Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:025 - Payment for services provided by an intermediate care facility for individuals with an intellectual disability, a dually-licensed pediatric facility, an institution for mental diseases, or a nursing facility with an all-inclusive rate unit

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				142.363,
				202B.010,
				42 C.F.R.
				413.9,
				413.17,
				413.85,
				413.90,
				413.94,
				413.98,
				413.106,
				413.153,
				435.1010,
				447.204,
				447.272,
				483.10,
				42 U.S.C.
				1395x,
				1396a,
				1396d
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services has responsibility to
				administer the Medicaid Program.
				KRS
				205.520(3) authorizes the
				cabinet by administrative regulation, to comply with any requirement that may
				be imposed, or opportunity presented, by federal law to qualify for federal
				Medicaid funds. This administrative regulation establishes the method for
				determining amounts payable by the Medicaid Program for nursing facility
				services provided by an intermediate care facility for individuals with an
				intellectual disability, a dually-licensed pediatric facility, an institution
				for mental diseases, or a nursing facility with an all-inclusive rate
				unit.
Section 1. Definitions.
(1) "Allowable cost" means that portion of a
			 facility's cost that is allowed by the department in establishing the
			 reimbursement rate.
(2) "Calculated
			 rate" means the rate effective July 1, 1999 and each July 1 thereafter for:
(a) An intermediate care facility for
			 individuals with an intellectual disability (ICF-IID); or
(b) A nursing facility certified as:
1. A dually-licensed pediatric facility;
			 or
2. An institution for mental
			 diseases.
(3)
			 "Cost-based facility" means a facility that:
(a) The department reimburses for all
			 allowable costs; and
(b) Is either:
1. A dually-licensed pediatric
			 facility;
2. An intermediate care
			 facility for individuals with an intellectual disability; or
3. An institution for mental
			 diseases.
(4)
			 "Cost report" means Cost-based Facility Reimbursement Cost Report Instructions
			 and Cost-based Facility Reimbursement Cost Report.
(5) "Department" means the Department for
			 Medicaid Services or its designee.
(6) "Dually-licensed pediatric facility"
			 means any facility providing both high intensity and low intensity nursing
			 facility services to:
(a) Children under age
			 twenty-one (21);
(b) Residents who
			 were admitted to the facility prior to reaching the age of twenty-one (21) and
			 who remain as residents in the facility after reaching the age of twenty-one
			 (21); or
(c) Residents who were
			 admitted to the facility prior to reaching the age of twenty-one (21) and who
			 were discharged to a different facility and who, but for being older than
			 twenty-one (21), continue to meet the level of care of the dually-licensed
			 pediatric facility.
(7)
			 "IHS Markit Index" means an indication of changes in health care costs from
			 year to year developed by IHS Markit, or its successor organization.
(8) "Institution for mental diseases" or
			 "IMD" is defined by 42
			 C.F.R. 435.1010.
(9) "Intermediate care facility for
			 individuals with an intellectual disability" or "ICF-IID" is defined by
			 KRS
			 202B.010(10).
(10) "Nursing facility" or "NF" means that:
(a) The state survey agency has:
1. Granted an NF license to the facility;
			 and
2. Recommended the NF to the
			 department for certification as a Medicaid provider; and
(b) The department has granted certification
			 for Medicaid participation to the NF.
(11) "Nursing facility with an all-inclusive
			 rate unit" means:
(a) A nursing facility with
			 a distinct part ventilator unit; or
(b) A nursing facility with a distinct part
			 brain injury unit.
(12)
			 "Occupancy factor" means a percentage representing:
(a) A facility's actual occupancy level;
			 or
(b) A minimum occupancy level
			 assigned to a facility if its occupancy level is below the minimum level
			 established in Section 3(17) of this administrative regulation.
(13) "Prospective rate" means a
			 payment rate for routine services based on allowable costs and other factors
			 that, except as specified in Section 3 of this administrative regulation, shall
			 not be retroactively adjusted, either in favor of the facility or the
			 department.
(14) "Routine services"
			 means services covered by the Medicaid Program pursuant to
			 42 C.F.R.
			 483.10(f)(11)(i).
(15) "State survey agency" means the Cabinet
			 for Health and Family Services, Office of Inspector General, Division of Health
			 Care.
(16) "Upper payment limit"
			 means the aggregate payment amount as described in
			 42 C.F.R.
			 447.272 for inpatient services furnished by
			 state-owned or operated ICF-IIDs.