Current through Register Vol. 43, No. 39, September 26, 2024
(a) General. The
per diem rate or rates for providers participating in the medicaid/medikan
program shall be based on an audit or desk review of the costs reported to
provide client care in each facility. The basis for conducting these audits or
reviews shall be the ICF-MR financial and statistical report MH&RS-2004.
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 which are widely
accepted in the ICF-MR and related fields shall be followed, except to the
extent that they may conflict with or be superseded by state or federal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) Pursuant to K.A.R. 30-10-213, ICF-MR
financial and statistical reports, MH&RS-2004, (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 principles, shall be based on the accrual basis of
accounting, and may include a current use value of the provider's fixed assets
used in client care. Estimates of costs shall not be allowable except on
projected cost reports submitted pursuant to K.A.R. 30-10-213.
(d) Recordkeeping requirements.
(1) Each provider shall furnish any
information to the agency that may be necessary:
(A) To assure proper payment by the program
pursuant to paragraph (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:
(A) Matters of the ICF-MR ownership,
organization, and operation, including documentation as to whether transactions
occurred between related parties;
(B) fiscal, medical, and other recordkeeping
systems;
(C) federal and state
income tax returns and all supporting documents;
(D) documentation of asset acquisition,
lease, sale or other action;
(E)
franchise or management arrangements;
(F) matters pertaining to costs of operation;
(G) amounts of income received, by
source and purpose;
(H) a
statement of changes in financial position; and
(I) actual cost of day care programs provided
to ICF/MR clients.
Other records and documents shall be made available as
necessary. Records and documents shall be made available in Kansas. Any
provider who fails to provide any documents requested by the agency may be
suspended from the ICF/MR program.
(3) Each provider, when requested, shall
furnish the agency with copies of client service charge schedules and changes
thereto as they are put into effect. The agency shall evaluate the charge
schedules to determine the extent to which they may be used for determining
program payment.
(4) Suspension of
program payments to a provider. 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, payments to that
provider may be suspended until deficiencies are corrected. Thirty days before
suspending payment to the provider, the agency shall send written notice to the
provider of its intent to suspend payments. 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.
(5) 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 to support costs reports shall be
retained for five years from the date of filing the cost report with the
agency. The effective date of this regulation shall be October 1, 1991.
