Publications iconKansas Register

Volume 40 - Issue 15 - April 15, 2021

State of Kansas

Department for Aging and Disability Services
Department of Health and Environment
Division of Health Care Finance

Notice of Proposed Nursing Facility Medicaid
Rates for State Fiscal Year 2022;
Methodology for Calculating Rates, and Rate Justifications;
Response to Written Comments;
Notice of Intent to Amend the Medicaid State Plan

Under the Medicaid program, 42 U.S.C. 1396 et seq., the State of Kansas pays nursing facilities, nursing facilities for mental health, and hospital long-term care units (hereafter collectively referred to as nursing facilities) a daily rate for care provided to residents who are eligible for Medicaid benefits. The Secretary of Aging and Disability Services administers the nursing facility program, which includes hospital long-term care units, and the nursing facility for mental health program. The Secretary acts on behalf of the Kansas Department of Health and Environment Division of Health Care Finance (DHCF), the single state Medicaid agency.

As required by 42 U.S.C. 1396a(a)(13), as amended by Section 4711 of the Balanced Budget Act of 1997, P.L. No. 105-33, 101 Stat. 251, 507-08 (August 5, 1997), the Secretary of the Kansas Department for Aging and Disability Services (KDADS) is publishing the proposed Medicaid per diem rates for Medicaid-certified nursing facilities for State Fiscal Year 2022, the methodology underlying the establishment of the nursing facility rates, and the justifications for those rates. KDADS and DHCF are also providing notice of the state’s intent to submit amendments to the Medicaid State Plan to the U. S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) on or before September 30, 2021.

I. Methodology Used to Calculate Medicaid Per Diem Rates for Nursing Facilities.

In general, the state uses a prospective, cost-based, facility-specific rate-setting methodology to calculate nursing facility Medicaid per diem rates, including the rates listed in this notice. The state’s rate-setting methodology is contained primarily in the following described documents and authorities and in the exhibits, attachments, regulations, or other authorities referenced in them:

A. The following portions of the Kansas Medicaid State Plan maintained by DHCF are being revised:

  1. Attachment 4.19D, Part I, Subpart C, Exhibit C-1, inclusive;

The text of the portions of the Medicaid State Plan identified above in section IA.1, but not the documents, authorities and the materials incorporated therein by reference, is reprinted in this notice. The Medicaid State Plan provisions set out in this notice appears in the version which the state currently intends to submit to CMS on or before September 30, 2021. The Medicaid State Plan amendment that the state ultimately submits to CMS may differ from the version contained in this notice.

Copies of the documents and authorities containing the state’s rate-setting methodology are available upon written request. A request for copies will be treated as a request for public records under the Kansas Open Records Act, K.S.A. 45-215 et seq. The state may charge a fee for copies, in accordance with Executive Order 18-05. Written requests for copies should be sent to:

Secretary of Aging and Disability Services
New England Building, Second Floor
503 S. Kansas Ave.
Topeka, KS 66603-3404
Fax: 785-296-0767

A.1 Attachment 4.19D, Part I, Subpart C, Exhibit C-1: Methods and Standards for Establishing Payment Rates for Nursing Facilities

Under the Medicaid program, the State of Kansas pays nursing facilities (NF), nursing facilities for mental health (NFMH), and hospital long-term care units (hereafter collectively referred to as nursing facilities) a daily rate for care provided to residents who are eligible for Medicaid benefits. The narrative explanation of the nursing facility reimbursement formula is divided into 11 sections. The sections are: Cost Reports, Rate Determination, Quarterly Case Mix Index Calculation, Resident Days, Inflation Factors, Upper Payment Limits, Quarterly Case Mix Rate Adjustment, Real and Personal Property Fee, Incentive Factors, Rate Effective Date, and Retroactive Rate Adjustments.

1) Cost Reports

The Nursing Facility Financial and Statistical Report (MS2004) is the uniform cost report. It is included in Kansas Administrative Regulation (K.A.R.) 129-10-17. It organizes the commonly incurred business expenses of providers into three reimbursable cost centers (operating, indirect health care, and direct health care). Ownership costs (i.e., mortgage interest, depreciation, lease, and amortization of leasehold improvements) are reported but reimbursed through the real and personal property fee. There is a non-reimbursable/non-resident related cost center so that total operating expenses can be reconciled to the providers’ accounting records.

