reglab/statecodes huggingface dataset:
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-84 - Medicaid determined eligibles; eligibility factors specific to work opportunities reward Kansans (WORK)

Current through Register Vol. 43, No. 28, July 11, 2024
(a) To
			 be eligible for participation in the medical assistance program under this
			 regulation, each person shall meet the following requirements:
(1) Meet the general eligibility requirements
			 of K.A.R. 129-6-50;
(2) be eligible
			 for and receiving assistance under K.A.R. 129-6-88;
(3) be employed in a competitive, integrated
			 work setting in which work is performed in the competitive labor market on a
			 full-time or part-time basis for which individuals are compensated at or above
			 minimum wage, but not less than the customary wage and level of benefits paid
			 to a nondisabled individual for the same or similar work. The work shall be
			 performed in a setting typically found in the community in which individuals
			 with the most severe disabilities interact with nondisabled individuals
			 according to the duties and responsibilities of the position; and
(4) be determined by an assessor authorized
			 by the secretary to need WORK services in order to live and work in the
			 community.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-85 - Medicaid determined eligibles; eligibility factors specific to the aged, blind, or disabled (ABD)

Current through Register Vol. 43, No. 28, July 11, 2024
Each applicant or recipient shall meet general eligibility
				requirements of
				K.A.R.
				129-6-50 and one of the following specific
				eligibility requirements to be eligible for participation in the medical
				assistance program related to ABD:
(a)
			 Age. Each individual shall have attained the age of 65 before or within the
			 month for which eligibility is being determined.
(b) Blindness. Each individual shall be
			 blind, based on social security administration criteria.
(c) Disability. Each individual shall be
			 determined disabled, based on social security administration
			 criteria.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-86 - Poverty-level, low-income, and expanded low-income medicare beneficiaries; determined eligibles

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each
			 applicant or recipient shall meet the general eligibility requirements of
			 K.A.R. 129-6-50 and the following specific eligibility requirements:
(1) Medicare part A beneficiary. Each
			 individual shall be entitled to medicare part A benefits.
(2) Financial eligibility. A percentage of
			 the official federal poverty-level income guidelines as established in K.A.R.
			 129-6-103 shall be used as the income standard for the number of persons in the
			 assistance plan and any other persons whose income is considered. The total
			 applicable income to be considered in the eligibility base period shall be
			 compared against the poverty level for the base period. However, the amount of
			 an annual social security cost-of-living adjustment shall be disregarded in
			 determining eligibility during the first quarter of the year for which the
			 adjustment is provided.
For an individual to be eligible, the total applicable income
				shall not exceed the poverty level established for the base period. The
				individual also shall not own non-exempt real or personal property with a
				resource value in excess of the allowable amounts specified in K.A.R.
				129-6-107(b)(1) for the number of persons whose nonexempt resources are
				considered available to the individual.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-87 - Poverty-level working disabled individuals; determined eligibles

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each applicant
			 or recipient shall meet the general eligibility requirements of K.A.R. 129-6-50
			 and the following specific eligibility requirements:
(1) Medicare part A beneficiary. Each
			 individual shall be entitled to medicare part A benefits under 42 U.S.C.
			 1395i-2a.
(2) Financial
			 eligibility. A percentage of the official federal poverty income guidelines as
			 specified in K.A.R. 129-6-103(a)(8) shall be used as the income standard for
			 the number of persons in the assistance plan and any other persons whose income
			 is considered. The total applicable income to be considered in the eligibility
			 base period shall be compared against the poverty level for the base period. To
			 be eligible under this regulation, the total applicable income shall not exceed
			 the poverty level established for the base period. The individual shall also
			 not own non-exempt real or personal property with a resource value in excess of
			 twice the allowable amount specified in K.A.R. 129-6-107 for the number of
			 persons whose non-exempt resources are considered available to the
			 individual.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-88 - Disabled individuals with earned income; determined eligibles

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each applicant and each recipient shall meet
			 the general eligibility requirements of K.A.R. 129-6-50 and the following specific
			 eligibility requirements:
(1) Each individual shall
			 be at least 16 years old but less than 65 years old.
(2) Each individual shall meet the blindness or
			 disability requirements of K.A.R. 129-6-85.
(3) Each individual shall have earned income that
			 is subject to federal insurance contributions act (FICA) taxes.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-89 - Individuals with breast or cervical cancer; determined eligibles

