Compensation. The total of all remuneration received, including cash, expenses paid, salary advances, etc.24.Complaint. The process by which an individual registers dissatisfaction with program operations, quality of services, or other relevant concerns. A complaint is separate from an appeal, and an individual is not required to submit a complaint in order to pursue an appeal under these rules.25.Control. Exists where an individual or an organization has the power, directly or indirectly, to significantly influence or direct the actions or policies of an organization or institution.26.Cost Center. A "collection point" for expenses incurred in the rendering of services, supplies, or materials that are related or so considered for cost-accounting purposes.27.Cost Component. The portion of the nursing facility's rate that is determined from a prior cost report, including property rental rate. The cost component of a nursing facility's rate is established annually July 1st of each year.28.Cost Reimbursement System. A method of fiscal administration of Title XIX and Title XXI that compensates the provider based on expenses incurred.29.Cost Report. A fiscal year report of provider costs required by the Medicare program and any supplemental schedules required by the Department.30.Cost Statements. An itemization of costs and revenues, presented on the accrual basis, that is used to determine cost of care for facility services for a specified period. These statements are commonly called income statements.31.Costs Related to Patient Care. All necessary and proper costs that are appropriate and helpful in developing and maintaining the operation of patient care facilities and activities. Necessary and proper costs related to patient care are usually costs that are common and accepted occurrences in the field of the provider's activity. They include costs such as depreciation, interest expenses, nursing costs, maintenance costs, administrative costs, costs of employee pension plans, and normal standby costs.32.Costs Not Related to Patient Care. Costs that are not appropriate or necessary and proper in developing and maintaining the operation of patient care facilities and activities. Such costs are nonallowable in computing reimbursable costs. They include, for example, cost of meals sold to visitors or employees, cost of drugs sold to other than patients, cost of operation of a gift shop, and similar items. Travel and entertainment expenses are nonallowable unless it can be shown that they relate to patient care and for the operation of the nursing facility.33.Customary Charges. Rates charged to Medicare participants and to patients liable for such charges, as reflected in the facility's records. Those charges are adjusted downward, when the provider does not impose such charges on most patients liable for payment on a charge basis or when the provider fails to make reasonable collection efforts. The reasonable effort to collect such charges is the same effort necessary for Medicare reimbursement as is needed for unrecovered costs attributable to certain bad debt under PRM, Chapter 3, Sections 310 and 312.34.Day Treatment Services. Developmental services provided regularly during normal working hours on weekdays by, or on behalf of, the ICF/IID. Day treatment services do not include recreational therapy, speech therapy, physical therapy, occupational therapy, or services paid for, or required to be provided by, a school or other entity.35.Department. The Idaho Department of Health and Welfare or its designee.36.Depreciation. The systematic distribution of the cost or other basis of tangible assets, less salvage, over the estimated life of the assets.37.Developmental Disability (DD). Defined under Section 66-402, Idaho Code, means a chronic disability of a person that appears before the age of twenty-two (22) years; anda. Is attributable to an impairment, such as an intellectual disability, cerebral palsy, epilepsy, autism, or other condition found to be closely related to or similar to one (1) of these impairments, that requires similar treatment or services, or is attributable to dyslexia resulting from such impairments;b. Results in substantial functional limitations in three (3) or more of the following areas of major life activity: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, or economic self-sufficiency; andc. Reflects the need for a combination or sequence of special, interdisciplinary, or generic care, treatment, or other services that are of lifelong or extended duration and individually planned and coordinated.38.Direct Care Costs. Costs directly assigned to the nursing facility or allocated to the nursing facility through the Medicare cost-finding principles and consisting of the following: a. Direct nursing salaries that include the salaries of RNs, certified nurse's aides, and unit clerks;b. Routine nursing supplies;c. Nursing administration;d. Direct portion of Medicaid-related ancillary services;g. Employee benefits associated with the direct salaries: andh. Medical waste disposal, for rates with effective dates beginning July 1, 2005.39.Director. The Director of the Department or their designee.40.Durable Medical Equipment (DME). Equipment other than prosthetics or orthotics that can withstand repeated use by one (1) or more individuals, is primarily and customarily used to serve a medical purpose, is generally not useful to a person in the absence of an illness or injury, is appropriate for use in the home, and is reasonable and necessary for the treatment of an illness or injury for a Medicaid participant.Idaho Admin. Code r. 16.03.10.010