All cost reports are desk reviewed by agency auditors. Adjustments are made, when necessary, to the reported costs in arriving at the allowable historic costs for the rate computations.

Calendar Year End Cost Reports

All providers that have operated a facility for 12 or more months on December 31 shall file a calendar year cost report. The requirements for filing the calendar year cost report are found in K.A.R. 129-10-17.

When a non-arms length or related party change of provider takes place or an owner of the real estate assumes the operations from a lessee, the facility will be treated as an ongoing operation. In this situation, the related provider or owner shall be required to file the calendar year end cost report. The new operator or owner is responsible for obtaining the cost report information from the prior operator for the months during the calendar year in which the new operator was not involved in running the facility. The cost report information from the old and new operators shall be combined to prepare a 12-month calendar year end cost report.

Projected Cost Reports

The filing of projected cost reports are limited to: 1) newly constructed facilities; 2) existing facilities new to the Medicaid program; or 3) a provider re-entering the Medicaid program that has not actively participated or billed services for 24 months or more. The requirements are found in K.A.R. 129-10-17.

2) Rate Determination

Rates for Existing Nursing Facilities

Medicaid rates for Kansas NFs are determined using a prospective, facility-specific rate-setting system. The rate is determined from the base cost data submitted by the provider. The current base cost data is the combined calendar year cost data from each available report submitted by the current provider during 2016, 2017, and 2018.

If the current provider has not submitted a calendar year report during the base cost data period, the cost data submitted by the previous provider for that same period will be used as the base cost data. Once the provider completes their first 24 months in the program, their first calendar year cost report will become the provider’s base cost data.

The allowable expenses are divided into three cost centers. The cost centers are Operating, Indirect Health Care and Direct Health Care. They are defined in K.A.R. 129-10-18.

The allowable historic per diem cost is determined by dividing the allowable resident related expenses in each cost center by resident days. Before determining the per diem cost, each year’s cost data is adjusted from the midpoint of that year to December 31, 2018. The resident days and inflation factors used in the rate determination will be explained in greater detail in the following sections.

The inflated allowable historic per diem cost for each cost center is then compared to the cost center upper payment limit. The allowable per diem rate is the lesser of the inflated allowable historic per diem cost in each cost center or the cost center upper payment limit. Each cost center has a separate upper payment limit. If each cost center upper payment limit is exceeded, the allowable per diem rate is the sum of the three cost center upper payment limits. There is also a separate upper payment limit for owner, related party, administrator, and co-administrator compensation. The upper payment limits will be explained in more detail in a separate section.

The case mix of the residents adjusts the Direct Health Care cost center. The reasoning behind a case mix payment system is that the characteristics of the residents in a facility should be considered in determining the payment rate. The idea is that certain resident characteristics can be used to predict future costs to care for residents with those same characteristics. For these reasons, it is desirable to use the case mix classification for each facility in adjusting provider rates.

There are add-ons to the allowable per diem rate. The add-ons consist of the incentive factor, the real and personal property fee, and per diems to cover costs not included in the cost report data. The incentive factor and real and personal property fee are explained in separate sections of this exhibit. The rate components are explained in separate subparts of Attachment 4.19D of the State Plan. The add-ons plus the allowable per diem rate equal the total per diem rate.

Rates for New Construction and New Facilities (New Enrollment Status)

The per diem rate for newly constructed nursing facilities, or new facilities to the Kansas Medical Assistance program shall be based on a projected cost report submitted in accordance with K.A.R. 129-10-17.

The cost information from the projected cost report and the first historic cost report covering the projected cost report period shall be adjusted to December 31, 2018. This adjustment will be based on the IHS Global Insight, National Skilled Nursing Facility Market Basket Without Capital Index (IHS Index). The IHS indices listed in the latest available quarterly publication will be used to adjust the reported cost data from the midpoint of the cost report period to December 31, 2018. The provider shall remain in new enrollment status until the base data period is reestablished. During this time, the adjusted cost data shall be used to determine all rates for the provider. Any additional factor for inflation that is applied to cost data for established providers shall be applied to the adjusted cost data for each provider in new enrollment status.