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each applicant
			 or recipient shall meet the general eligibility requirements of K.A.R. 129-6-55
			 and the following specific eligibility requirements:
(1) Each individual shall be screened for
			 breast or cervical cancer under the breast and cervical cancer early detection
			 program established under title XV of the public health service act, 42 U.S.C.
			 300k et seq., by the centers for disease control and prevention and shall be
			 found to need treatment for either breast or cervical cancer.
(2) Each individual shall be uninsured and
			 not be otherwise eligible for medical assistance under this article.
(3) Each individual shall be under the age of
			 65.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-91 - Youth formerly in foster care; determined eligibles

Current through Register Vol. 43, No. 28, July 11, 2024
Each applicant or recipient shall meet the general eligibility
				requirements of
				K.A.R.
				129-6-50 and the following conditions:
(a) In the month of the individual's 18th
			 birthday, be in the custody of the department for children and families or the
			 department of corrections and be in an out-of-home placement; and
(b) be at least 18 years old but under the
			 age of 26.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-94 - Non-medicaid determined eligibles; eligibility factors specific to persons living in nursing facilities for mental health

Current through Register Vol. 43, No. 28, July 11, 2024
(a) To be eligible for participation in the
			 medical assistance program under this regulation, each individual shall meet
			 the following conditions:
(1) Meet the general
			 eligibility requirements of K.A.R. 129-6-50;
(2) be aged 21 or older and under the age of
			 65;
(3) have a "severe and
			 persistent mental illness," as defined in K.A.R. 30-10-1a;
(4) be otherwise eligible for medicaid;
			 and
(5) not meet the requirements
			 of K.A.R. 129-6-60(b) or 129-6-81(b).
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-95 - Non-medicaid determined eligibles; eligibility factors specific to the medikan program

Current through Register Vol. 43, No. 28, July 11, 2024
(a) To be
			 eligible for participation in the medical assistance program under this
			 regulation, each individual shall meet the following conditions:
(1) Not be otherwise eligible for medicaid
			 and not be rendered ineligible for medicaid by either deliberate or voluntary
			 actions on the part of the individual;
(2) meet the general eligibility requirements
			 of K.A.R. 129-6-50;
(3) be aged 18
			 or older and under the age of 65; and
(4) have a severe impairment that
			 significantly limits physical or mental ability to do basic work activity and
			 is expected to last at least 12 months or result in death.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-96 - Continuous eligibility for children and certain adult eligibles

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Children.
			 Except for children determined eligible for presumptive medical assistance as
			 specified in K.A.R. 129-6-151, each child under the age of 19 who becomes
			 eligible for medicaid under any category of medical assistance shall continue
			 to be eligible for medical assistance for 12 months beginning with the month in
			 which eligibility is determined or redetermined regardless of any changes in
			 circumstances, except for any of the following:
(1) The child reaches the age of
			 19.
(2) Medical assistance for the
			 child is voluntarily terminated.
(3) The child no longer resides in
			 Kansas.
(4) The secretary
			 determines that eligibility was granted erroneously because of fraud or
			 department error.
(5) The child
			 dies.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-97 - Emergency medical services for certain noncitizens

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each noncitizen who does not meet the
			 requirements of K.A.R. 129-6-55(b) but who is otherwise eligible for medicaid
			 shall receive coverage as specified in subsection (b) of this regulation. The
			 general requirements of K.A.R. 129-6-50, except for K.A.R. 129-6-55(b) and
			 129-6-56(c), shall be applicable.
(b)
(1)
			 Eligibility shall be limited to coverage of an emergency medical condition, as
			 approved by the secretary, that requires emergency medical treatment after the
			 sudden onset of a condition, including labor and delivery, manifesting itself
			 by acute symptoms of sufficient severity, including severe pain, so that the
			 absence of immediate medical attention could reasonably be expected to result
			 in any of the following:
(A) Serious jeopardy
			 to the patient's health;
(B)
			 serious impairment of bodily functions; or
(C) serious dysfunction of any bodily organ
			 or part.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-106 - General requirements for consideration of resources, including real property, personal property, and income

