Kan. Admin. Regs. § 129-10-210
Current through Register Vol. 44, No. 2, January 9, 2025
Section 129-10-210 - ICF-MR reimbursement(a)(1) Each provider with a current signed provider agreement shall be paid a per diem rate for services furnished to eligible Kansas medical assistance program clients. Payment shall be for the type of medical or health care required by the beneficiary as determined by either of the following: (A) The attending physician's or physician extender's certification upon admission; or (B) inspection of care and utilization review teams, as specified in K.A.R. 30-10-207. (2) Payment for services shall not exceed the type of care the provider is certified to provide under the Kansas medical assistance program. The type of care required by the beneficiary may be verified by the agency before and after payment. No payment shall be made for care or services determined to be the result of unnecessary utilization. (A) Initial eligibility for ICF-MR level services shall be determined based on a screening completed by the agency or its designee. (B) Continued eligibility for ICF-MR level services shall be determined by a professional review of the client by the utilization review team of the Kansas department on aging. (b) Payment for routine services and supplies, pursuant to K.A.R. 129-10-200, shall be included in the per diem reimbursement. No provider shall bill or be reimbursed for these services and supplies. (1) The following durable medical equipment, medical supplies, and other items and services shall be considered routine: (A) Alternating pressure pads and pumps; (C) bedpans, urinals, and basins; (D) bed rails, beds, mattresses, and mattress covers; (I) dressing items, including applicators, tongue blades, tape, gauze, bandages, adhesive bandages, pads and compresses, elasticized bandages, petroleum jelly gauze, cotton balls, slings, triangle bandages, and pressure pads; (J) emesis basins and bath basins; (K) enemas and enema equipment; (L) facial tissues and toilet paper; (O) gel pads or cushions; (Q) gloves, rubber or plastic; (S) heat lamps and examination lights; (U) ice bags and hot water bottles; (V) intermittent positive-pressure breathing (IPPB) machines; (W) IV stands and clamps; (X) laundry, including personal laundry; (AA) occupational therapy that exceeds the quantity of services covered by the Kansas medical assistance program; (BB) oxygen masks, stands, tubing, regulators, hoses, catheters, cannulae, and humidifiers; (CC) parenteral and enteral infusion pumps; (DD) patient gowns and bed linens; (EE) physical therapy that exceeds the quantity of services covered by the Kansas medical assistance program; (GG) sheepskins and foam pads; (HH) speech therapy that exceeds the quantity of services covered by the Kansas medical assistance program; (II) sphygmomanometers, stethoscopes, and other examination equipment; (KK) suction pumps and tubing; (LL) syringes and needles; (NN) traction apparatus and equipment; (OO) underpads and adult diapers, disposable and nondisposable; (QQ) water pitchers, glasses, and straws; (TT) irrigation solution, including water and normal saline; (UU) lotions, creams, and powders, including baby lotion, oil and powders; (VV) first aid-type ointments; (WW) skin antiseptics, including alcohol; (ZZ) over-the-counter analgesics; (AAA) two types of laxatives; (BBB) two types of stool softeners; (CCC) nutritional supplements; and (DDD) blood glucose monitors and supplies; (EEE) urinary supplies; and (FFF) nutritional therapy. (c) Payment for ancillary services, as defined in K.A.R. 129-10-200, shall be billed separately when the services are required. (d) Payment for a day service program for clients of an ICF-MR shall be included in the per diem reimbursement. Each provider shall allow the client or the client's guardian to select a day service program offered by another agency. The other agency shall be licensed and unencumbered by documented service deficiencies that would prevent the provider from becoming certified or remaining certified as a medicaid provider. The provider shall pay the actual cost of the service provided by the other agency, which shall not exceed 24 percent of the provider's approved per diem rate. Expenses incurred by the provider for this service shall be allowable expenses and may be reported on the provider's financial and statistical report. (e) Payment shall be limited to providers who accept, as payment in full, the amount paid in accordance with the fee structure established by the Kansas medical assistance program. Kan. Admin. Regs. § 129-10-210
Authorized by K.S.A. 2007 Supp. 75-7403 and 75-7412; implementing K.S.A. 2007 Supp. 75-7405 and 75-7408; effective Sept. 19, 2008.