37.88.1402    INSTITUTIONS FOR MENTAL DISEASES, DEFINITIONS

In ARM 37.88.1401, 37.88.1402, 37.88.1405, 37.88.1406, 37.88.1410, 37.88.1411 and 37.88.1420 the following definitions apply:

(1) "Department" means the Montana department of public health and human services or its agents, including but not limited to parties under contract to perform audit services, claim processing and utilization review.

(2) "Devoted to the provision of inpatient psychiatric hospital care to adults" means an institution for mental disease which is licensed and certified as a hospital and whose goals, purpose and care are designed for and devoted exclusively to providing diagnosis, treatment or care to persons with mental diseases age 18 and older.

(3) "Hospital" means a facility licensed, accredited or approved under the laws of Montana or a facility operated as a hospital by the state that provides, by or under the supervision of licensed physicians, services for the diagnosis, treatment, rehabilitation and care of persons with mental diseases.

(4) "Institution for mental diseases" means a hospital, nursing facility, or other institution with more than 16 beds which the department has determined is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services. An institution for the mentally retarded, including an intermediate care facility for the mentally retarded, is not an institution for mental diseases.

(a) An institution for mental diseases is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not it is licensed as such.

(i) In making a determination of whether an institution is an institution for mental diseases, the department shall consider the guidelines set forth in subsection C of section 4390 of the state medicaid manual, but no single guideline or combination of guidelines shall necessarily be determinative. The state medicaid manual is promulgated by the federal health care financing administration to provide guidance to states on administration of the medicaid program. The department hereby adopts and incorporates herein by reference subsection C of section 4390 of the state medicaid manual (1994) . A copy of subsection C of section 4390 of the state medicaid manual may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(5) "Medicaid recipient" means a person who is eligible and receiving assistance under Title XIX of the Social Security Act for nursing facility services.

(6) "Mental disease" means a disease listed as a mental disorder in the current edition of the Diagnostic and Statistical Manual of Mental Diseases but does not include mental retardation, senility and organic brain syndrome.

(7) "Nursing facility services" means services defined in ARM 37.40.302, but not including intermediate care facility services for the mentally retarded.

(8) "Patient contribution" means the total of all of a resident's income from any source available to pay the cost of care, less the resident's personal needs allowance. The patient contribution includes a resident's incurment determined in accordance with applicable eligibility rules.

(9) "Patient day" means a whole 24-hour period that a person is present and receiving nursing facility services, regardless of the payment source. Even though a person may not be present for a whole 24-hour period on the day of admission or day of death, such day will be considered a patient day.

(10) "Provider" means a nursing facility or hospital that meets the provider participation requirements specified in ARM 37.88.1405.

(11) "Resident" means a person admitted to the provider's facility who has been present in the facility for at least one 24-hour period.

History: Sec. 53-2-201 and 53-6-113, MCA; IMP, Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2000 MAR p. 2036, Eff. 7/28/00.