Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:033 - Payments for dual licensed pediatric facility services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 C.F.R.
				447.250,
				42 U.S.C.
				1396a, b, d
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 of Medical Assistance.
				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 dual licensed pediatric facility services.
Section 1. Dual Licensed Pediatric
			 Facilities. The cabinet shall make payment to participating providers on the
			 following basis:
(1) Method of reimbursement.
			 A dual licensed pediatric facility shall be reimbursed on the basis of rates
			 which are reasonable and adequate to meet the costs which must be incurred by
			 efficiently and economically operated facilities in order to provide care and
			 services in conformity with applicable state and federal laws, regulations and
			 quality and safety standards. The payment shall be prospective in nature with
			 no year end adjustment for routine costs of care. The nursing facility services
			 payment principles as specified in
			 907
			 KAR 1:025 shall apply except for variations specified
			 in this administrative regulation. The cost of ancillaries shall be excluded
			 from the cost when computing the payment rate and shall be reimbursed
			 separately (in accordance with nursing facility services payment principles)
			 with a retroactive settlement.
(2)
			 Composite rate. The facility(ies) shall be paid at a composite rate for a
			 nursing facility day of care. The following procedures shall be followed in
			 establishing the composite rate:
(a) The
			 allowable cost for nursing facility days of care shall be determined based on
			 prior year actual costs (or, in the case of a new facility, projected costs
			 which are determined by the cabinet to be reasonable).
(b) The department shall set a uniform rate
			 year (July 1 - June 30) for facilities in this class in the same manner as for
			 nursing facilities, with allowable costs trended to the beginning of the rate
			 year. The trended allowable costs shall then be indexed for the rate year;
			 however, there shall be no administratively established upper limit. Fixed or
			 capital costs shall be neither trended nor indexed. Since projected costs for
			 new facilities reflect the best estimate of actual costs, these shall also be
			 neither trended nor indexed.
(c)
			 Allowable costs shall be then compared with the number of projected (for new
			 facilities) bed days or the number of bed days based on the prior year's actual
			 utilization to arrive at a per diem composite rate.
(d) An occupancy factor of ninety (90)
			 percent shall be applied. In the case of new facilities the occupancy factor
			 shall be waived during the first full fiscal year of participation in the
			 program.
(e) The cost incentive and
			 investment factor (CIIF) schedule shall be applied to prospective current year
			 per diem cost in determination of a final prospective rate for each facility.
			 The CIIF schedule shall be transmitted to appropriate providers.
(f) The component (cost center) limitations
			 specified in
			 907
			 KAR 1:025 shall not be
			 applicable.