Rates for Facilities Recognized as a Change of Provider (Change of Provider Status)

The payment rate for the first 24 months of operation shall be based on the base cost data of the previous owner or provider. This base cost data shall include data from each calendar year cost report that was filed by the previous provider from 2016-2018. If base cost data is not available, the most recent calendar year data for the previous provider shall be used. Beginning with the first day of the 25th month of operation the payment rate shall be based on the historical cost data for the first calendar year submitted by the new provider.

All data used to set rates for facilities recognized as a change-of-provider shall be adjusted to December 31, 2018. This adjustment will be based on the IHS Index. The IHS indices listed in the latest available quarterly publication will be used to adjust the reported cost data from the midpoint of the cost report period to December 31, 2018. The provider shall remain in change-of-provider status until the base data period is reestablished. During this time, the adjusted cost data shall be used to determine all rates for the provider. Any additional factor for inflation that is applied to cost data for established providers shall be applied to the adjusted cost data for each provider in change of provider status.

Rates for Facilities Re-entering the Program (Reenrollment Status)

The per diem rate for each provider reentering the Medicaid program shall be determined from a projected cost report if the provider has not actively participated in the program by the submission of any current resident service billings to the program for 24 months or more. The per diem rate for all other providers reentering the program shall be determined from the base cost data filed with the agency or the most recent cost report filed preceding the base cost data period.

All cost data used to set rates for facilities reentering the program shall be adjusted to December 31, 2018. This adjustment will be based on the IHS Index. The IHS indices listed in the latest available quarterly publication will be used to adjust the reported cost data from the midpoint of the cost report period to December 31, 2018. The provider shall remain in reenrollment status until the base data period is reestablished. During this time, the adjusted cost data shall be used to determine all rates for the provider. Any additional factor for inflation that is applied to cost data for established providers shall be applied to the adjusted cost data for each provider in reenrollment status.

3) Quarterly Case Mix Index Calculation

Providers are required to submit to the agency the uniform assessment instrument, which is the Minimum Data Set (MDS), for each resident in the facility. The MDS assessments are maintained in a computer database.

The Resource Utilization Groups-III (RUG-III) Version 5.20, 34 group, index maximizer model is used as the resident classification system to determine all case- mix indices, using data from the MDS submitted by each facility. Standard Version 5.20 (Set D01) case mix indices developed by the Centers for Medicare and Medicaid Services (CMS) shall be the basis for calculating facility average case mix indices to be used to adjust the Direct Health Care costs in the determination of upper payment limits and rate calculation. Resident assessments that cannot be classified will be assigned the lowest CMI for the State.

Each resident in the facility on the first day of each calendar quarter with a completed and submitted assessment shall be assigned a RUG-III 34 group calculated on the resident’s most current assessment available on the first day of each calendar quarter. This RUG-III group shall be translated to the appropriate CMI. From the individual resident case mix indices, three average case mix indices for each Medicaid nursing facility shall be determined four times per year based on the assessment information available on the first day of each calendar quarter.

The facility-wide average CMI is the simple average, carried to four decimal places, of all resident case mix indices. The Medicaid-average CMI is the simple average, carried to four decimal places, of all indices for residents, including those receiving hospice services, where Medicaid is known to be a per diem payer source on the first day of the calendar quarter or at any time during the preceding quarter. The private-pay/other average CMI is the simple average, carried to four decimal places, of all indices for residents where neither Medicaid nor Medicare were known to be the payer source on the first day of the calendar quarter or at any time during the preceding quarter. Case mix indices for ventilator-dependent residents for whom additional reimbursement has been determined shall be excluded from the average CMI calculations.

Rates will be adjusted for case mix twice annually using case mix data from the two quarters preceding the rate effective date. The case mix averages used for the rate adjustments will be the simple average of the case mix averages for each quarter. The resident listing cut-off for calculating the average CMIs for each quarter will be the first day of the quarter. The following are the dates for the resident listings and the rate periods in which the average Medicaid CMIs will be used in the semi-annual rate-setting process.

Rate Effective Date: Cut-Off Dates for Quarterly CMI:
July 1 January 1 and April 1
January 1 July 1 and October 1

The resident listings will be distributed to providers prior to the dates the semi-annual case mix adjusted rates are determined. This will allow the providers time to review the resident listings and make corrections before they are notified of new rates. The cut off schedule may need to be modified in the event accurate resident listings and Medicaid CMI scores cannot be obtained from the MDS database.

