Kan. Admin. Regs. § 129-10-200 - Definitions for intermediate care facility for mentally retarded (ICF-MR)

(a) "Accrual basis of accounting" means that the revenue of the provider is reported in the period when the revenue is earned, regardless of when it is collected, and expenses are reported in the period in which the expenses are incurred, regardless of when the expenses are paid.

(b) "Adequate cost and other accounting information" means that the data, including source documentation, is accurate, current, and in sufficient detail to accomplish the purposes for which the data is intended. Source documentation, including petty cash payout memoranda and original payout 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 costs data, financial and statistical records shall be maintained in a manner that is consistent from one period to another. This requirement shall not preclude a beneficial change in accounting procedures if there is a compelling reason to effect a change of procedures.

(c) "Agency" means the Kansas department of social and rehabilitation services.

(d) "Ancillary services and other medically necessary services" mean those special services or supplies for which charges are made in addition to those for routine services.

(e) "Approved staff educational activities" means formally organized or planned programs of study usually engaged in by providers in order to enhance the quality of client care in an ICF-MR. These activities shall be licensed when required by state law.

(f) A "client day" means that period of service rendered to a client between the 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 client who was not in the home. The census-taking hours consist of 24 hours beginning at midnight.

(g) "Common ownership" means that any individual or an organization holds five percent or more ownership or equity of the ICF-MR and of the facility or organization serving the ICF-MR.

(h) "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.

(i) "Cost finding" means the process of recasting the data derived from the accounts ordinarily kept by a provider to ascertain costs of the various types of services rendered.

(j) "Costs related to client 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 client care facilities and activities. Specific items of expense shall be limited pursuant to K.A.R. 30-10-218, K.A.R. 30-10-219, K.A.R. 30-10-220, K.A.R. 30-10-221, K.A.R. 30-10-222, K.A.R. 30-10-223, K.A.R. 30-10-224, and K.A.R. 30-10-225.

(k) "Costs not related to client care" means costs that are not appropriate or not necessary and proper in developing and maintaining the ICF-MR operation and activities. These costs shall not be allowable in computing reimbursable costs.

(l) "Extra care" means temporary care required by a client that takes more time, services, and supplies than the care provided an average ICF-MR client. Extra care shall require prior authorization before reimbursement.

(m) "General accounting rules" mean the generally accepted accounting principles as established by the American institute of certified public accountants except as otherwise specifically indicated by ICF-MR program policies and regulations. Adoption of any of these principles shall not supersede any specific regulations and policies of the ICF-MR program.

(n) "Inadequate care" means any act or failure to take action that potentially could be physically or emotionally harmful to a recipient.

(o) "Inspection of care review of intermediate care facilities for the mentally retarded" means a yearly, clientoriented review of only Kansas medical assistance program clients, conducted by a team from the Kansas department on aging consisting of a nurse, a social worker, and a medical doctor, to determine whether those clients' needs are being met.

(p) "Intermediate care facility for the mentally retarded" and "ICF-MR" mean a facility that has met state licensure standards and meets the following conditions:

(1) Is primarily for the diagnosis, treatment, or habilitation of the mentally retarded or persons with related conditions; and

(2) provides, in a protected residential setting, ongoing evaluation, planning, 24-hour supervision, coordination, and integration of health or habilitative services to help each individual function at that person's greatest ability.

(q) "Levels-of-care model" means a residential model with five residential facility levels established by serviceintensity categories and size of facilities, according to the following:

(1) Small facility: four through eight beds;

(2) medium facility: nine through 16 beds; and

(3) large facility: more than 16 beds.

(r) "Mental retardation" means subaverage general intellectual functioning that originates in the developmental period and is associated with impairment in adaptive behavior, as defined by the 1983 revision of "classification in mental retardation," authored by the American association of mental deficiency.

(s) "Net cost of educational activities" means the cost of approved educational activities less any grants, specific donations, or reimbursements of tuition.

(t) "Nonworking owners" means any individual or organization who has an interest of at least five percent in the provider and does not perform a client-related function for the ICF-MR.

(u) "Nonworking related party" means any related party, as defined in this regulation, who does not perform a client-related function for the ICF-MR.

