reglab/statecodes huggingface dataset:
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 30-5-81b - The basis of reimbursement for hospital services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Payment for
			 hospital services provided to program participants shall be made to those
			 hospitals filing cost reports with the Kansas department of social and
			 rehabilitation services. Cost reports shall be due 30 days after the due date
			 of the medicare cost report to the medicare fiscal intermediary.
(b) General hospitals; inpatient services.
			 For covered services rendered to program recipients, each general hospital
			 shall be reimbursed on the basis of the diagnosis related group reimbursement
			 system pursuant to the provisions of K.A.R. 30-5-81t through 30-5-81v except as
			 set forth below.
(c) General
			 hospitals; outpatient services. For covered services rendered to program
			 recipients, each general hospital shall be reimbursed based on the
			 reimbursement methodology for comparable services rendered by non-hospital
			 providers. For laboratory and radiology services, each general hospital shall
			 be reimbursed its customary charges not to exceed the range maximum set forth
			 in K.A.R. 30-5-85a plus 2%.
(d)
			 General hospitals; long term care in swing bed hospitals. For covered services
			 rendered to program recipients, each general hospital shall be reimbursed
			 pursuant to 42 CFR
			 447.250 through
			 447.280, revised October 1, 1988,
			 which are adopted by reference.
(e) State-operated hospitals. Each
			 state-operated hospital shall be reimbursed the lesser of reasonable costs or
			 customary charges for covered inpatient services rendered to program
			 recipients. Each state-operated hospital shall be reimbursed reasonable fees as
			 related to customary charges for covered outpatient services rendered to
			 program recipients, except no fee shall be paid in excess of the range maximum.
			 The range of charges shall provide the base for computations.
(f) Hospitals which are determined to be
			 disproportionate share hospitals shall be reimbursed with a disproportionate
			 share payment adjustment as determined in accordance with the Omnibus Budget
			 Reconciliation Act, Public Law 100-203, section 4112, effective July 1, 1988.
			 The effective date of this regulation shall be October 1, 1993.
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 30-5-81d - This rule and regulation shall expire on July 1, 1989

Current through Register Vol. 43, No. 28, July 11, 2024
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 30-5-81q - This rule and regulation shall expire on July 1, 1989

Current through Register Vol. 43, No. 28, July 11, 2024
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 30-5-81r - This rule and regulation shall expire on July 1, 1989

Current through Register Vol. 43, No. 28, July 11, 2024
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 30-5-81s - This rule and regulation shall expire on July 1, 1989

Current through Register Vol. 43, No. 28, July 11, 2024
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 30-5-81u - General hospital groups under the diagnosis-related group (DRG) reimbursement system

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each general
			 hospital participating in the Kansas medicaid/medikan program shall be assigned
			 by the Kansas department of social and rehabilitation services to one of four
			 groups. Each general hospital shall be annually notified by the department in
			 writing of the hospital's group assignment.
(1) Each general hospital assigned to group
			 one shall meet either of the following criteria:
(A) Be located within a metropolitan
			 statistical area within the state of Kansas and have at least 200 general
			 hospital inpatient beds; or
(B) be
			 located within the state of Kansas and within 10 miles of a general hospital
			 meeting the criteria specified in paragraph (a)(1)(A).
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 30-5-81v - Reimbursement for general hospital inpatient services under the diagnosis related group (DRG) reimbursement system

