Nursing Facility and Adult Care Home Programs

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
  • Applied semi-annually
• 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

The following is a basic timeline for the rate setting process:

• End of February=Cost Reports submitted to KDADS
• Feb through early May=Desk Reviews completed
• Mid-late April=Proposed Rate Methodology published
• Mid-late April through mid-late May=Comment Period 
• End of May=Rates to State and MCOs
• Early-mid June=Final Methodology published*
• Early-mid June=July 1 rates sent to providers
• Throughout year=Field Audits conducted & cost report adjustments
• December 1=adjustments submitted to KMAP and MCO for Jan 1 rates
• Early December=January 1 rate adjustments sent to providers

Medicaid Enrollment Instructions and Application Fee

Disclosure of Ownership Control Interest Form

NF Provider Agreement Form

CMS 671 Form

NPI Form

W-9 Form

KS Organizational Provider Credentialing Recredentialing Application

Section 12 Attestation Consent and Release Form

Disclosure of Ownership Control Interest Form

NF Provider Agreement Form

W-9 Form

2017-2020 NF Medicaid Occupancy

January 2021 Ratelist

July 2020 Ratelist

January 2020 Ratelist

July 2019 Ratelist

January 2019 Ratelist

July 2018 Ratelist

January 2018 Ratelist

July 2017 Ratelist

January 2017 Ratelist

July 2016 Ratelist

January 2016 Ratelist

October 2015 Ratelist

Medicaid Enrollment Instructions and 2023 Application Fee

Disclosure of Ownership and Control Interest Form

ICF Provider Agreement Form

CMS 671 Form

NPI Form

W-9 Form

KS Organizational Provider Credentialing Recredentialing Application Form

Section 12 Attestation Consent and Release Form

Disclosure of Ownership and Control Interest Form

ICF Provider Agreement Form

W-9 Form