For the purposes of this chapter, the term:
(1) “Case mix reimbursement methodology” means a prospective Medicaid payment rate system for nursing facilities that includes:
(A) A point-of-sale prescription system;
(B) A resident classification system based on resident acuity and needs; and
(C) The following 3 peer groupings for rate purposes:
(i) All freestanding nursing facilities, except those owned by the District of Columbia;
(ii) All hospital-based nursing facilities; and
(iii) All nursing facilities owned by the District of Columbia.
(2) “Fiscal year” means the 12-month accounting period of the District of Columbia beginning on October 1 and ending on September 30 of the next year.
(3) “Fund” means the Nursing Facility Quality of Care Fund established by this chapter.
(4) “Gross resident revenue” means the sum of resident charges, ancillary service charges, and other charges related to the provision of services to residents.
(5) “Medicaid” means the medical assistance programs authorized by title XIX of the Social Security Act, approved July 30, 1965 (79 Stat. 343; 42 U.S.C. § 1396 et seq.), and by [§ 1-307.02], and administered by the Department of Health.
(6) “Net resident revenue” means gross resident revenue less deductions resulting from a nursing facility's inability to collect full payment of its established charges to residents. The deductions include:
(A) Bad debts;
(B) Contractual adjustments, including the difference between the amount that would be realized at the nursing facility's established charges and the amount actually received pursuant to contractual agreements entered into to receive Medicare payments, Medicaid payments, Blue Cross or Blue Shield plan payments, or other third-party payments;
(C) Uncompensated or charity care; and
(D) Administrative, courtesy, and policy discounts and adjustments.
(7) “Nursing facility” means a health care facility as defined in and codified at § 44-501(a)(3), but does not include a health care facility operated by the federal government.
(8) “Quality of care initiatives” means initiatives that include a case mix reimbursement methodology, reimbursement of the costs of the audit required by § 47-1262(d), and, to the extent that amounts in the Fund remain, other programs designed to promote and foster the improved care, safety, and health of residents in Medicaid-certified nursing facilities.
(9) “Resident” means a person receiving services in a nursing facility.
(10) “Superior Court” means the Superior Court of the District of Columbia.
CREDIT(S)
(Dec. 7, 2004, D.C. Law 15-205, § 5202(c), 51 DCR 8441.)
HISTORICAL AND STATUTORY NOTES
Emergency Act Amendments
For temporary (90 day) addition, see § 5202(c) of Fiscal Year 2005 Budget Support Emergency Act of 2004 (D.C. Act 15-486, August 2, 2004, 51 DCR 8236).
For temporary (90 day) addition, see § 5202(c) of Fiscal Year 2005 Budget Support Congressional Review Emergency Act of 2004 (D.C. Act 15-594, October 26, 2004, 51 DCR 11725).
Legislative History of Laws
Law 15-205, the “Fiscal Year 2005 Budget Support Act of 2004”, was introduced in Council and assigned Bill No. 15-768, which was referred to the Committee of the Whole. The Bill was adopted on first and second readings on May 14, 2004, and June 29, 2004, respectively. Signed by the Mayor on August 2, 2004, it was assigned Act No. 15-487 and transmitted to both Houses of Congress for its review. D.C. Law 15-205 became effective on December 7, 2004.
Miscellaneous Notes
Short title of subtitle B of title V of Law 15-205: Section 5201 of D.C. Law 15-205 provided that subtitle B of title V of the act may be cited as the Nursing Facility Quality of Care Act of 2004.
