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RATE SETTING
For questions regarding rate setting please contact the Program Team via email: [email protected]

COST REPORTS:
For questions regarding cost reports please contact the Program Team via email: [email protected]

REBASING REQUESTS:
For questions regarding Real and Personal Property Fee (RPPF) rebasing requests please contact the Program Team via email: [email protected]

CONTINUING CARE RETIREMENT FACILITY (CCRC):
For questions regarding CCRC status or to submit decision letters, please contact the Program Team via email: [email protected]

NURSING FACILITY RESIDENT LISTING & RATE SCHEDULE PORTAL:
For questions regarding accessing your facility's most recent Case Mix Listing/Resident Listing, Rate Schedule, or Quality Outcomes Incentive Factors, send an email to [email protected] or call 785-228-6701 or 1-800-255-2309.

BILLING AND CLAIM QUESTIONS:
For questions regarding how to bill claims please contact KMAP Provider Customer Service at 1-800-933-6593 or https://portal.kmap-state-ks.us/PublicPage/Public/ProviderHome/.

Nursing Facility and Adult Care Home Programs

The KDADS Nursing Facility and Adult Care Home Program provides oversight of the following:

Medicaid Enrollment K.A.R. 30-10-1b
Change of Ownership K.A.R. 30-10-1b
Reimbursement/Rate Setting K.A.R. 129-10-18; K.A.R. 129-10-19; K.S.A. 75-5958
Review of Cost Report submissions K.A.R. 129-10-17
Quality Care Assessment K.A.R. 129-10-31; K.S.A. 75-7435
Rebasing Requests K.A.R. 129-10-18: K.A.R. 129-10-25
CMS Enforcement Actions SOM Chapter 7, 42 CFR 488
Ventilator Program K.A.R. 129-10-18 (i)
Promoting Excellent Alternatives in Kansas Nursing Homes (PEAK) SPA Incentive Factors
ICF-IID Gatekeeping K.A.R. 30-64-29, K.A.R. 30-63-21, K.S.A. 39-1801, 42 CFR 483.440

Implementing the Patient-Driven Payment Model (PDPM)

The Centers for Medicare and Medicaid Services (CMS) will soon eliminate the current Resource Utilization Group (RUGs) Medicare Part A Prospective Payment System (PPS) and replace it with a new PPS called the Patient-Driven Payment Model (PDPM). PDPM is intended to promote more specialized treatment of patients with more medically complex care needs, foster individual care planning, and to reduce the administrative burden for skilled nursing facilities.

In preparation for this conversion:

PDPM & MDS trainings were held for providers in June, August, September, October, and November
PDPM data will be available for full 2021-2023 base period for the SFY25 rates (effective July 1, 2024)
Kansas will not use an Optional State Assessment (OSA)
The Nursing component of PDPM will be used for Medicaid acuity adjustments
Below is a list of questions and answers gathered from the November 6, 2023, Kansas Medicaid PDPM training and a PDPM table.

IMPLEMENTED: The Patient-Driven Payment Model (PDPM)

Effective July 1, 2024, Kansas skilled nursing facility rates begin using the PDPM Medicare Part A Prospective Payment System (PPS). The Centers for Medicare and Medicaid Services’ (CMS) intention for the change to PDPM is to promote more specialized treatment of patients with more medically complex care needs, foster individual care planning, and reduce the administrative burden for skilled nursing facilities. For updates on the final rates for FY25 see the posting at the link below.

PDPM Training FAQ 10.6.23

PDPM Table

Rate Setting Process

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Basics of the Rate Setting Process
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
Timeline for the Rate Setting Process
The following is a basic timeline for the rate setting process: