Definitions

# (1)

“A managed care company under contract to the Medicaid agency” means an entity that meets the definition of an MCO under 42 C.F.R. § 438.2 and has a contract with the Delaware Medicaid program.

# (2)

“CMS” means the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services.

# (3)

“Continuing care retirement community” and “CCRC” means an entity providing nursing facility services together with assisted living or independent living on a contiguous campus with the number of assisted living and independent living beds in the aggregate being at least twice the number of nursing facility beds. For purposes of this definition “contiguous” means land adjoining or touching other property held by the same or related organization. Land divided by a public road shall be considered contiguous.

# (4)

“DHSS” means the Delaware Department of Health and Social Services.

# (5)

“Fiscal year” shall mean the time period from July 1 to June 30.

# (6)

The terms “Medicaid” and “medical assistance” mean the Medicaid program operated in Delaware by the DHSS under Title XIX of the federal Social Security Act [42 U.S.C. § 1396 et seq.].

# (7)

“Medicaid resident day” means a resident day paid for by the Delaware medical assistance program including a managed care company under contract to the Medicaid agency.

# (8)

“Medicare resident day” means:

a. A resident day paid for by the Medicare program, a Medicare Advantage program or Special Needs Plan; or

b. A resident day in a facility for a resident enrolled in a Medicare hospice program under which hospice services are covered by the Medicare program while the facility is compensated for room and board services by the Medicaid program or another payer.

# (9)

“Non-Medicare resident day” means a resident day not paid for by the Medicare program, a Medicare Advantage or special needs plan, or by a Medicare hospice program.

# (10)

“Nursing facility” means a nursing facility as defined and licensed pursuant to Chapter 11 of Title 16. As used in this chapter, the term “nursing facility” shall include for-profit and nonprofit entities but shall exclude the Delaware Veterans Home and any state, federal or other public government-owned facilities and any facilities that maintain an average daily census of 80% or more serving children under 21 years of age.

# (11)

“Nursing facility services” has the meaning given that term in 42 C.F.R. § 433.56, or any successor regulation or superseding statute.

# (12)

“Resident day” means a calendar day of care provided to a nursing facility resident, including the day of admission and excluding the day of discharge, provided that 1 resident day shall be deemed to exist when admission and discharge occur on the same day. A resident day includes a day on which a bed is held for a patient and for which the facility receives compensation for holding the bed.