Current through Register Vol. 43, No. 28, July 11, 2024
(a) For purposes of determining eligibility
			 for medical assistance, legal title shall determine ownership. In the absence
			 of legal title, possession shall determine ownership.
(b) Each resource shall be of a nature that
			 the value can be defined and measured, according to the following:
(1) Real property. The value of real property
			 shall be initially determined by the latest uniform statewide appraisal value
			 of the property, which shall be adjusted to reflect current market value. If
			 the property has not been appraised or if the market value determined is not
			 satisfactory to the applicant, recipient, or department, an estimate or
			 appraisal of the value of the property shall be obtained from an impartial real
			 estate broker. The cost of obtaining an estimate or appraisal shall be paid by
			 the department.
(2) Personal
			 property. The market value of personal property shall be initially determined
			 using a reputable trade publication. If such a publication is not available or
			 if there is a difference of opinion between the department and the individual
			 regarding the value of the property, an estimate from a reputable dealer shall
			 be used. The cost of obtaining an estimate or appraisal shall be paid by the
			 department.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-107 - Property exemption

Current through Register Vol. 43, No. 28, July 11, 2024
(a)
			 Ownership of otherwise nonexempt real property or personal property shall not
			 affect eligibility if the aggregate resource value is not in excess of $2,000
			 for one person or $3,000 for two or more persons, including the number of
			 persons whose nonexempt resources are considered available to a person in the
			 assistance plan.
(b) Ownership of
			 property with a resource value in excess of the amounts specified in subsection
			 (a) shall render the applicant or recipient and the members of the applicant's
			 or recipient's assistance plan ineligible for medical assistance, except for
			 the following:
(1) For medicare beneficiaries
			 who meet the requirements of K.A.R. 129-6-86, the resource value shall be in
			 excess of the following standards before the applicant or recipient and the
			 members of the applicant's or recipient's family group shall be rendered
			 ineligible:
(A) For calendar year 2006, $6,000
			 for one person or $9,000 for a couple; and
(B) for subsequent years, the amounts
			 established in paragraph (b)(1)(A) increased by the annual percentage increase
			 in the consumer price index for all items based on the United States city
			 average as established in September of the previous year.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-108 - Real property

Current through Register Vol. 43, No. 28, July 11, 2024
(a)
			 Definitions.
(1) "Home" shall mean the house
			 or shelter in which the applicant or recipient is living, as well as the tract
			 of land and contiguous tracts of land upon which the house and other
			 improvements essential to the use or enjoyment of the home are located. Tracts
			 of land shall be considered to be contiguous if lying side by side, except for
			 streets, alleys, and other easements. Pieces of property that touch only at the
			 corners shall not be considered to be contiguous.
(2) "Other real property" shall mean real
			 property other than a home, including land and buildings.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-109 - Personal property

Current through Register Vol. 43, No. 28, July 11, 2024
(a)
			 Definitions. For purposes of this regulation, each of the following terms shall
			 have the meaning specified in this regulation:
(1) "Cash assets" means the following
			 resources:
(A) Cash surrender or loan values
			 of life insurance policies;
(B)
			 investments;
(C) money;
(D) similar items from which a determinate
			 amount of money can be realized; and
(E) trust funds.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-110 - Income

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Treatment of
			 income for MAGI-based coverage groups. For purposes of this regulation,
			 "prospective monthly amount" shall mean an amount that is projected for
			 purposes of determining an applicant's or recipient's monthly income. For those
			 groups specified in K.A.R. 129-6-34(c)(1), all earned income and unearned
			 income expected to be received in the month of application shall be used to
			 determine a prospective monthly amount. This amount shall be used in the
			 determination of both eligibility in the prior three months and current
			 eligibility. For changes in earned income and unearned income, an estimate of
			 those changes shall be used to determine a prospective monthly amount. For
			 self-employment income, a prospective monthly amount shall be based on annual
			 federal tax information from the most recent tax year. In the absence of
			 federal tax information from the most recent tax year, an estimate shall be
			 used to determine a prospective monthly amount.
(b) Treatment of income for MAGI-excepted
			 coverage groups. For those groups specified in K.A.R. 129-6-34(c)(2), income
			 shall be classified as income in the eligibility base period in which the
			 income is received and as a cash asset following this eligibility base period.
(1) Prior eligibility. For individuals in
			 independent living, current income as defined in paragraph (b)(2) shall be
			 considered in the determination of eligibility for the prior three months. For
			 individuals in long-term care arrangements, income received in the prior three
			 months shall be considered in the determination of eligibility for the prior
			 three months, except that self-employment income shall be averaged.
(2) Current eligibility. Income shall be
			 considered prospectively to determine eligibility, beginning with the month of
			 application. All income received or reasonably expected to be received shall be
			 considered in determining the applicable income for the eligibility base
			 period. Income from self-employment and intermittent income shall be considered
			 and averaged. Intermittent income shall be divided by the applicable number of
			 months to establish the monthly amount. Intermittent income shall be considered
			 as income beginning with the eligibility base period in which this income is
			 received.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-111 - Applicable income