Current through Register Vol. 43, No. 28, July 11, 2024
(a) The Kansas
			 department of social and rehabilitation services shall reimburse general
			 hospitals for inpatient services provided to recipients covered pursuant to
			 K.A.R. 30-5-81 on the basis of the diagnosis related group (DRG) reimbursement
			 system.
(b) Reimbursement shall be
			 determined as follows:
(1) The standard DRG
			 amount shall constitute reimbursement for each covered general hospital
			 inpatient stay except in circumstances described in subsections (b)(5) and
			 (b)(6) below. An additional payment shall be made for each day outlier or each
			 cost outlier pursuant to subsections (b)(2), (b)(3) and (b)(4) below.
(2) If a covered general hospital
			 inpatient stay is determined to be a cost outlier, the reimbursement for the
			 cost outlier additional payment shall be obtained by multiplying two items: The
			 DRG adjustment percentage and the difference between the estimated cost of the
			 covered inpatient stay and the cost outlier limit.
(3) If a covered general hospital inpatient
			 stay is determined to be a day outlier, the reimbursement for the day outlier
			 additional payment shall be obtained by multiplying three items: The DRG daily
			 rate, the DRG adjustment percentage, and the difference between the actual
			 covered length of inpatient stay and the day outlier limit.
(4) If a covered general hospital inpatient
			 stay is determined to be both a cost outlier and a day outlier, the additional
			 payment shall be the greater of the amounts computed in subsections (b)(2) or
			 (b)(3) above.
(5) If a recipient
			 is transferred during a covered general hospital inpatient stay from one
			 hospital to another hospital, the reimbursement to both hospitals shall be
			 determined by a methodology specified by the secretary.
(6) Reimbursement shall not be made for a
			 recipient's readmission to a hospital if the readmission for the same recipient
			 is determined to have resulted from an inappropriate discharge. The effective
			 date of this regulation shall be July 1, 1989.
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 30-5-82 - Scope of rural health clinic services

Current through Register Vol. 43, No. 28, July 11, 2024
Rural health clinic services and other ambulatory services
				shall be covered under the Kansas medical assistance program pursuant to
				42 CFR
				447.371, effective September 30, 1986, when
				provided by clinics accepted by the health care financing administration as
				qualified to furnish rural health clinic services for participation under the
				medicare program. A clinic may be certified as either an independent or a
				provider-based rural health clinic. Covered rural health clinic services and
				other ambulatory services shall include the following:
(a) Physician services. These are
			 professional services performed by a physician.
(b) Advanced registered nurse practitioner
			 and physician assistant services. These are professional services furnished by
			 an advanced registered nurse practitioner or a physician assistant under both
			 of the following conditions:
(1) Services are
			 in accordance with medical orders prepared by a physician for the care and
			 treatment of a patient.
(2) A
			 physician is available at least once every two weeks to supervise the delivery
			 of services and to perform services that are not in the scope of advanced
			 registered nurse practitioner and physician assistant services as defined in
			 the Kansas statutes.
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 30-5-82a - Reimbursement for rural health clinic services

Current through Register Vol. 43, No. 28, July 11, 2024
Reimbursement for rural health clinic services and other
				ambulatory services covered by the Kansas medical assistance program shall be
				at reasonable cost pursuant to
				42 CFR
				447.371, effective September 30, 1986; 42 CFR
				Part 413, revised as of October 1, 1997; Section 4205 of the balanced budget
				act of 1997; and the provisions discussed in this regulation.
(a) Reimbursement method. An interim rate per
			 visit shall be paid to each rural health clinic, subject to a fiscal year-end
			 retroactive cost settlement.
(b)
			 Interim reimbursement rate per visit.
(1)
			 Rate for independent rural health clinic. Each clinic shall be paid by the
			 agency the all-inclusive reasonable cost rate per visit determined by the
			 medicare carrier.
(A) Initial rate at
			 enrollment. The medicaid payment rate shall be the current medicare rate.
(B) Rate changes. The interim
			 payment rate of an independent rural health clinic shall be changed by the
			 agency each time a rate change notification for that clinic is received from
			 the medicare carrier.
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 30-5-83 - Scope of services for ambulatory surgical centers

Current through Register Vol. 43, No. 28, July 11, 2024
Coverage shall be limited to non-elective surgical services,
				except for sterilization operations or for participants in the Kan Be Healthy
				program.
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 30-5-83a - Reimbursement for ambulatory surgical centers

