Kansas Administrative Regulations › Agency 30 - KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES › Article 10 - ADULT CARE HOME PROGRAM › Section 30-10-1a - Nursing facility program definitions

Current through Register Vol. 43, No. 28, July 11, 2024
(a) The following
			 words and terms, when used in this article, shall have the following meanings,
			 unless the context clearly indicates otherwise.
(1) "Accrual basis of accounting" means that
			 revenue of the provider is reported in the period when it is earned, regardless
			 of when it is collected, and expenses are reported in the period in which they
			 are incurred, regardless of when they are paid.
(2) "Active treatment for individuals with
			 mental retardation or a related condition" means a continuous program for each
			 client, which shall include aggressive, consistent implementation of a program
			 of specialized and generic training, treatment, health services, and related
			 services that is directed toward the following:
(A) The acquisition of the behaviors
			 necessary for the client to function with as much self-determination and
			 independence as possible; and
(B)
			 the prevention or deceleration of regression or loss of current optimal
			 functional status.
(3)
			 "Agency" means the department of social and rehabilitation services.
(4) "Ancillary services and other medically
			 necessary services" means those special services or supplies, in addition to
			 routine services, for which charges are made.
(5) "Case mix" means a measure of the
			 intensity of care and services used by a group of residents in a facility.
(6) "Case mix index" means a
			 numeric score with a specific range that identifies the relative resources used
			 by a particular group of residents and represents the average resource
			 consumption across a population or sample. Two average case mix index scores
			 are considered in setting rates for nursing facility program participants.
			 These indexes are the following:
(A)
			 "Medicaid average case mix index," which means the average case mix index
			 calculated using case mix scores for only the medicaid residents in a
			 population; and
(B) "facility
			 average case mix index," which means the average case mix index calculated
			 using case mix scores for all the residents in a nursing facility.
(7) "Change of ownership" means a
			 transfer of rights and interests in real and personal property used for nursing
			 facility services through an arm's-length transaction between unrelated persons
			 or legal entities.
(8) "Change of
			 provider" means a change of ownership or lessee specified in the provider
			 agreement.
(9) "Common ownership"
			 means that an entity holds a minimum of five percent ownership or equity in the
			 provider facility or in a company engaged in business with the provider
			 facility.
(10) "Control" means
			 that an individual or organization has the power, directly or indirectly, to
			 significantly influence or direct the actions or policies of an organization or
			 facility.
(11) "Cost and other
			 accounting information" means adequate financial data about the nursing
			 facility operation, including source documentation, that is accurate, current,
			 and sufficiently detailed to accomplish the purposes for which it is intended.
			 Source documentation, including petty cash payout memoranda and original
			 invoices, shall be valid only if the documentation originated at the time and
			 near the place of the transaction. In order to provide the required cost data,
			 the provider shall maintain financial and statistical records in a manner that
			 is consistent from one period to another. This requirement shall not preclude a
			 beneficial change in accounting procedures when there is a compelling reason to
			 effect a change of procedures.
(12) "Cost finding" means recasting the data
			 derived from the accounts ordinarily kept by a provider to ascertain costs of
			 the various types of services rendered.
(13) "Costs not related to resident care"
			 means costs that are not appropriate, necessary, or proper in developing and
			 maintaining the nursing facility operation and activities. These costs shall
			 not be allowed in computing reimbursable costs.
(14) "Costs related to resident care" means
			 all necessary and proper costs, arising from arm's-length transactions in
			 accordance with general accounting rules, that are appropriate and helpful in
			 developing and maintaining the operation of resident care facilities and
			 activities. Specific items of expense shall be limited pursuant to K.A.R.
			 30-10-23a, K.A.R. 30-10-23b, K.A.R. 30-10-23c, K.A.R. 30-10-24, K.A.R.
			 30-10-25, K.A.R. 30-10-26, K.A.R. 30-10-27, and K.A.R. 30-10-28.
(15) "Cost report" means the nursing facility
			 financial and statistical report (MS-2004).
(16) "Educational activities" means an
			 approved, formally organized, or planned program of study usually engaged in by
			 providers in order to enhance the quality of resident care in an institution.
			 These activities shall be licensed when required by state law.