Current through Register Vol. 43, No. 28, July 11, 2024
"Applicable income" shall mean the amount of earned and
				unearned income that is compared with the appropriate income standard to
				establish financial eligibility.
(a)
			 MAGI-based coverage groups. For those groups specified in K.A.R.
			 129-6-34(c)(1), all earned income and unearned income shall be considered
			 applicable, unless exempted in accordance with K.A.R. 129-6-53(a)(2), and shall
			 be determined as follows:
(1) Applicable
			 income shall be based on the methodologies used to determine modified adjusted
			 gross income, as specified in K.A.R. 129-6-53(a), for persons in the household,
			 as specified in K.A.R. 129-6-53(b).
(2) An amount equivalent to five percentage
			 points of the federal poverty level for the applicable family size shall be
			 deducted from the combined household income in accordance with K.A.R.
			 129-6-53(a) when determining eligibility for the MAGI-based coverage groups
			 under K.A.R. 129-6-34(c)(1) with the highest income standard for which the
			 individual's eligibility is being determined.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-120 - Eligibility before the month of application

Current through Register Vol. 43, No. 28, July 11, 2024
The eligibility of an applicant for the medical assistance
				program shall be determined for the three months immediately before the month
				of application if the applicant requests this determination.
(a) Automatic eligibles. The applicant shall
			 be eligible for medical assistance in any of the three months in which the
			 applicant would have been automatically eligible for medical assistance if the
			 applicant would have applied for medical assistance during the month.
(b) Determined eligibles. The prior
			 eligibility base period shall begin on the first day of the first month in
			 which all eligibility factors other than financial are met without regard to
			 current eligibility.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-140 - Correction and discontinuance of medical assistance

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Overpayments. Each recipient who receives
			 an overpayment, whether caused by the department or the individual, shall repay
			 the amount of the overpayment, either by voluntary action or through
			 administrative processes including recoupment and legal action.
(b) Welfare fraud penalty. Each person
			 convicted of medical assistance program fraud, pursuant to 42 U.S.C. 1320a-7b,
			 shall be ineligible to participate in the medical assistance program for one
			 year from the date of the conviction.
(c) Discontinuance of medical assistance. A
			 recipient's participation in the medical assistance program shall be
			 discontinued if the recipient no longer meets one or more of the applicable
			 eligibility requirements.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-150 - Estate recovery

Current through Register Vol. 43, No. 28, July 11, 2024
(a)
			 Pursuant to
			 K.S.A.
			 39-709 and amendments thereto and this
			 regulation, each recipient's real and personal property or estate shall be
			 subject to the recovery of the cost of all medical assistance provided on the
			 recipient's behalf. By applying for and receiving medical assistance, the
			 recipient shall agree to the department's use of liens against the recipient's
			 property, claims against the recipient's estate, agreements with heirs, and any
			 other collection method allowed by Kansas statutes.
(b) The amount of any medical assistance paid
			 on behalf of a recipient after June 30, 1992 shall be a claim against the
			 property or estate of a deceased recipient, subject to whether the medical
			 assistance was correctly paid on behalf of an eligible recipient.
(1) If the medical assistance was correctly
			 paid on behalf of an eligible recipient, the department's claim against the
			 recipient's estate shall be restricted to medical assistance paid when the
			 recipient met either of the following conditions:
(A) Was 55 years of age or older;
			 or
(B) was admitted as an inpatient
			 in a long-term care facility, including a PACE institutional
			 arrangement.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-151 - Presumptive eligibility