Current through Register Vol. 43, No. 28, July 11, 2024
Reimbursement shall be made as a fee for service established by
				the secretary. No fee shall be paid in excess of reasonable cost or charges,
				whichever is less.
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 30-5-84 - This rule and regulation shall expire on January 1, 1990

Current through Register Vol. 43, No. 28, July 11, 2024
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 30-5-84a - This rule and regulation shall expire on January 1, 1990

Current through Register Vol. 43, No. 28, July 11, 2024
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 30-5-85 - Scope of independent laboratory services

Current through Register Vol. 43, No. 28, July 11, 2024
The services of independent laboratories shall be available to
				program recipients if:
(a) the
			 laboratory has been certified by medicare to perform the services;
(b) the laboratory is independent from the
			 office of the ordering physician; and
(c) the laboratory services are prescribed.
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 30-5-85a - Reimbursement for independent laboratory services

Current through Register Vol. 43, No. 28, July 11, 2024
Reasonable fees as related to customary charges shall be paid
				for independent laboratory services, except no fee shall be paid in excess of
				the range maximum. The range of charges shall provide the base for
				computations.
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 30-5-86 - Scope of services by community mental health centers

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Community
			 mental health center services shall be available to program recipients in:
(1) Outpatient treatment programs licensed by
			 mental health and retardation services;
(2) approved inpatient treatment programs;
(3) partial hospitalization
			 programs approved by mental health and retardation services pursuant to K.A.R.
			 30-5-110 and certified to participate in medicare; and
(4) the recipient's private residence.
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 30-5-86a - Reimbursement for community mental health centers

Current through Register Vol. 43, No. 28, July 11, 2024
Reasonable fees as related to customary charges shall be paid
				for community mental health center services, except no fee shall be paid in
				excess of the range maximum. The range of charges shall provide the base for
				computations. The effective date of this regulation shall be July 1, 1988.
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 30-5-86b - Existing provider rates for community mental health centers

Current through Register Vol. 43, No. 28, July 11, 2024
(a) For an existing
			 provider and those providers resulting from a separation from or a division of
			 an existing provider, the agency shall review the fee schedule retained for
			 cost auditing and supplied annually to the agency by the provider to determine
			 per hour rates. The rates shall be based on the patient-related costs submitted
			 by the provider for its fiscal year ending on or before December 31, 1981, and
			 any subsequent base years thereafter, as established by the secretary. The rate
			 may be adjusted on or after each July 1 by an inflation factor established by
			 the secretary. The rates shall be limited to the lesser of the computed rate,
			 the highest fee charged to and paid by private patient resources within the
			 catchment area, or the range maximums established by the secretary. Under no
			 circumstances shall a separation or division from an existing provider be
			 considered as the establishment of a new provider, and the existing rate shall
			 be continued. A provider shall be reimbursed for recipients living outside
			 their catchment areas at the same rate as recipients located within their
			 catchment areas.
(b) Failure to
			 complete and submit any required cost report or other financial data shall
			 result in that center's new reimbursement rate being reduced to the lowest rate
			 paid to a community mental health center until such time that a cost report is
			 received and reviewed by the division of medical programs. This rule and
			 regulation shall expire on July 1, 1988.
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 30-5-86c - New provider rates for community mental health centers

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Rates for the
			 first 18 months of a new community mental health center shall be computed from
			 projected costs. The first projection, based on 12-month projected cost data,
			 shall apply to the first six months of operation. The second 12-month
			 projection, based on six months' actual cost data, shall be filed within 60
			 days after the end of the sixth month. The projected rate shall remain in
			 effect until a rate can be established from a cost report based on historical
			 cost data for the last 12 months of the projection period. Failure to complete
			 and submit the required cost report or other financial data shall result in
			 that center's reimbursement rate being reduced to the lowest rate paid to a
			 community mental health center.
(b) Each new provider shall file a cost
			 report based on historical cost data for the 12-month period ending on the last
			 day of the 18th month following licensure of the community mental health
			 center. Retroactive adjustments of the payments made during the projection
			 period shall be made at the end of the 18-month period after audit of the
			 historical cost data. Settlement of an overpayment or underpayment shall be at
			 the audited rate computed from the historical cost data reported in accordance
			 with this paragraph, or at the highest fee charged to and paid by private
			 patient resources within the catchment area, or at the range maximums
			 established by the secretary, whichever is less.
(c) Rates for a new provider, subsequent to
			 the projection period, shall be based on the historical cost data reported in
			 accordance with subsection (b), adjusted by an inflation factor established by
			 the secretary, to compute a rate comparable to the rates computed in K.A.R.
			 30-5-86b for existing providers. This rule and regulation shall expire on July
			 1, 1988.
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 30-5-86d - Financial recordkeeping for community mental health centers

