907 KAR 1:042.

Amounts payable for hospital furnished skilled nursing and intermediate care

facility services.

 

      RELATES TO: KRS

205.520

      STATUTORY AUTHORITY:

KRS 194A.030(2), 194A.050(1), 205.520(3), EO 2004-726

      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. (Recodified from 904 KAR 1:042,

5-2-86; Am. 14 Ky.R. 310; eff. 9-10-87; 15 Ky.R. 688; eff. 9-21-88.)