In Kansas, nursing facilities are reimbursed for Medicaid resident care
using a facility specific, cost-based, prospective payment system. The
basics of the rate setting process include:
- Facility Specific Per-Diem Reimbursement Rates
- Per-diem reimbursement rates are based on individual facility costs and number of beds
- Costs are submitted annually by each facility via cost reports
- Prospective
- Costs are inflated using the Global Insight Skilled Nursing Facility Market Basket Index
- Base Year System
- Average of three base years were utilized in FY2023
- Cost Centers
- Costs are broken out into three (3) cost centers: Operating, Indirect Healthcare, and Direct Healthcare
- Upper Payment Limits are applied to each cost center and property/ownership costs (also known as Real and Personal Property Fees or RPPFs - see Rebasing Requests below)
- Add-ons
- Add-ons are applied for incentive performance; opportunities may include:
- PEAK
- Quality care assessment (bed assessment) tax
- Staff retention
- Staff turnover
- Case mix adjusted staffing ratio
- Medicaid Occupancy Rate of 65% or more
- Case Mix (acuity) Adjustments
- Rebasing Requests
- The Real and Personal Property Fee (RPPF) is the property component used in the calculation of a provider’s Medicaid per diem reimbursement rates, based on the historical cost report filings.
- A provider may submit a rebasing request at a later date to potentially increase their RPPF reimbursement per diem amount.
- As per K.A.R. 129-10-25(c)(1): “Rebase requests shall be reviewed to determine a revised real and personal property fee if the provider meets the following capital expenditure thresholds:
- (A) $25,000.00 for facilities with 50 or fewer beds; or
- (B) $50,000.00 for facilities with 51 or more beds.”
- Budget Adjustment
- Any adjustments requested by legislation