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Records shall
			 be maintained by the provider to document income and expenditures, hours of
			 services provided, allocation methodologies, and fees charged to and paid by
			 private patient resources.
(b)
			 Each provider record used in support of costs, charges and payments for
			 services and supplies shall be subject to inspection and audit by the agency,
			 the United States department of health and human services, and the United
			 States general accounting office. Standardized definitions, accounting,
			 statistics and reporting practices which are widely accepted in community
			 mental health centers and related fields shall be followed. This rule and
			 regulation shall expire on July 1, 1988.
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 30-5-86e - Modification of prospective rates for community mental health centers

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each community
			 mental health center participating in the prospective payment system may
			 request that the rate review committee set forth in paragraph (g) modify its
			 reimbursement rate if its current medicaid/medikan program unit cost exceeds
			 the unit reimbursement rate by at least 15%.
(b) Each rate modification request shall be
			 in writing, shall set forth sufficient information and documentation to support
			 the request, and shall be received by the division of medical programs prior to
			 April 1 of each year.
(c) The
			 review committee shall submit its recommendations to the commissioner of income
			 maintenance and medical services within 60 days after its receipt of the
			 request.
(d) The commissioner
			 shall have five working days from the receipt of the review committee's
			 recommendations to accept, modify or reject them. The recommendations of the
			 review committee shall become final if the commissioner fails to act within 60
			 days of the committee's receipt of the request.
(e) The commissioner shall notify the agency
			 or community mental health center of the disposition of its modification
			 request within five working days of the final decision.
(f) Each approved modification shall become
			 effective on and after July 1 of that year.
(g) The secretary shall appoint a rate review
			 committee consisting of six members and six alternates. Three of the members
			 and three of the alternates shall be selected in consultation with the
			 association of community mental health centers of Kansas. This rule and
			 regulation shall expire on July 1, 1988.
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 30-5-87 - Scope of the Kan Be Healthy program

Current through Register Vol. 43, No. 28, July 11, 2024
Kan Be Healthy screenings shall be available at intervals
				designated by the Kansas department of social and rehabilitation services and
				at other medically necessary intervals for all program recipients under 21
				years of age.
(a) The Kan Be Healthy
			 medical screening shall include, but shall not be limited to, the following
			 procedures:
(1) Comprehensive health and
			 developmental history;
(2)
			 comprehensive, unclothed physical examination;
(3) appropriate laboratory tests;
(4) appropriate immunizations according to
			 age and health history;
(5) health
			 education including anticipatory guidance; and
(6) scheduling or referral for diagnosis and
			 treatment necessary to correct defects and chronic conditions discovered during
			 screening.
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 30-5-87a - Reimbursement for Kan Be Healthy program services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Reimbursement
			 for screening and appropriate referral shall be made as a fee for service
			 established by the secretary. No fee shall be paid in excess of reasonable cost
			 or charges, whichever is less.
(b)
			 Reimbursement for diagnosis and treatment shall follow the guidelines
			 established for all other provider groups in the program.
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 30-5-88a - Reimbursement for physician services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Reasonable fees
			 as related to customary charges shall be paid for physician services, except no
			 fee shall be paid in excess of the range maximum. The range of charges shall
			 provide the base for computations.
(b) The maximum rate for services provided by
			 a physician extender shall be 75% of that allowed for the physician who is
			 billing for the physician extender services.
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 30-5-89 - Scope of home health services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Covered home
			 health services shall be available to program recipients if both of the
			 following conditions are met:
(1) A physician
			 has developed a plan of treatment and has certified the need for the service.
(2) The service is determined to
			 be medically necessary pursuant to K.A.R. 30-5-58.
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 30-5-89a - Reimbursement for home health services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Reimbursement
			 shall be based upon the fee for services and at a rate established by the
			 secretary.
(b) Reimbursement for
			 medical supplies shall be pursuant to K.A.R. 30-5-108a.
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 30-5-90 - This rule and regulation shall expire on August 1, 1990