Current through Register Vol. 43, No. 28, July 11, 2024
A presumptive period of eligibility shall be provided if a
				qualified entity, designated by the department in accordance with
				K.A.R.
				129-6-152, determines that the individual
				meets the presumptive eligibility requirements as follows.
(a) Pregnant women.
(1) Each woman shall be at least 18 years of
			 age.
(2) Each woman shall meet the
			 general eligibility requirements of K.A.R. 129-6-52 and 129-6-55 and the
			 determined eligible requirements of K.A.R. 129-6-71.
(3) Financial eligibility shall be based on
			 the requirements of K.A.R. 129-6-53.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-152 - Presumptive eligibility when determined by qualified entities other than qualified hospitals

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Except
			 for qualified hospitals pursuant to K.A.R. 129-6-153, each qualified entity
			 shall be designated by the department to make determinations of presumptive
			 eligibility as specified in K.A.R. 129-6-151.
(b) Each qualified entity shall meet the
			 requirements of 42 C.F.R.
			 435.1101 and
			 435.1103.
(c) For each determination of presumptive
			 eligibility under this regulation, a qualified entity shall perform the
			 following:
(1) Make a finding of presumptive
			 eligibility pursuant to K.A.R. 129-14-51(b) or 129-6-151;
(2) notify the pregnant woman or the child's
			 parent or caretaker, by written or electronic means, of the results of the
			 determination at the time of the determination;
(3) provide the pregnant woman or the parent
			 or caretaker of the child with an application for ongoing medical assistance.
			 For an individual determined to be presumptively eligible, the qualified entity
			 shall provide notification that this application shall be required to be
			 submitted before the last day of the month following the month of the
			 presumptive determination or eligibility shall end on that date;
(4) assist the pregnant woman or the child's
			 parent or caretaker in completing and filing an application for ongoing medical
			 assistance; and
(5) notify the
			 department of the presumptive determination within five working days after the
			 determination.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-153 - Presumptive eligibility when determined by qualified hospitals

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each hospital
			 that meets the following requirements shall be approved to make determinations
			 of presumptive eligibility as specified in K.A.R. 129-6-151:
(1) Participates as a medicaid provider in
			 Kansas;
(2) indicates interest in
			 writing to the department to make determinations of presumptive
			 eligibility;
(3) enters into a
			 formal written agreement with the secretary to make determinations of
			 presumptive eligibility in accordance with department regulations and
			 policies;
(4) uses forms and other
			 tools approved by the secretary for determining eligibility;
(5) satisfactorily completes state-provided
			 training; and
(6) meets the
			 performance standards established by the secretary, which shall include the
			 following:
(A) Processing applications for
			 presumptive eligibility within prescribed time limits; and
(B) achieving an accuracy rate of at least 90
			 percent in eligibility determinations made by the hospital.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 7 - APPEALS, FAIR HEARINGS AND TAF/GA DISQUALIFICATION HEARINGS › Section 129-7-65 - Notice to recipients of intended action

Current through Register Vol. 43, No. 28, July 11, 2024
(a)
(1) "Adequate notice" shall mean a written
			 notice that includes a statement of what action the agency intends to take, the
			 reasons for the intended agency action, the specific policies supporting the
			 action, an explanation of the individual's right to request a hearing, and the
			 circumstances under which assistance is continued if a hearing is requested.
(2) "Timely" shall mean that a
			 notice is mailed at least 10 days, including Saturdays, Sundays, and legal
			 holidays, before the date upon which the action that is the subject of the
			 notice would become effective.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 10 - ADULT CARE HOME PROGRAM › Section 129-10-15b - Financial data

Current through Register Vol. 43, No. 28, July 11, 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.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 10 - ADULT CARE HOME PROGRAM › Section 129-10-17 - Cost reports

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Historical cost
			 data.
(1) For cost reporting purposes, each
			 provider shall submit the "nursing facility financial and statistical report,"
			 form MS-2004, revised August 2004 and hereby adopted by reference, completed in
			 accordance with the accompanying instructions. The MS-2004 cost report shall be
			 submitted on diskette, using software designated by the agency for cost report
			 periods ending on or after December 31, 1999.
(2) Each provider who has operated a facility
			 for 12 or more months on December 31 shall file the nursing facility financial
			 and statistical report on a calendar year basis.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 10 - ADULT CARE HOME PROGRAM › Section 129-10-18 - Per diem rates of reimbursement

