Section 51.42. Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

Allowable cost—A necessary cost directly or indirectly associated with the provision of a cost-based services.

Approved cost report—A cost report which complies with the Department’s cost-based reporting instructions and passes the Department’s desk review.

Attestation engagement—The term includes audits, examinations, reviews, compilations and agreed-upon procedures.

Board—The participant’s share of food and food preparation costs.

Cost-based rate-setting methodology—The Department’s process of reviewing approved cost reports, aggregating the cost of each cost-based service and then determining the provider specific rate for each cost-based services.

Cost-based services—An HCBS reimbursed through a rate established by aggregating provider cost reports.

Cost report—A data collection tool issued by the Department to collect cost and utilization information from providers that includes supplemental schedules or addenda requested by the Department.

Department-established fee—A non-MA funded fee established by the Department for a portion of an HCBS not eligible for Federal financial participation.

Eligible expenses—Allowable costs that are eligible for Federal financial participation.

FASB—The Financial Accounting Standards Board.

Fee schedule HCBS—An HCBS listed on the MA Program fee schedule.

Fiscal review—A review of billing records against provider documentation to ensure HCBS were provided in the type, amount, duration and frequency as required by the approved ISP.

Fixed asset—A major item, excluding real estate, which can be expected to have a useful life of more than 1 year or that can be used repeatedly without materially changing or impairing its physical condition by normal repair, maintenance or replacement of components.

Funded equity—The value of property over the liability on the property.

GAAP—Generally Accepted Accounting Principles—The standard framework of guidelines for financial accounting used in any given jurisdiction which are generally known as accounting standards.

Indirect cost—Expense allocations and functions which are needed for program operations but not directly related to participant HCBS.

Ineligible costs—Allowable costs that are not eligible for Federal financial participation but are eligible for reimbursement by the Department.

Management fees—Expenses related to charges from a parent or affiliated company of the provider.

Market-based approach—A process used to develop MA or Department-established fees based on independent data sources for a particular waiver service’s cost components, including the consideration of reasonable and necessary costs for the delivery of a waiver service.

OMB Circular A-122—Office of Management and Budget Circular A-122, Cost Principles for Non-Profit Organizations.

Rate adjustment factor—A downward adjustment to a rate based on an analysis of State and Federal expenditures that are projected using the proposed payment rates and projected provider utilization compared to the appropriation amounts.

Related party—The term as defined in FASB Accounting Standards Codification Section 850-10-20 as may be amended or superseded by FASB or a successor organization.

Representative payee—A person or organization appointed by the Social Security Administration to receive benefits on behalf of a participant.

Reserved capacity—The capacity held for a participant when the participant has been discharged from the waiver and has been identified by the Department for re-enrollment into the waiver.

Respite care ineligible—The portion of payment for respite care HCBS that is not eligible for Federal financial participation.

Restricted gift—A donation or gift given to an HCBS provider for a specific purpose.

Room—A participant’s share of lodging costs which includes utility costs such as electricity, heating, water and sewage. The term also includes annual upkeep costs of the residential habilitation service location including trash collection, general maintenance, necessary repairs and renovation costs.

SNAP—Supplemental Nutrition Assistance Program. The term is also known as food stamps.

SSI—Supplemental Security Income.

Third-party resource—Private or governmental health insurance benefits.

Vacancy factor—A standard factor applied to a provider’s cost-based rate to account for when a participant is absent from the residential habilitation service location.