Current through Register Vol. 43, No. 28, July 11, 2024
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 30-5-92 - Scope of pharmacy services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) The medical
			 services provided to program recipients shall include pharmacy services.
(1) Kan Be Healthy participants shall be
			 limited to those prescription-only and over-the-counter drugs, supplies, and
			 devices that have been accepted for inclusion on any formulary listing for Kan
			 Be Healthy participants adopted and distributed by the secretary to eligible
			 providers of service.
(2) Other
			 medicaid recipients shall be limited to those prescription-only and
			 over-the-counter drugs, supplies, and devices that have been accepted for
			 inclusion on any formulary listing for other medicaid recipients adopted and
			 distributed by the agency to eligible providers of service.
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 30-5-94 - Reimbursement for pharmacy services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each pharmacy
			 provider shall be reimbursed for covered pharmacy services on the basis of
			 product acquisition cost plus a dispensing fee. In no case shall reimbursement
			 for a prescription exceed the lesser of the provider's usual and customary
			 charge for that prescription or the state allowable for that prescription. The
			 submitted charge and payment for covered over-the-counter pharmacy products
			 shall not exceed the lesser of the product acquisition cost plus the dispensing
			 fee or the usual and customary over-the-counter charge of the pharmacy
			 provider.
(b) The acquisition cost
			 shall include a maximum allowable cost for selected multiple-source drugs as
			 determined by the secretary.
(c)
			 The dispensing fee assigned to pharmacy providers shall be $3.40 per
			 prescription unless a different rate is established by the secretary.
(d) If an inactive pharmacy wishes
			 to become an active provider, the pharmacy shall reapply according to K.A.R.
			 30-5-59.
(e) In areas in which
			 pharmacy services are not available, each physician dispensing prescriptions to
			 consumers shall be eligible to receive reimbursement for provision of those
			 services after a pharmacy provider number has been issued by the department
			 according to K.A.R. 30-5-59.
(1) Each
			 physician assigned a pharmacy provider number shall be reimbursed on the basis
			 of product acquisition cost plus a dispensing fee of $.74 per prescription.
(2) The physician shall not be
			 reimbursed a dispensing fee for injectable drugs administered in the office,
			 except as included in the charge for the professional services of the
			 physician.
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 30-5-95 - Cost report requirement for pharmacy services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) The cost
			 reports filed by pharmacy providers for professional fee determination shall
			 reflect data which coincides with the immediate fiscal year used for federal
			 income taxes that ends prior to the cost report filing due date, except in
			 those cases where the provider is not required to file a federal income tax
			 return. In such cases, the provider shall file a cost report from the official
			 financial reporting records of the business.
(b)
(1) A
			 pharmacy shall have been in operation for at least six months in the cost
			 reporting period and have submitted at least 250 medicaid prescription claims
			 annually during the cost reporting period at fiscal year end, to file an
			 initial cost report.
(2) Any
			 Kansas pharmacy that fails or refuses to file a cost reports when required
			 shall not be assigned a professional fee.
(3) Any pharmacy that does not receive a
			 professional fee as a result of failure or refusal to file cost reports shall
			 have a professional fee calculated and assigned following the completion of the
			 next report as required by the department. The assignment of such a
			 professional fee will take effect at the same time all professional fees of
			 pharmacies are adjusted through the standard fee setting procedures of the
			 department. If all pharmacy fees are not adjusted through the standard fee
			 setting procedures of the department, the pharmacy shall be assigned a fee that
			 corresponds to the average fee in effect at the time the pharmacy submits the
			 cost report. The assignment of a fee to a pharmacy which previously failed or
			 refused to file a cost report shall take effect at a date set by the secretary.
			 There shall be no retroactive cost adjustment or settlement.
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 30-5-96 - Cost report data and record keeping requirements for pharmacy services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) The principles
			 of cost related reimbursement require that providers maintain sufficient
			 financial and prescription records to facilitate appropriate cost reporting and
			 professional fee determination. Standardized definitions, accounting,
			 statistics, record keeping and reporting practices which are widely accepted in
			 pharmacy practice and related fields shall be adhered to. Significant
			 modifications in these practices and systems shall not be required in order to