(v) "Organization costs" mean those costs directly incidental to the creation of the corporation or other form of business. These costs are intangible assets in that they represent expenditures for rights and privileges that have value to the enterprise. The services inherent in organization costs extend over more than one accounting period and shall be amortized over a period of not less than 60 months from the date of incorporation.

(w) "Owner-related party compensation" means salaries, drawings, consulting fees, or other payments paid to or on behalf of any owner with an interest of at least five percent 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.

(x) "Persons with related conditions" means individuals who have a severe, chronic disability that meets all of the following conditions:

(1) Is attributable to either of the following:

(A) Cerebral palsy or epilepsy; or

(B) any other condition, other than mental illness, found to be closely related to mental retardation because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of mentally retarded persons and requires treatment or services similar to those required for these persons;

(2) is manifested before the person attains the age of 22;

(3) is likely to continue indefinitely; and

(4) results in substantial functional limitations in three or more of the following areas of major life activity:

(A) Self-care;

(B) understanding and use of language;

(C) learning;

(D) mobility;

(E) self-direction; and

(F) capacity for independent living.

(y) "Physician extender" means a person who is registered as a physician's assistant or licensed advanced registered nurse practitioner in the jurisdiction where the service is provided and who is working under supervision as required by law or state regulation.

(z) "Plan of care" means a document that states the need for care, the estimated length of the program, the methodology to be used, and the expected results.

(aa) "Projected cost report" means a cost report submitted to the agency by a provider prospectively for a 12-month period. The projected cost report is based on an estimate of the costs, revenues, resident days, and other financial data for the 12-month period.

(bb) "Projection status" means that a provider has been assigned a previous provider's rate for a set period or is allowed to submit a projected cost report. The provider shall submit a historic cost report at the end of the projection period to be used for a settlement of the interim rates and to determine a prospective rate.

(cc) "Provider" means the operator of the ICF-MR specified in the provider agreement.

(dd) "Psychological evaluations or reevaluations in intermediate care facilities for the mentally retarded" means a review of the previous pertinent psychological material to determine if the evaluation is consistent with the client's present status.

(ee) "Related parties" means two or more parties with a relationship in which one party has the ability to influence another party to the transaction such that one or more of the transacting parties might fail to pursue its own separate interests fully. This term 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. Transactions or agreements that are illusory or a sham shall not be recognized.

(ff) "Related to the ICF-MR" means that the facility, to a significant extent, is associated or affiliated with, has control of, or is controlled by, the organization furnishing the services, facilities, or supplies.

(gg) "Representative" means legal guardian, conservator, or representative payee as designated by the social security administration, or any person who is designated in writing by the client to manage the client's personal funds and is willing to accept the designation.

(hh) "Routine services and supplies" mean services and supplies that are commonly stocked for use by or provided to any client. These services and supplies shall be included in the provider's cost report.

(1) Routine services and supplies may include the following:

(A) All general nursing services;

(B) items that are furnished routinely to all clients;

(C) items stocked at nursing stations in large quantities and either distributed or utilized individually in small quantities;

(D) routine items covered by the pharmacy program if ordered by a physician for occasional use; and

(E) items that are used by individual clients but are reusable and expected to be available in a facility.

(2) Routine services and supplies shall be distinguished from nonroutine services and supplies that are ordered or prescribed by a physician on an individual or scheduled basis. Medication ordered may be considered nonroutine if either of the following conditions is met:

(A) The medication is not a stock item of the facility.

(B) The medication is a stock item with unusually high usage by the individual for whom prior authorization may be required.

(3) Routine services and supplies shall not include ancillary services and other medically necessary services as defined in subsection (d) and also shall not include those services and supplies the client must provide.

(4) Reasonable transportation expenses necessary to secure routine and nonemergency medical services shall be considered reimbursable through the medicaid per diem rate.

(ii) "Working trial balance" means the summary from the provider's general ledger that was used in completing the cost report. This summary shall contain the account number, a description of the account, the amount of the account, and the line of the cost report specifying the account.

Notes

Kan. Admin. Regs. § 129-10-200

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.