Kansas Administrative Regulations
Agency 30 - KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES
Article 10 - ADULT CARE HOME PROGRAM
Section 30-10-214 - ICF-MR rates of reimbursement
Universal Citation: KS Admin Regs 30-10-214
Current through Register Vol. 43, No. 39, September 26, 2024
(a) Rates for ICF's-MR.
(1) The determination of per diem
rates shall be made, at least annually by the secretary, on the basis of the
cost information supplied by the provider, and retained for cost auditing. The
cost information for each provider shall be compared with limits established
based on the level of care needs of clients to determine the allowable per diem
cost.
(2) Ownership allowance
shall be determined as follows:
(A) All
ICF's-MR initially certified to participate in the medicaid/medikan program
prior to July 1, 1991 shall be held to the established ownership allowance.
(B) All ICF's-MR certified on or
after July 1, 1991 shall be subject to an absolute cap on ownership costs.
(3) Per diem rates for
the following cost centers shall be limited by absolute caps.
(A) The cost center limits shall be based on
facility size and level of care. The cost centers and limiting factors shall
be:
(i) Direct service based on facility size
and level of care. Direct service consists of the room and board and health
care cost centers in the ICF-MR financial and statistical report;
(ii) administration based on facility size;
and
(iii) plant operating based on
total allowable costs;
(B) The absolute caps shall be reviewed at
least annually for reasonableness based on the reimbursement model and the
allowable historical costs. The absolute caps shall be approved by the
secretary or a designated official.
(4) To establish a per diem rate for each
provider by facility size and level of care, a factor for inflation may be
added to the allowable per diem cost. The per diem rate shall be based on the
lower of the actual allowable cost or the absolute cost center limits. A
detailed listing of the computation of the rate shall be provided to each
provider. The effective date of the rate for existing facilities shall be in
accordance with subsection (a) of K.A.R. 30-10-215.
(b) Comparable service rate limitations.
(1) Intermediate care facilities for the
mentally retarded and persons with related conditions. The per diem rate for
intermediate care for the mentally retarded and persons with related conditions
shall not exceed the rate charged to clients not under the medicaid/medikan
program for the same level of care in the ICF-MR and for the same type of
service.
(2) All private pay rate
structure changes and the effective dates shall be reported on the uniform cost
report.
(3) The ICF-MR shall
notify the agency of any private pay rate structure changes within 30 days of
the effective date of a new medicaid rate.
(4) Providers shall have a grace period to
raise the rate or rates charged to clients not under the medicaid/medikan
program for the same level of care in the ICF-MR.
(A) The grace period shall end the first day
of the third calendar month following the notification date of a new
medicaid/medikan rate.
(B) The
notification date is the date typed on the letter which informs the provider of
a new medicaid/medikan rate.
(C)
There shall be no penalty during the grace period if the rate charged to
clients not under the medicaid/medikan program is lower than the
medicaid/medikan rate for the same level of care in the ICF-MR and for the same
type of service.
(D) If the rate
charged to clients not under the medicaid/medikan program is lower than the
rate charged to medicaid/medikan clients after the grace period, the
medicaid/medikan rate will be lowered as of the original effective date of the
most recent changes.
(c) Rates for new construction or bed additions. The per diem rate for newly constructed ICF's-MR shall be based on a projected cost report submitted in accordance with K.A.R. 30-10-213. No rate shall be paid until an ICF-MR financial and statistical report is received and approved. Limitations established for existing facilities providing the same level of care shall apply. The effective date of the per diem rate shall be in accordance with K.A.R. 30-10-215.
(d) Change of provider.
(1) When a new provider makes no change in
the facility, number of beds or operations, the interim payment rate for the
first 12 months of operation shall be based on the historical cost data of the
previous owner or provider. The new owner or provider shall file a 12-month
historical cost report within three months after the end of the first 12 months
of operation and within three months after the end of the provider's fiscal
year established for tax or accounting purposes. The rate determined from the
historical cost reports shall be effective in accordance with K.A.R. 30-10-215.
(2) The agency may approve a new
rate based on a projected cost report when the care of the clients is certified
by the Kansas department of health and environment to be at risk because the
per diem rate of the previous provider is not sufficient for the new provider
to provide care and services in conformity with applicable state and federal
laws, regulations, and quality and safety standards.
(e) Per diem rate errors.
(1) When the per diem rate, whether based
upon projected or historical cost data, is audited by the agency and is found
to contain errors, a direct cash settlement shall be required between the
agency and the provider for the amount of money overpaid or underpaid. If a
provider no longer operates a facility with an identified overpayment, the
settlement shall be recouped from a facility owned or operated by the same
provider or provider corporation unless other arrangements have been made to
reimburse the agency. A net settlement may be made when a provider has more
than one facility involved in settlements.
(2) The per diem rate for a provider may be
increased or decreased as a result of a desk review or audit on the provider's
cost reports. Written notice of per diem rate changes and desk review or audit
findings shall be sent to the provider. Retroactive adjustments of the rate
paid during any projection period shall apply to the same period of time
covered by the projected rate.
(3)
Providers may request an administrative review of the audit adjustments that
result in an overpayment or underpayment within 30 days from the date of the
audit report cover letter. The request shall specify the finding or findings
that the provider wishes to have reviewed.
(4) Any audit exception imposed on the agency
by the department of health and human services due to provider action may be
recovered from the provider.
(f) ICF-MR closure. An ICF-MR may submit a plan to the agency to individually place all residents out of the facility, close the facility permanently and cease operations as a certified ICF-MR.
(1) The plan for ICF-MR closure shall
include:
(A) A schedule for the placement of
residents out of the facility; and
(B) a projected budget for the cost of
operating the facility while closure is occurring.
(2) The plan for ICF-MR closure shall be
reviewed for reasonableness. If approved by the secretary, the plan may be
implemented as written.
(3) The
facility may be reimbursed on a projected basis for cost of operating the
facility while closure is occurring according to the agreed upon plan.
Reimbursement may exceed limits established for any cost centers for ICF's-MR
including but not limited to:
(A)
Administration;
(B) ownership
allowance;
(C) plant operating;
and
(D) direct service, including
room and board and habilitation.
(4) After the ICF-MR ceases operation, an
audit of the actual costs incurred during implementation of the approved
closure plan shall be conducted.
(A) If the
actual overall costs incurred during closure are not as great as the costs
projected in the approved closure plan, the facility shall repay the difference
to the agency.
(B) If the actual
overall cost incurred during closure meets or exceeds the projected costs in
the approved closure plan, no additional payment shall be made to the ICF-MR.
(5) If the ICF-MR does
not close as agreed upon, the ICF-MR must repay the excess of the amount paid
under the closure agreement above the regular payments the ICF-MR would have
received, based on the most recent historical actual cost report, if the ICF-MR
had not submitted a closure plan to the agency.
(g) Provision of services out-of-state. Rates for clients served out-of-state by certified participants in a medicaid program shall be the rate or rates approved by the agency. All payments made for services provided outside the state of Kansas require prior authorization by the agency. The effective date of this regulation shall be October 1, 1992.
Disclaimer: These regulations may not be the most recent version. Kansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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