			 determine costs pertinent to the principle of cost related reimbursement.
(b) The pharmacy provider shall
			 keep and make available for review, upon request of the agency, the supporting
			 records and documents as are necessary to ascertain that the cost related
			 professional fee determination and program payments are appropriate. These
			 records shall include matters regarding pharmacy ownership and organizational
			 structure; fiscal and prescription record keeping systems; lease and
			 acquisition agreements; state and federal income tax returns with all
			 supporting documents; drug product, devices and supply purchase invoices; asset
			 acquisition, lease or sale; franchise or management arrangements; pharmacy
			 services charge schedules; income receipts by source and purpose; and records
			 pertaining to all other reported costs of operation on the cost study report.
			 Other records shall be made available as necessary. Pertinent records shall be
			 maintained by the pharmacy provider for five (5) years from the date of filing
			 the corresponding cost report with the agency. Records in support of costs,
			 charges and payments for services and products are subject to inspection and
			 audit by the agency and the United States department of health and human
			 services. If a pharmacy provider does not maintain adequate records to support
			 cost related professional fee determination, the assigned professional fee to
			 that provider shall be suspended or reduced to the lowest fee determined for
			 all participating pharmacy providers that filed a cost report for the period of
			 inadequate records. Program payments to such providers shall be suspended or
			 reduced until the agency is assured that adequate records are maintained.
(c) Cost reports filed by pharmacy
			 providers shall reflect cost data provided in accordance with generally
			 accepted accounting principles, and in adequate detail to permit recasting of
			 the costs derived from the accounts ordinarily kept by the provider to
			 ascertain the costs pertinent to various facets of the total pharmacy
			 operation. The data, including source documentation, shall be accurate for the
			 appropriate reporting period and sufficient to support cost related
			 professional fee determination.
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 30-5-97 - Cost report data limitations and allowances for pharmacy services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Allowable costs
			 for cost related reimbursement and professional fee determination shall be
			 limited to those that arise from arms length transactions between unrelated
			 parties. Related parties shall exist when one (1) party of a transaction has
			 the ability to significantly influence another party to the extent that their
			 own separate interests may not be fully pursued.
(1) Costs not related to the provision of
			 pharmacy services shall be disallowed in the computation of the professional
			 fee. Related costs shall be allowed in total, fractionally allocated or limited
			 in the professional fee computation process per cost finding and allocation
			 techniques employed in the analysis of pharmacy cost reports.
(2) The following costs shall be disallowed,
			 fractionally allocated or limited in the analysis of cost reports:
(A) transactions between related parties are
			 disallowed as costs (i.e., non-arms length transactions), except that
			 compensation received by owners shall be limited to a reasonable amount and
			 accepted as an allowable cost if the owner actually performs functions directly
			 related to the provision of pharmacy services. The reasonable limitation of an
			 owner's compensation shall take into consideration the costs that would have
			 been incurred to pay a non-owner employee for performance of the duties related
			 to the provision of pharmacy services;
(B) costs deemed unreasonable by comparison
			 with similar costs incurred by similar pharmacy providers may be limited or
			 disallowed;
(C) non-competition
			 covenant expenses are not allowable as costs for professional fee
			 determination; and
(D) corporate
			 officer's fees shall be considered as owner's compensation and subject to the
			 limitations applicable to owner's compensation.
(3) Nothing in this section shall preclude
			 application of reasonable limitations on any other specific cost data items as
			 considered appropriate by the agency.
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 30-5-100 - Scope of dental services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Dental services
			 shall be covered for recipients receiving a Kan Be Healthy dental screening.
(1) Both a Kan Be Healthy medical screening
			 and a Kan Be Healthy dental screening shall be required for coverage of limited
			 orthodontia services, with the exception of emergency services.
(2) Prior authorization shall be required for
			 designated services.
(3) Prior
			 authorization shall be required for dental treatment plans estimated to exceed,
			 during a calendar year, the range maximum established by the secretary.
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 30-5-100a - Reimbursement for dental services