(17) "Educational activities net cost" means
			 the cost of approved educational activities less any grants, specific
			 donations, or reimbursements of tuition.
(18) "Hospital-based nursing facility" means
			 a nursing facility, as defined in this regulation, that is attached to or
			 associated with a hospital.
(19)
			 "Inadequate care" means any act or failure to act that may be physically or
			 emotionally harmful to a recipient.
(20) "Level of care" means the type and
			 intensity of services prescribed in the resident's plan of care as based on the
			 assessment and reassessment process.
(21) "Mental illness" means a clinically
			 significant behavioral or psychological syndrome or pattern that is typically
			 associated with either a distressing symptom or impairment of function.
			 Relevant diagnoses shall be limited to schizophrenia, recurrent and severe
			 major affective disorders, atypical psychosis, bipolar disorder, paranoid
			 disorders, schizoaffective disorder, psychotic disorder, obsessive-compulsive
			 disorder, or borderline personality disorder.
(22) "Mental retardation" means subaverage
			 general intellectual functioning that originates in the developmental period
			 and is associated with an impairment in adaptive behavior.
(23) "Nonworking owners" means any individual
			 or organization having five percent or more interest in the provider who does
			 not perform a resident-related function for the nursing facility.
(24) "Nonworking related party or director"
			 means any related party, as defined in this regulation, who does not perform a
			 resident-related function for the nursing facility.
(25) "Nursing facility (NF)" means a facility
			 that conforms to these criteria:
(A) Meets
			 state licensure standards;
(B)
			 provides health-related care and services, as prescribed by a physician; and
(C) provides 24-hour-a-day,
			 seven-day-a-week licensed nursing supervision to residents for ongoing
			 observation, treatment, or care for long-term illness, disease, or injury.
(26) "Nursing facility
			 for mental health" means a nursing facility that meets these criteria:
(A) Meets state licensure standards;
(B) provides structured mental
			 health rehabilitation services, in addition to health-related care, for
			 individuals with a severe and persistent mental illness; and
(C) provides 24-hour-a-day, seven-day-a-week
			 licensed nursing supervision. The nursing facility shall have been operating in
			 accordance with a provider agreement with the agency on June 30, 1994.
(27) "Ongoing entity"
			 means that a change in the provider has not been recognized for Kansas medical
			 assistance program payment purposes.
(28) "Organization costs" means those costs
			 directly incidental to the creation of the corporation or other form of legal
			 business entity. These costs shall be considered to be intangible assets
			 representing expenditures for rights and privileges that have value to the
			 business.
(29) "Owner and related
			 party compensation" means salaries, drawings, consulting fees, or other
			 payments paid to or on behalf of any owner with a five percent or greater
			 interest in the provider or any related party, as defined in this regulation,
			 whether the payment is from a sole proprietorship, partnership, corporation, or
			 nonprofit organization.
(30)
			 "Owner" means the person or legal entity that has the rights and interests of
			 the real and personal property used to provide the nursing facility services.
(31) "Plan of care for nursing
			 facilities" means a document completed by the nursing facility staff that
			 states the need for care, the estimated length of the program, the methodology
			 to be used, and the expected results for each resident.
(32) "Prescription drug" means a simple or
			 compound substance or mixture of substances prescribed for the cure,
			 mitigation, or prevention of disease or for health maintenance that is
			 prescribed by a licensed physician or practitioner and dispensed by a licensed
			 pharmacist.
(33) "Projected cost
			 report" means a cost report submitted to the agency by a provider prospectively
			 for a 12-month period of time. The projected cost report shall be based on an
			 estimate of the costs, revenues, resident days, and other financial data for
			 that 12-month period of time.
(34)
			 "Provider" means the operator of the nursing facility specified in the provider
			 agreement.
(35) "Recipient" means
			 a person determined to be eligible for the Kansas medical assistance program in
			 a nursing facility.
(36) "Related
			 parties" means two or more parties with a relationship in which one party has
			 the ability to influence another party to the transaction in the following
			 manner:
(A) When one or more of the
			 transacting parties might fail to pursue the party's or parties' own separate
			 interests fully;
(B) when the
			 transaction is designed to inflate the Kansas medical assistance program costs;
			 or
(C) when any party considered a
			 related party to a previous owner or operator becomes the employee, or
			 otherwise functions in any capacity on behalf of a subsequent owner or
			 operator. Related parties shall include parties related by family, business, or
			 financial association, or by common ownership or control. Transactions between
			 related parties shall not be considered to have arisen through arm's-length
			 negotiations.