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Per diem rates for existing nursing
			 facilities.
(1) The determination of per diem
			 rates shall be made, at least annually, using base-year cost information
			 submitted by the provider and retained for cost auditing and analysis.
(A) The base year utilized for cost
			 information shall be reestablished at least once every seven years.
(B) A factor for inflation may be applied to
			 the base-year cost information.
(C)
			 For each provider currently in new enrollment, re-enrollment, or change of
			 ownership status, the base year shall be determined in accordance with
			 subsections (c), (d), and (e), respectively.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 10 - ADULT CARE HOME PROGRAM › Section 129-10-19 - Per diem rates; effective dates

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Effective date of per diem rates for
			 ongoing providers filing calendar year cost reports. The effective date of a
			 new per diem rate that is based on information and data in the nursing facility
			 cost report for the calendar year shall be July 1.
(b) Effective date of the per diem rate for a
			 new provider operating on the rate from cost data of the previous provider.
(1) The effective date of the per diem rate
			 for a new provider shall be the date of certification by the state licensing
			 agency.
(2) The effective date of
			 the per diem rate based on the first historical cost report filed in accordance
			 with K.A.R. 129-10-17 shall be the
			 first day of the 25th month of operation. Each rate paid after the effective
			 date of the rate based on the first historical cost report shall be adjusted to
			 the new rate from the historical cost report.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 10 - ADULT CARE HOME PROGRAM › Section 129-10-23b - Costs allowed with limitations

Current through Register Vol. 43, No. 28, July 11, 2024
(a) The following
			 amortized expenses or costs shall be allowed with limitations:
(1) The provider shall amortize loan
			 acquisition fees and standby fees over the life of the related loan if the loan
			 is related to resident care.
(2)
			 Only the following taxes shall be allowed as amortized costs:
(A) Taxes in connection with financing,
			 refinancing, or refunding operations; and
(B) special assessments on land for capital
			 improvements over the estimated useful life of those improvements.
(3) The start-up cost of a
			 provider with a newly constructed facility or a facility that has been closed
			 for 24 months or more shall be recognized if the cost meets the following
			 criteria:
(A) Is incurred within 90 days of
			 the opening of the facility and related to developing the ability to care for
			 residents;
(B) is amortized over a
			 period of at least 60 months;
(C)
			 is consistent with the facility's federal income tax return and internal and
			 external financial reports, with the exception of paragraph (a)(3)(B); and
(D) is identified in the cost
			 report as a start-up expense, which may include the following:
(i) Administrative and nursing salaries;
(ii) utilities;
(iii) taxes, as identified in paragraphs
			 (a)(2)(A) and (B);
(iv) insurance;
(v) mortgage interest;
(vi) employee training costs; and
(vii) any other allowable costs incidental to
			 the operation of the facility.
(4) Each cost that can properly be identified
			 as an organization expense or can be capitalized as a construction expense
			 shall be appropriately classified and excluded from the start-up cost.
(5) Organization and other
			 corporate costs, as defined in K.A.R. 30-101a, of a provider that is newly
			 organized shall be amortized over a period of at least 60 months beginning with
			 the date of organization.
(A) The costs shall
			 be reasonable and limited to the preparation and filing of documents required
			 by the various governmental entities, the costs of preparing sale or lease
			 contracts, and the associated legal and professional fees.
(B) The costs shall not include expenses of
			 resolving contested issues of title or disputes arising from the performance of
			 contracts or agreements related to the purchase or sale of a property or
			 business.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 10 - ADULT CARE HOME PROGRAM › Section 129-10-25 - Real and personal property fee

Current through Register Vol. 43, No. 28, July 11, 2024
(a) A real and
			 personal property fee shall be developed by the agency in lieu of an allowable
			 cost for ownership or lease expense, or both. The fee shall be
			 facility-specific and shall not change as a result of change of ownership, a
			 change in lease, or reenrollment in the medicaid program by providers. An
			 inflation factor may be applied to the fee on an annual basis.
The real and personal property fee shall include an appropriate
				component for the following:
(1) Rent
			 or lease expense;
(2) interest
			 expense on a real estate mortgage;
(3) amortization of leasehold improvements;
			 and
(4) depreciation on buildings
			 and equipment.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 10 - ADULT CARE HOME PROGRAM › Section 129-10-26 - Interest expense