Current through Register Vol. 43, No. 28, July 11, 2024
Reimbursement shall be made on the basis of reasonable charges,
				except no fee shall be paid in excess of the range maximum. The range of
				charges shall provide the base for computations. The sum of payments per Kan Be
				Healthy recipient for dental services provided during each fiscal year
				beginning July 1, 1987, shall be limited to an amount specified by the
				secretary. Prior authorization shall be obtained before exceeding this payment
				limit. The effective date of this regulation shall be December 31, 1992.
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 30-5-102 - Scope of optometric and optical services

Current through Register Vol. 43, No. 28, July 11, 2024
Optometric and optical services shall be covered for medicaid
				recipients.
(a) These services shall
			 include the following:
(1) Optometric
			 examinations;
(2) medical
			 treatment pursuant to
			 K.S.A.
			 65-1501, and amendments thereto;
(3) grinding and edging lenses, and
			 assembling and dispensing eyeglasses; and
(4) providing optical materials. Optical
			 materials shall include the following:
(A)
			 Frames. The materials covered shall be only frames showing the manufacturer's
			 name on either the front or temple; and
(B) lenses. Only lenses meeting designated
			 standards shall be acceptable. For single lens replacement, the replacement
			 lens shall be made of quality similar to that of the remaining usable lens.
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 30-5-102a - Reimbursement for optometric and optical services

Current through Register Vol. 43, No. 28, July 11, 2024
Reimbursement for covered services shall be made on the basis
				of reasonable charges, except no fee shall be paid in excess of the range
				maximum. The range of charges shall provide the base for computations.
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 30-5-103 - Scope of podiatric services

Current through Register Vol. 43, No. 28, July 11, 2024
Podiatric services shall be covered for Kan Be Healthy program
				participants.
(a) Covered services
			 shall be diagnosis and the manual, medical, surgical or pharmaceutical
			 treatment of those parts of the body below the ankle. Diagnosis and treatment
			 of tendons and muscles of the lower leg as they relate to conditions of the
			 foot shall also be covered.
(b)
			 Surgery shall be limited to that performed on an outpatient basis.
(c) Routine foot care shall not be covered.
			 The effective date of this regulation shall be October 28, 1991.
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 30-5-103a - Reimbursement for podiatric services

Current through Register Vol. 43, No. 28, July 11, 2024
Reimbursement for covered services shall be made on the basis
				of reasonable charges, except that a fee in excess of the range maximum shall
				not be paid.
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 30-5-104 - Scope of psychological services

