Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:042 - Amounts payable for hospital furnished skilled nursing and intermediate care facility services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520
NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective
				July 9, 2004, reorganized the Cabinet for Health Services and placed the
				Department for Medicaid Services and the Medicaid Program under the Cabinet for
				Health and Family Services. The Cabinet for Health and Family Services has
				responsibility to administer the program for Medical Assistance in accordance
				with Title XIX of the Social Security Act.
				KRS
				205.520(3) empowers the
				cabinet, by administrative regulation, to comply with any requirement that may
				be imposed, or opportunity presented, by federal law for the provision of
				medical assistance to Kentucky's indigent citizenry. This administrative
				regulation sets forth the method for determining amounts payable by the cabinet
				for hospital furnished skilled nursing facility and intermediate care facility
				services.
Section 1. Reimbursement for
			 Hospital Furnished Skilled Nursing and Intermediate Care Services. To qualify
			 for reimbursement, any hospital(s) providing skilled nursing facility services
			 and intermediate care facility services must have in effect an agreement with
			 the secretary, Department of Health and Human Services, pursuant to Section
			 1883 of the Social Security Act, or be dual licensed (as provided for in KRS
			 Chapter 216B) to provide skilled nursing and/or intermediate care services in
			 an acute care hospital bed. Such hospital(s) shall be paid for swing-bed
			 services provided pursuant to Section 1883 of the Act at a rate equal to the
			 average rate per patient-day paid for routine services during the previous
			 calendar year under the state's Title XIX plan to skilled nursing and
			 intermediate care facilities, respectively, located in the state in which the
			 hospital is located; for dual licensed skilled nursing or intermediate care
			 services, such hospital shall be paid at a rate equal to the hospital based
			 skilled nursing facility upper limit or intermediate care facility upper limit,
			 as appropriate for the level of care provided, in effect at the time the
			 service is provided. The reasonable cost of ancillary services shall be
			 determined in the same manner as the reasonable cost of ancillary services
			 provided for inpatient hospital services; covered ancillary services shall be
			 the same as for all other skilled nursing and intermediate care
			 facilities.
Section 2. Rate Review
			 and Adjustment. Any participating facility may appeal its established rates
			 using either the customary appeals mechanism for providers of hospital
			 inpatient services or for providers of skilled nursing and intermediate care
			 facility services.
Section 3.
			 Eligibility for Reimbursement. A facility shall be eligible for reimbursement
			 only when considered to be a participating vendor, and reimbursement shall be
			 made only for covered services rendered eligible Title XIX recipients meeting
			 patient status as determined in accordance with applicable administrative
			 regulations.
Section 4. The
			 amendments to this administrative regulation shall be effective with regard to
			 services provided on or after July 1, 1987.
STATUTORY AUTHORITY:
				  KRS
				  194A.030(2),
				  194A.050(1),
				  205.520(3),
				  EO 2004-726