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Only necessary
			 interest on working capital or personal property loans shall be an allowable
			 expense. Interest on real estate or personal property covered by the real and
			 personal property fee in accordance with K.A.R. 129-10-25 shall not be
			 included.
(b) The interest expense
			 shall be incurred on indebtedness established with either of the following:
(1) Lenders or lending organizations not
			 related to the borrower; or
(2)
			 partners, stockholders, home office organizations, or related parties, if the
			 following requirements are met:
(A) The terms
			 and conditions of payment of the loans shall resemble terms and conditions of
			 an arm's-length transaction by a prudent borrower with a recognized, local
			 lending institution with the capability of entering into a transaction of the
			 required magnitude. Allowable interest expense shall be limited to the annual
			 expense submitted on the loan amortization schedule, unless the loan principal
			 is retired before the end of the amortization period, or working capital loans
			 if the period is one year or less; and
(B) the provider shall demonstrate, to the
			 satisfaction of the agency, a primary business purpose for the loan other than
			 increasing the per diem rate.
(C)
			 The transaction shall be recognized and reported by all parties for federal
			 income tax purposes.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 10 - ADULT CARE HOME PROGRAM › Section 129-10-27 - Central office costs

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Allocation of
			 costs. Allocation of central office costs shall be reasonable, conform to
			 general accounting rules, and allowed only to the extent that the central
			 office is providing a service normally available in the nursing facility.
			 Central office costs shall not be recognized or allowed to the extent that they
			 are unreasonably in excess of the central office costs of similar nursing
			 facilities in the program. The burden of furnishing sufficient evidence to
			 establish a reasonable level of costs shall be on the provider. All expenses
			 reported as central office costs shall be limited to the actual
			 resident-related costs of the central office.
(1) The provider shall report cost of
			 ownership or the arm's-length lease expense, utilities, maintenance, property
			 taxes, insurance, and other plant operating costs of the central or regional
			 office space for resident-related activities report as central office costs.
(2) The provider shall report all
			 administrative expenses incurred by central and regional offices as central
			 office costs. These may include the following:
(A) Salaries;
(B) benefits;
(C) office supplies;
(D) printing, management, and consultant
			 fees;
(E) telephones and other
			 forms of communications;
(F)
			 travel and vehicle expenses;
(G)
			 allowable advertising;
(H)
			 licenses and dues; and
(I) legal,
			 accounting, data processing, insurance, and interest expenses.
The administrative expenses reported as central office costs
				shall not be directed to individual facilities operated by the provider or
				reported on any other line of the cost report.
(3) Nonreimbursable costs in K.A.R.
			 129-10-23a, costs allowed with limitations in K.A.R. 129-10-23b, and the
			 revenue offsets in K.A.R. 30-10-23c shall apply to central office costs.
(4) Estimates of central office
			 costs shall not be allowable.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 10 - ADULT CARE HOME PROGRAM › Section 129-10-31 - Responsibilities of, assessment of, and disbursements for the nursing facility quality care assessment program

Current through Register Vol. 43, No. 28, July 11, 2024
(a) In addition to the terms defined in
			 K.S.A.
			 75-7435 and amendments thereto, each of the
			 following terms shall have the meaning specified in this subsection, unless the
			 context requires otherwise:
(1) High medicaid
			 volume skilled nursing care facility" means any facility that provided more
			 than 25,000 days of nursing facility care to medicaid recipients during the
			 most recent calendar year cost-reporting period.
(2) Kansas homes and services for the aging,"
			 as used in
			 K.S.A.
			 75-7435 and amendments thereto, means
			 leadingage Kansas.
(3) "Nursing
			 facility quality care assessment program" means the determination, imposition,
			 assessment, collection, and management of an annual assessment imposed on each
			 licensed bed in a skilled nursing care facility required by
			 K.S.A.
			 75-7435, and amendments thereto.
(4) Skilled nursing care facility that is
			 part of a continuing care retirement facility" means a provider who is
			 certified as such by the Kansas insurance department before the start of the
			 state's fiscal year in which the assessment process is occurring.
(5) Small skilled nursing care facility"
			 means any facility with fewer than 46 licensed nursing facility beds.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 10 - ADULT CARE HOME PROGRAM › Section 129-10-210 - ICF-MR reimbursement

