Section 1324.20 Of Article 7.6. Skilled Nursing Facility Quality Assurance Fee From California Health And Safety Code >> Division 2. >> Chapter 2. >> Article 7.6.
1324.20
. For purposes of this article, the following definitions
shall apply:
(a) (1) "Continuing care retirement community" means a provider of
a continuum of services, including independent living services,
assisted living services as defined in paragraph (5) of subdivision
(a) of Section 1771, and skilled nursing care, on a single campus,
that is subject to Section 1791, or a provider of such a continuum of
services on a single campus that has not received a Letter of
Exemption pursuant to subdivision (d) of Section 1771.3.
(2) Notwithstanding paragraph (1), beginning with the 2010-11 rate
year and for every rate year thereafter, the term "continuing care
retirement community" shall have the definition contained in
paragraph (11) of subdivision (c) of Section 1771.
(b) "Department," unless otherwise specified, means the State
Department of Health Care Services.
(c) (1) "Exempt facility" means a skilled nursing facility that is
part of a continuing care retirement community, a skilled nursing
facility operated by the state or another public entity, a unit that
provides pediatric subacute services in a skilled nursing facility, a
skilled nursing facility that is certified by the department for a
special treatment program and is an institution for mental disease as
defined in Section 1396d(i) of Title 42 of the United States Code,
or a skilled nursing facility that is a distinct part of a facility
that is licensed as a general acute care hospital.
(2) Notwithstanding paragraph (1), beginning with the 2010-11 rate
year and for every rate year thereafter, the term "exempt facility"
shall mean a skilled nursing facility that is part of a continuing
care retirement community, as defined in paragraph (2) of subdivision
(a), a skilled nursing facility operated by the state or another
public entity, a unit that provides pediatric subacute services in a
skilled nursing facility, a skilled nursing facility that is
certified by the department for a special treatment program and is an
institution for mental disease as defined in Section 1396d(i) of
Title 42 of the United States Code, or a skilled nursing facility
that is a distinct part of a facility that is licensed as a general
acute care hospital.
(3) Notwithstanding paragraph (1), beginning with the 2010-11 rate
year and every rate year thereafter, a multilevel facility, as
described in paragraph (1) of subdivision (a), shall not be exempt
from the quality assurance fee requirements pursuant to this article,
unless it meets the definition of a continuing care retirement
community in paragraph (11) of subdivision (c) of Section 1771.
(4) (A) Notwithstanding paragraph (1), beginning with the 2011-12
rate year, and every rate year thereafter, a unit that provides
freestanding pediatric subacute care services in a skilled nursing
facility, as described in paragraph (1) of subdivision (c), shall not
be exempt from the quality assurance fee requirements pursuant to
this article.
(B) For the purposes of this article, "freestanding pediatric
subacute care unit" has the same meaning as defined in Section
51215.8 of Title 22 of the California Code of Regulations.
(d) (1) "Net revenue" means gross resident revenue for routine
nursing services and ancillary services provided to all residents by
a skilled nursing facility, less Medicare revenue for routine and
ancillary services, including Medicare revenue for services provided
to residents covered under a Medicare managed care plan, less payer
discounts and applicable contractual allowances as permitted under
federal law and regulation.
(2) Notwithstanding paragraph (1), for the 2009-10, 2010-11, and
2011-12 rate years, and each rate year thereafter, "net revenue"
means gross resident revenue for routine nursing services and
ancillary services provided to all residents by a skilled nursing
facility, including Medicare revenue for routine and ancillary
services and Medicare revenue for services provided to residents
covered under a Medicare managed care plan, less payer discounts and
applicable contractual allowances as permitted under federal law and
regulation. To implement this paragraph, the department shall request
federal approval pursuant to Section 1324.27.
(3) "Net revenue" does not mean charitable contributions and bad
debt.
(e) "Payer discounts and contractual allowances" means the
difference between the facility's resident charges for routine or
ancillary services and the actual amount paid.
(f) "Skilled nursing facility" means a licensed facility as
defined in subdivision (c) of Section 1250.