Section 16.03.10.011 - DEFINITIONS: E THROUGH KFor the purposes of these rules, the following terms are used as defined below:
01.Educational Services. Services that are provided in buildings, rooms or areas designated or used as a school or as educational facilities; that are provided during the specific hours and time periods in which the educational instruction takes place in the normal school day and period of time for these students; and that are included in the individual educational plan for the participant or required by federal and state educational statutes or regulations; are not related services; and such services are provided to school age individuals as defined in Section 33-201, Idaho Code.02.Eligibility Rules. IDAPA 16.03.01, "Eligibility for Health Care Assistance for Families and Children," and IDAPA 16.03.05, "Eligibility for Aid to the Aged, Blind and Disabled (AABD)."03.Emergency Medical Condition. A medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, that a prudent lay person, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in the following:a. Placing the health of the individual, or, with respect to a pregnant woman, the health of the woman or unborn child, in serious jeopardy.b. Serious impairment to bodily functions.c. Serious dysfunction of any bodily organ or part.04.Enhanced Plan. The medical assistance benefits included under this chapter of rules.05.EPSDT. Early and Periodic Screening Diagnosis and Treatment.06.Equity. The net book value of all tangible and intangible assets less the recorded value of all liabilities, as recognized and measured in conformity with generally accepted accounting principles.07. Facility. Facility refers to a hospital, nursing facility, or an intermediate care facility for persons with intellectual disabilities. a. "Free-standing and Urban Hospital-based Behavioral Care Unit" means the same as Subsection 011.07.b. or 011.07.h. of this rule, and qualifies as a behavioral care unit nursing facility provider described in Section 266 of these rules.b. "Free-standing Nursing Facility" means a nursing facility that is not owned, managed, or operated by, nor is otherwise a part of a licensed hospital.c. "Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)" means an entity as defined in Subsection 011.30 in this rule.d. "Nursing Facility (NF)" means a facility licensed as a nursing facility and federally certified to provide care to Medicaid and Medicare patients.e. "Rural Hospital-based Provider" means a hospital-based nursing facility not located within a metropolitan statistical area (MSA) as defined by the United States Bureau of the Census.f. "Rural Hospital-based Behavioral Care Unit" means the same as Subsection 011.07.e., and qualifies as a behavioral care unit nursing facility provider described in Section 266 of these rules.g. Skilled Nursing Facility" means a nursing facility licensed by the Department to provide twenty-four (24) hour skilled nursing services and federally certified as a "Nursing Facility" under Title XVIII.h. "Urban Hospital-based Nursing Facility" means a hospital-based nursing facility located within a metropolitan statistical area (MSA) as defined by the United States Bureau of the Census.08.Fiscal Intermediary Agency. An entity that provides services that allow the participant receiving personal assistance services, or their designee or legal representative, to choose the level of control they will assume in recruiting, selecting, managing, training, and dismissing their personal assistant regardless of who the employer of record is, and allows the participant control over the manner in which services are delivered.09.Fiscal Year. An accounting period that consists of twelve (12) consecutive months.10.Forced Sale. A forced sale is a sale required by a bankruptcy, foreclosure, the provisions of a will or estate settlement pursuant to the death of an owner, physical or mental incapacity of an owner that requires ownership transfer to existing partner or partners, or a sale required by the ruling of a federal agency or by a court order.11.Funded Depreciation. Amounts deposited or held that represent recognized depreciation.12.Generally Accepted Accounting Principles (GAAP). A widely accepted set of rules, conventions, standards, and procedures for reporting financial information as established by the Financial Standards Accounting Board.13.Goodwill. The amount paid by the purchaser that exceeds the value of the net tangible assets. The value of goodwill is derived from the economic benefits that a going concern may enjoy, as compared with a new one, from established relations in the related markets, with government departments and other noncommercial bodies and with personal relationships. These intangible assets cannot be separated from the business and sold as can plant and equipment. Under the theory that the excess payment would be made only if expected future earnings justified it, goodwill is often described as the price paid for excess future earnings. The amortization of goodwill is a nonallowable, nonreimbursable expense.14.Healthy Connections. The primary care case management model of managed care under Idaho Medicaid.15.Historical Cost. The actual cost incurred in acquiring and preparing an asset for use, including feasibility studies, architects' fees, and engineering studies.16.Home and Community-Based Services (HCBS). HCBS are those long-term services and supports that assist eligible participants to remain in their home and community.17.ICF/IID Living Unit. The physical structure that an ICF/IID uses to house patients.18.Improvements. Improvements to assets that increase their utility or alter their use.19.Indirect Care Costs. The following costs either directly coded to the nursing facility or allocated to the nursing facility through the Medicare step-down process described in the PRM:b. Administrative and general care costs;c. Central service and supplies;d. Dietary (non-"raw food" costs);e. Employee benefits associated with the indirect salaries;i. Other costs not included in direct care costs, or costs exempt from cost limits; andj. Plant operations and maintenance (excluding utilities).20.Inflation Adjustment. The cost used in establishing a nursing facility's prospective reimbursement rate is indexed forward from the midpoint of the cost report period to the midpoint of the rate year using the inflation factor.21.Inflation Factor. For use in establishing nursing facility prospective rates, the inflation factor is the Skilled Nursing Facility Market Basket as established by IHS Markit, or its successor. If subsequent to the effective date of these rules, IHS Markit, or its successor develops an Idaho-specific nursing facility index, it will be used. The Department is under no obligation to enter into an agreement with IHS Markit or its successor to have an Idaho-specific index established. The national index is used when there is no state or regional index.22.In-State Care. Medical services provided within the Idaho border or in counties bordering Idaho are considered to be in-state, excluding long term care.23.Inspection of Care Team (IOCT). An interdisciplinary team that provides inspection of care in intermediate care facilities for persons with intellectual disabilities approved by the Department as providers of care for eligible medical assistance participants. Such a team is composed of:a. At least one (1) licensed registered nurse; andb. One (1) Qualified Intellectual Disabilities Professional (QIDP); and when required, one (1) of the following: i. A consultant physician; orii. A consultant social worker; oriii. When appropriate, other health and human services personnel responsible to the Department as employees or consultants.24.Instrumental Activities of Daily Living (IADL). Those activities performed in supporting the activities of daily living, including, but not limited, to managing money, preparing meals, shopping, light housekeeping, using the telephone, or getting around in the community.25.Interest. The cost incurred for the use of borrowed funds.26.Interest on Capital Indebtedness. The cost incurred for borrowing funds used for acquisitions of capital assets, improvements, etc. These costs are reported under property costs.27.Interest on Working Capital. The costs incurred for borrowing funds that will be used for "working capital" purposes. These costs are reported under administrative costs.28.Interest Rate Limitation. The interest rate allowed for working capital loans and for loans for major movable equipment for ICF/IID facilities is the prime rate as published in the western edition of the Wall Street Journal or successor publication, plus one percent (+1%) at the date the loan is made.29.Interim Reimbursement Rate (IRR). A rate paid for each Medicaid patient day that is intended to result in total Medicaid payments approximating the amount paid at audit settlement. The interim reimbursement rate is intended to include any payments allowed in excess of the percentile cap.30.Intermediary. Any organization that administers the Title XIX and Title XXI program; in this case the Department of Health and Welfare.31.Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). An entity licensed as an ICF/IID and federally certified to provide care to Medicaid and Medicare participants with developmental disabilities.32.Keyman Insurance. Insurance on owners or employees with extraordinary talents in which the direct or indirect beneficiary is the facility or its owners. Premiums related to keyman insurance are not allowable.Idaho Admin. Code r. 16.03.10.011