Current through Register Vol. 43, No. 12, March 20, 2024
(a) General. The
per diem rate or rates for providers participating in the Kansas medical
assistance program shall be based on an audit or desk review of the costs
reported to provide resident care in each facility. The basis for conducting
these audits or reviews shall be form MS 2004, as adopted by reference in
K.A.R. 129-10-17. Each provider shall maintain sufficient financial records and
statistical data for proper determination of reasonable and adequate rates.
Standardized definitions, accounting, statistics, and reporting practices that
are widely accepted in the nursing facility and related fields shall be
followed, except to the extent that they conflict with or are superseded by
state or federal medicaid requirements. Changes in these practices and systems
shall not be required in order to determine reasonable and adequate rates.
(b) Cost reports. Pursuant to
K.A.R. 129-10-17, cost reports shall be required from providers on an annual
basis.
(c) Adequate cost data and
cost findings. Each provider shall provide adequate cost data on the cost
report. This cost data shall be in accordance with state and federal medicaid
requirements and general accounting rules and shall be based on the accrual
basis of accounting. Estimates of costs shall not be allowable except on
projected cost reports submitted pursuant to K.A.R. 129-10-17.
(d) Recordkeeping requirements.
(1) Each provider shall furnish any
information to the agency that is necessary to meet these criteria:
(A) To ensure proper payment by the program
pursuant to paragraph (d)(2);
(B)
to substantiate claims for program payments; and
(C) to complete determinations of program
overpayments.
(2) Each
provider shall permit the agency to examine any records and documents that are
necessary to ascertain information pertinent to the determination of the proper
amount of program payments due. These records shall include the following:
(A) Documentation of the nursing facility
ownership, organization, and operation, including documentation as to whether
transactions occurred between related parties;
(B) fiscal, medical, and other documents;
(C) federal and state income tax
returns and all supporting documents;
(D) documentation of asset acquisition,
lease, sale, or other action;
(E)
documentation of franchise or management arrangements;
(F) documentation pertaining to costs of
operations;
(G) a record of the
amounts of income received, by source and purpose; and
(H) a statement of changes in financial
position.
(3) Other
records and documents shall be made available as necessary.
(4) Records and documents shall be made
available in Kansas.
(5) Each
provider, when requested, shall furnish the agency with copies of resident
service charge schedules and changes to these charge schedules as they are put
into effect. The charge schedules shall be evaluated by the agency to determine
the extent to which the schedules may be used for determining program payment.
(6) Suspension of program payments
may be made if the agency determines that any provider does not maintain or no
longer maintains adequate records for the determination of reasonable and
adequate per diem rates under the program or the provider fails to furnish
requested records and documents to the agency. Payments to that provider may be
suspended.
(7) Thirty days before
suspending payment to the provider, written notice shall be sent by the agency
to the provider of the agency's intent to suspend payments, except as provided
in paragraph(e)(2). The notice shall explain the basis for the agency's
determination with respect to the provider's records and shall identify the
provider's recordkeeping deficiencies.
(8) All records of each provider that are
used in support of costs, charges, and payments for services and supplies shall
be subject to inspection and audit by the agency, the United States department
of health and human services, and the United States general accounting office.
All financial and statistical records used to support cost reports shall be
retained for five years following the last day on which rates determined from
those cost reports are effective.
(e) Desk review requirement.
(1) Each provider shall submit all
information requested by the agency that is necessary to complete the desk
review of the cost report.
(2) If
a provider does not submit the information deemed necessary by the agency to
complete the desk review of the cost report for a nursing facility, the
provider shall be notified in writing by the agency that the provider has 10
working days from the date of this notice to submit the required information,
or the Kansas medical assistance program payments shall be suspended for the
nursing facility.
