RELATES TO:
KRS
205.520
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 for Medical Assistance in accordance
with Title XIX of the Social Security Act.
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 hospital furnished skilled nursing facility and intermediate care facility
services.
Section 1. Reimbursement for
Hospital Furnished Skilled Nursing and Intermediate Care Services. To qualify
for reimbursement, any hospital(s) providing skilled nursing facility services
and intermediate care facility services must have in effect an agreement with
the secretary, Department of Health and Human Services, pursuant to Section
1883 of the Social Security Act, or be dual licensed (as provided for in KRS
Chapter 216B) to provide skilled nursing and/or intermediate care services in
an acute care hospital bed. Such hospital(s) shall be paid for swing-bed
services provided pursuant to Section 1883 of the Act at a rate equal to the
average rate per patient-day paid for routine services during the previous
calendar year under the state's Title XIX plan to skilled nursing and
intermediate care facilities, respectively, located in the state in which the
hospital is located; for dual licensed skilled nursing or intermediate care
services, such hospital shall be paid at a rate equal to the hospital based
skilled nursing facility upper limit or intermediate care facility upper limit,
as appropriate for the level of care provided, in effect at the time the
service is provided. The reasonable cost of ancillary services shall be
determined in the same manner as the reasonable cost of ancillary services
provided for inpatient hospital services; covered ancillary services shall be
the same as for all other skilled nursing and intermediate care
facilities.
Section 2. Rate Review
and Adjustment. Any participating facility may appeal its established rates
using either the customary appeals mechanism for providers of hospital
inpatient services or for providers of skilled nursing and intermediate care
facility services.
Section 3.
Eligibility for Reimbursement. A facility shall be eligible for reimbursement
only when considered to be a participating vendor, and reimbursement shall be
made only for covered services rendered eligible Title XIX recipients meeting
patient status as determined in accordance with applicable administrative
regulations.
Section 4. The
amendments to this administrative regulation shall be effective with regard to
services provided on or after July 1, 1987.