(37)
			 "Related to the nursing facility" means that the facility is significantly
			 associated or affiliated with, has control of, or is controlled by the
			 organization furnishing the services, facilities, or supplies.
(38) "Representative" means either of the
			 following:
(A) A legal guardian, conservator,
			 or representative payee as designated by the social security administration; or
(B) any person who is designated
			 in writing by the resident to manage the resident's personal funds and who is
			 willing to accept the designation.
(39) "Resident assessment form" means the
			 document that meets these requirements:
(A)
			 Is jointly specified by the Kansas department of health and environment and the
			 agency;
(B) is approved by the
			 health care finance administration; and
(C) includes the minimum data set.
(40) "Resident assessment
			 instrument" means the resident assessment form, resident assessment protocols,
			 and the plan of care, including reassessments.
(41) "Resident day" means that period of
			 service rendered to a resident between census-taking hours on two successive
			 days and all other days for which the provider receives payment, either full or
			 partial, for any Kansas medical assistance program or non-Kansas medical
			 assistance program resident who was not in the nursing facility. Census-taking
			 hours shall consist of 24 hours beginning at midnight.
(42) "Resident status review" means a
			 reassessment to identify any nursing facility resident who may no longer meet
			 the level of care criteria.
(43)
			 "Routine services and supplies" means services and supplies that are commonly
			 stocked for use by or provided to any resident. The services and supplies shall
			 be included in the provider's cost report.
(44) "Sale-leaseback" means a transaction in
			 which an owner sells a facility to a related or nonrelated purchaser and then
			 leases the facility from the new owner to operate as the provider.
(45) "Severe and persistent mental illness"
			 means mental illness as defined in this regulation, but shall include both of
			 the following additional requirements:
(A)
			 The individual meets one of the following criteria:
(i) Has undergone psychiatric treatment more
			 intensive than what could have been provided through outpatient care more than
			 once in a lifetime; or
(ii) has
			 experienced a single episode of continuous, structured, supportive residential
			 care other than hospitalization for a duration of at least two months.
(B) The individual
			 meets at least two of the following criteria, on a continuing or intermittent
			 basis, for at least two years:
(i) Is
			 unemployed, is employed in a sheltered setting, or has markedly limited skills
			 and a poor work history;
(ii)
			 requires public financial assistance for out-of-hospital maintenance and may be
			 unable to procure this assistance without help;
(iii) shows a severe inability to establish
			 or maintain a personal social support system;
(iv) requires help in basic living skills; or
(v) exhibits inappropriate social
			 behavior that results in a need for intervention by the mental health or
			 judicial system.
(46) "Specialized mental health
			 rehabilitation services" means one of the specialized rehabilitative services
			 that provide ongoing treatment for mental health problems and that are aimed at
			 attaining or maintaining the highest level of mental and psychosocial
			 well-being. The specialized rehabilitative services shall include the
			 following:
(A) Crisis intervention services;
(B) drug therapy or monitoring of
			 drug therapy;
(C) training in
			 medication management;
(D)
			 structured socialization activities to diminish tendencies toward isolation and
			 withdrawal;
(E) development and
			 maintenance of necessary daily living skills, including grooming, personal
			 hygiene, nutrition, health and mental health education, and money management;
			 and
(F) maintenance and
			 development of appropriate personal support networks.
(47) "Specialized services" means inpatient
			 psychiatric care for the treatment of an acute episode of mental illness.
(48) "State licensing agency"
			 means the department of health and environment for hospital-based nursing
			 facilities and the department on aging for all other nursing facilities.
(49) "Swing bed" means a hospital
			 bed that can be used interchangeably as either a hospital bed or nursing
			 facility bed.
(50)
			 "Twenty-four-hour nursing care" means the provision of 24-hour licensed nursing
			 services with the services of a registered nurse for at least eight consecutive
			 hours a day, seven days a week.
(51) "Working trial balance" means a list of
			 the account balances in general ledger order that was used in completing the
			 cost report.