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

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.

Below is a list of questions and answers gathered from the November 6, 2023, Kansas Medicaid PDPM training and a PDPM table:

Rate Setting Process

FY25 rates can be found here: https://sos.ks.gov/publications/Register/Volume-43/Issues/Issue-25/06-20-24-52235.html

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:

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*
- The final nursing facility methodology and rates are posted in the Kansas Register on the Secretary of State’s website. FY24 rates can be found at the Kansas Secretary of State website.
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

Forms and documents related to rates, cost report data, and change of ownership/revalidation are below:

Important Updates:

Department for Aging and Disability Services

Programs Finder

HoW DO I…

Request…

Appliance Pick Up

Nursing Facility and Adult Care Home Programs

Implemented: The Patient-Driven Payment Model (PDPM)

Rate Setting Process

Basics of the Rate Setting Process

Timeline for the Rate Setting Process

Nursing Facility (NF) and Nursing Facility for Mental Health (NFMH)

Documents

Change of Ownership

Documents

Revalidation

Documents

Nursing Facility Medicaid / MediKan Rate Lists

Documents

Historical Ratelists & Occupancy Reports

Documents

Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID)

Documents

Change of Ownership

Documents

Revalidation

Documents

Psychiatric Residential Treatment Facilities (PRTF)

Documents