Current through Register Vol. 43, No. 28, July 11, 2024
(a)
(1) Each provider with a current signed
			 provider agreement shall be paid a per diem rate for services furnished to
			 eligible Kansas medical assistance program clients. Payment shall be for the
			 type of medical or health care required by the beneficiary as determined by
			 either of the following:
(A) The attending
			 physician's or physician extender's certification upon admission; or
(B) inspection of care and utilization review
			 teams, as specified in K.A.R. 30-10-207.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 14 - CHILDREN'S HEALTH INSURANCE PROGRAM › Section 129-14-2 - Definitions

Current through Register Vol. 43, No. 28, July 11, 2024
The terms defined in
				K.A.R.
				129-1-1 shall be applicable to this article.
				In addition and for purposes of this article, each of the following terms shall
				have the meaning specified in this regulation, unless the context clearly
				indicates otherwise:
(a) "Capitated
			 managed care" means health care services provided by a contracted provider for
			 which payment is made on an approved contracted rate for each enrolled person
			 assigned to the provider, regardless of the number or nature of the services
			 provided.
(b) "Caretaker" means the
			 person who is assigned the primary responsibility for the care and control of
			 the child and who is any of the following persons:
(1) Parent, including parent of an unborn
			 child;
(2) guardian, conservator,
			 legal custodian, or person claiming the child as a tax dependent;
(3) sibling;
(4) nephew;
(5) niece;
(6) aunt;
(7) uncle;
(8) person of a preceding generation who is
			 denoted by a term that includes any of the following prefixes: "grand,"
			 "great-," "great-great-," or "great-great-great-";
(9) stepfather, stepmother, stepbrother, or
			 stepsister;
(10) legally adoptive
			 parent or another relative of adoptive parents as listed in this subsection;
			 or
(11) spouse of any person listed
			 in this subsection or former spouse of any of those persons, if marriage is
			 terminated by death or divorce.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 14 - CHILDREN'S HEALTH INSURANCE PROGRAM › Section 129-14-3 - Providers

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Subject to
			 provider availability, any recipient may be required to be enrolled in a
			 managed care option in order to access covered program services.
(b) Managed care contractors shall be
			 selected by the secretary from willing providers, as determined by the
			 secretary or designees.
(c) Before
			 signing a contract to provide services, each provider of capitated managed care
			 shall demonstrate the ability to meet contract requirements, including
			 providing or maintaining the following:
(1)
			 Financial solvency;
(2) a panel of
			 service providers, who shall meet the following requirements:
(A) Have professional credentials required by
			 the state in which the services are provided;
(B) be in active practice;
(C) be available to provide services to
			 program enrollees; and
(D) be able
			 to provide services sensitive to the needs of a diverse population, including
			 individuals of any race, ethnicity, or disability;
(3) a quality management process under 42
			 C.F.R. Part 438; and
(4) any other
			 relevant requirements as determined by the secretary.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 14 - CHILDREN'S HEALTH INSURANCE PROGRAM › Section 129-14-20 - Application process

Current through Register Vol. 43, No. 28, July 11, 2024
(a) An
			 application for kancare-CHIP shall be made by an applicant or by another person
			 authorized to act on the applicant's behalf.
(b) An application for kancare-CHIP shall be
			 made using a department-approved form. The applicant or person authorized to
			 act on behalf of the applicant shall sign the application. Electronic
			 signatures, including telephonically recorded signatures, and handwritten
			 signatures transmitted by any other electronic transmission shall be
			 acceptable. If any person signs by mark, the names and addresses of two
			 witnesses shall be required.
Each application shall be submitted on the state application
				web site or the federally facilitated exchange web site, by telephone, in
				person, by mail, by electronic mail, or by fax.
(c) If the department denies an application
			 within 45 days of receipt of the application and the applicant reap-plies or
			 provides required information within this 45-day period, the application shall
			 be reactivated.