Current through Register Vol. 43, No. 28, July 11, 2024
Psychological services shall be covered for medicaid recipients
				when provided by clinical psychologists who are licensed by the behavioral
				sciences regulatory board.
(a)
			 Psychotherapy services shall be limited to 40 hours per calendar year for Kan
			 Be Healthy program participants.
(b) Psychotherapy services shall be limited
			 to 32 hours per calendar year for those not participating in the Kan Be Healthy
			 program.
(c) Psychotherapy shall
			 not be covered when provided concurrently by the same provider with both
			 partial hospitalization and case management.
(d) Special psychological services for Kan Be
			 Healthy program participants shall be rendered pursuant to a plan approved by
			 the Kansas department of social and rehabilitation services. The plan shall
			 require prior authorization, and shall not exceed a two-year period. Quarterly
			 progress reports shall be submitted to the department upon request.
(e) Inpatient hospital visits shall be
			 limited to those visits ordered by the recipient's physician, and shall not
			 exceed those allowable days for which the hospital is paid or would be paid if
			 there were no spenddown requirements.
(f) Visits to nursing facilities by the
			 psychologist as part of the plan of care shall be ordered by the recipient's
			 physician. Visits to intermediate care facilities for mental retardation shall
			 be limited to psychological testing and evaluation. Visits to nursing
			 facilities for mental health shall be limited to program consultation.
(g) Four hours of psychological
			 testing and evaluation shall be allowed every two consecutive calendar years
			 for medicaid program recipients regardless of provider except that Kan Be
			 Healthy program participants shall be allowed six hours. The effective date of
			 this regulation shall be July 1, 1991.
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 30-5-104a - Reimbursement for psychologists services

Current through Register Vol. 43, No. 28, July 11, 2024
Reimbursement shall be made on the basis of reasonable charges,
				except no fee shall be paid in excess of the range maximum. The range of
				charges shall provide the base for computations.
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 30-5-105 - Scope of hearing services

Current through Register Vol. 43, No. 28, July 11, 2024
Hearing services shall be covered for medicaid recipients.
(a) Medical diagnosis, audiological
			 testing, and the fitting and dispensing of hearing aids and appropriate
			 accessories shall be covered.
(b)
			 A medical diagnosis shall be made by an ear specialist or by a general
			 practitioner if an ear specialist is not easily available.
(c) Audiological testing shall be performed
			 by a physician or an audiologist.
(d) Fitting, dispensing, and follow-up shall
			 be performed by a hearing aid dealer.
(e) A hearing aid shall not be covered if the
			 physician indicates that a medical condition contraindicates the effectiveness
			 of an aid.
(f) This regulation
			 shall be effective on and after January 1, 2004.
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 30-5-105a - Reimbursement for hearing services

Current through Register Vol. 43, No. 28, July 11, 2024
Reimbursement for hearing services and for the fitting and
				dispensing of hearing aids, accessories, and follow-up service shall be made on
				the basis of reasonable charges, except that a fee in excess of the range
				maximum shall not be paid. The range of charges shall provide the base for
				computations.
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 30-5-106 - Scope of ambulance services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) General
			 provisions of coverage. Ambulance services shall be available to program
			 recipients. Services shall include the following:
(1) emergency transportation to a facility
			 where medical services will be rendered; and
(2) non-emergency transportation of a
			 recipient between the recipient's residence and a medical facility in the
			 recipient's local community or the nearest facility able to render the
			 medically necessary services, and transportation of a patient from one medical
			 facility to another medical facility when the original facility provides
			 inadequate services for treating the patient. Transportation under this
			 paragraph shall require prior authorization for designated services.
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 30-5-106a - Reimbursement for ambulance services

Current through Register Vol. 43, No. 28, July 11, 2024
Reasonable fees as related to customary charges shall be paid
				for ambulance services. However, no fee shall be paid in excess of the range
				maximum. The range of charges shall provide the base for computations.
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 30-5-107 - Scope of non-emergency medical transportation services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Non-commercial
			 transportation, including wheelchair transportation, to and from
			 medicaid-covered services, shall require prior authorization except for trips
			 to receive emergency care. Services shall be provided only when transportation
			 is not otherwise available to the recipient.
(b) The least expensive means of
			 transportation suitable to the recipient's medical need shall be used.
(c) Non-emergency medical
			 transportation for nursing facility residents shall not be covered.
(d) This regulation shall be effective on and
			 after July 1, 2003.