Kansas Administrative Regulations › Agency 30 - KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES › Article 5 - PROVIDER PARTICIPATION, SCOPE OF SERVICES, AND REIMBURSEMENTS FOR THE MEDICAID (MEDICAL ASSISTANCE) PROGRAM › Section 30-5-58 - Definitions

Current through Register Vol. 43, No. 28, July 11, 2024
The following words and terms, when used in this article, shall
				have the following meanings, unless the context clearly indicates otherwise.
(a) "Accept medicare assignment"
			 means the provider will accept the medicare-allowed payment rate as payment in
			 full for services provided to a recipient.
(b) "Accrual basis accounting" means that
			 revenue of the provider is reported in the period in which 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.
(c) "Acquisition cost" means the allowable
			 reimbursement price for each covered drug, supply, or device as determined by
			 the secretary in accordance with federal regulations.
(d) "Admission" means entry into a hospital
			 for the purpose of receiving inpatient medical treatment.
(e) "Agency" means the department of social
			 and rehabilitation services.
(f)
			 "Ambulance" means a state-licensed vehicle equipped for emergency
			 transportation of injured or sick recipients to facilities where medical
			 services are rendered.
(g)
			 "Arm's-length transaction" means a transaction between unrelated parties.
(h) "Border cities" means those
			 communities outside of the state of Kansas but within a 50-mile range of the
			 state border.
(i) "Capitated
			 managed care" means a type of managed care plan that uses a risk-sharing
			 reimbursement method whereby providers receive fixed periodic payments for
			 health services rendered to plan members. Capitated fees shall be set by
			 contract with providers and shall be paid on a per person basis regardless of
			 the amount of services rendered or costs incurred.
(j) "Capitation reimbursement" means a
			 reimbursement methodology establishing payment rates, per program consumer or
			 eligible individual, for a designated group of services.
(k) "Case conference" means a scheduled,
			 face-to-face meeting involving two or more persons to discuss problems
			 associated with the treatment of the facility's patient or patients. Persons
			 involved in the case conference may include treatment staff, or other
			 department representatives of the client or clients.
(l) "Change of ownership" means a change that
			 involves the following:
(1) An arm's-length
			 transaction between unrelated parties; and
(2)
(A) The
			 dissolution or creation of a partnership when no member of the dissolved
			 partnership or the new partnership retains ownership interest from the previous
			 ownership affiliation;
(B) a
			 transfer of title and property to another party if the property is owned by a
			 sole proprietor;
(C) the change or
			 creation of a new lessee acting as a provider of pharmacy services; or
(D) a consolidation of two or more
			 corporations that creates a new corporate entity. The transfer of participating
			 provider corporate stock shall not in itself constitute a change of ownership.
			 A merger of one or more corporations with a participating provider corporation
			 surviving shall not constitute a change of ownership.