4) Resident Days

Facilities with 60 beds or less

For facilities with 60 beds or less, the allowable historic per diem costs for all cost centers are determined by dividing the allowable resident related expenses by the actual resident days during the cost report period(s) used to establish the base cost data.

Facilities with more than 60 beds

For facilities with more than 60 beds, the allowable historic per diem costs for the Direct Health Care cost center and for food and utilities in the Indirect Health Care cost center are determined by dividing the allowable resident related expenses by the actual resident days during the cost report period(s) used to establish the base cost data. The allowable historic per diem cost for the Operating and Indirect Health Care Cost Centers less food and utilities is subject to an 85% minimum occupancy rule. For these providers, the greater of the actual resident days for the cost report period(s) used to establish the base cost data or the 85% minimum occupancy based on the number of licensed bed days during the cost report period(s) used to establish the base cost data is used as the total resident days in the rate calculation for the Operating cost center and the Indirect Health Care cost center less food and utilities. All licensed beds are required to be certified to participate in the Medicaid program.

There are two exceptions to the 85% minimum occupancy rule for facilities with more than 60 beds. The first is that it does not apply to a provider who is allowed to file a projected cost report for an interim rate. Both the rates determined from the projected cost report and the historic cost report covering the projected cost report period are based on the actual resident days for the period.

The second exception is for the first cost report filed by a new provider who assumes the rate of the previous provider. If the 85% minimum occupancy rule was applied to the previous provider’s rate, it is also applied when the rate is assigned to the new provider. However, when the new provider files a historic cost report for any part of the first 12 months of operation, the rate determined from the cost report will be based on actual days and not be subject to the 85% minimum occupancy rule for the months in the first year of operation. The 85% minimum occupancy rule is then reapplied to the rate when the new provider reports resident days and costs for the 13th month of operation and after.

5) Inflation Factors

Inflation will be applied to the allowable reported costs from the calendar year cost report(s) used to determine the base cost data from the midpoint of each cost report period to December 31, 2018. The inflation will be based on the IHS Global Insight, CMS Nursing Home without Capital Market Basket index.

The IHS Global Insight, CMS Nursing Home without Capital Market Basket Indices listed in the latest available quarterly publication will be used to determine the inflation tables for the payment schedules processed during the payment rate period. This may require the use of forecasted factors in the inflation table. The inflation tables will not be revised until the next payment rate period.

The inflation factor will not be applied to the following costs:

  1. Owner/Related Party Compensation
  2. Interest Expense
  3. Real and Personal Property Taxes

6) Upper Payment Limits

There are three types of upper payment limits that will be described. One is the owner/related party/administrator/co-administrator limit. The second is the real and personal property fee limit. The last type of limit is an upper payment limit for each cost center. The upper payment limits are in effect during the payment rate period unless otherwise specified by a State Plan amendment.

Owner/Related Party/Administrator/Co-Administrator Limits

Since salaries and other compensation of owners are not subject to the usual market constraints, specific limits are placed on the amounts reported. First, amounts paid to non-working owners and directors are not an allowable cost. Second, owners and related parties who perform resident related services are limited to a salary chart based on the Kansas Civil Service classifications and wages for comparable positions. Owners and related parties who provide resident related services on less than a full time basis have their compensation limited by the percent of their total work time to a standard work week. A standard work week is defined as 40 hours. The owners and related parties must be professionally qualified to perform services which require licensure or certification.

The compensation paid to owners and related parties shall be allocated to the appropriate cost center for the type of service performed. Each cost center has an expense line for owner/related party compensation. There is also a cost report schedule titled, “Statement of Owners and Related Parties.” This schedule requires information concerning the percent of ownership (if over five percent), the time spent in the function, the compensation, and a description of the work performed for each owner and/or related party. Any salaries reported in excess of the Kansas Civil Service based salary chart are transferred to the Operating cost center where the excess is subject to the Owner/Related Party/Administrator/Co-Administrator per diem compensation limit.

Schedule C is an array of non-owner administrator and co-administrator salaries. The schedule includes the calendar year 2018 historic cost reports in the database from all active nursing facility providers. The salary information in the array is not adjusted for inflation. The per diem data is calculated using an 85% minimum occupancy level for those providers in operation for more than 12 months with more than 60 beds. Schedule C for the owner/related party/administrator/co-administrator per diem compensation limit is the first schedule run during the rate setting.

Schedule C is used to set the per diem limitation for all non-owner administrator and co-administrator salaries and owner/related party compensation in excess of the civil service-based salary limitation schedule. The per diem limit for a 50-bed or larger home is set at the 90th percentile on all salaries reported for non-owner administrators and co-administrators. A limitation table is then established for facilities with less than 50 beds. This table begins with a reasonable salary per diem for an administrator of a 15-bed or less facility. The per diem limit for a 15-bed or less facility is inflated based on the State of Kansas annual cost of living allowance for classified employees for the rate period. A linear relationship is then established between the compensation of the administrator of the 15-bed facility and the compensation of the administrator of a 50-bed facility. The linear relationship determines the per diem limit for the facilities between 15 and 50 beds.

The per diem limits apply to the non-owner administrators and co-administrators and the compensation paid to owners and related parties who perform an administrative function or consultant type of service. The per diem limit also applies to the salaries in excess of the civil service-based salary chart in other cost centers that are transferred to the operating cost center.

Real and Personal Property Fee Limit

The property component of the reimbursement methodology consists of the real and personal property fee that is explained in more detail in a later section. The upper payment limit is 105% of the median determined from a total resident day-weighted array of the property fees in effect April 1, 2021.

Cost Center Upper Payment Limits

Schedule B is an array of all per diem costs for each of the three cost centers-Operating, Indirect Health Care, and Direct Health Care. The schedule includes a per diem determined from the base cost data from all active nursing facility providers. Projected cost reports are excluded when calculating the limit.

The per diem expenses for the Operating cost center and the Indirect Health Care cost center less food and utilities are subject to the 85% minimum occupancy for facilities over 60 beds. All previous desk review and field audit adjustments are considered in the per diem expense calculations. The costs are adjusted by the owner/related party/administrator/co-administrator limit.

Prior to the Schedule B arrays, the cost data on certain expense lines is adjusted from the midpoint of the cost report period to December 31, 2018. This will bring the costs reported by the providers to a common point in time for comparisons. The inflation will be based on the IHS Global Insight, CMS Nursing Home Without Capital Market Basket Index.

Certain costs are exempt from the inflation application when setting the upper payment limits. They include owner/related party compensation, interest expense, and real and personal property taxes.

Schedule B is the median compilations. These compilations are needed for setting the upper payment limit for each cost center. The median for each cost center is weighted based on total resident days. The upper payment limits will be set using the following:

Operating 110% of the median
Indirect Health Care 115% of the median
Direct Health Care 130% of the median

Direct Health Care Cost Center Limit

The Kansas reimbursement methodology has a component for a case mix payment adjustment. The Direct Health Care cost center rate component and upper payment limit are adjusted by the facility average CMI.

For the purpose of setting the upper payment limit in the Direct Health Care cost center, the facility cost report period CMI and the statewide average CMI will be calculated. The facility cost report period CMI is the resident day-weighted average of the quarterly facility-wide average case mix indices, carried to four decimal places. The quarters used in this average will be the quarters that most closely coincide with the financial and statistical reporting period. For example, a 01/01/20XX-12/31/20XX financial and statistical reporting period would use the facility-wide average case mix indices for quarters beginning 04/01/XX, 07/01/XX, 10/01/XX and 01/01/XY. The statewide average CMI is the resident day-weighted average, carried to four decimal places of the facility cost report period case mix indices for all Medicaid facilities.

The statewide average CMI and facility cost report period CMI are used to set the upper payment limit for the Direct Health Care cost center. The limit is based on all facilities with a historic cost report in the database. There are three steps in establishing the base upper payment limit.

The first step is to normalize each facility’s inflated Direct Health Care costs to the statewide average CMI. This is done by dividing the statewide average CMI for the cost report year by the facility’s cost report period CMI, then multiplying this answer by the facility’s inflated costs. This step is repeated for each cost report year for which data is included in the base cost data.

The second step is to determine per diem costs and array them to determine the median. The per diem cost is determined by dividing the total of each provider’s inflated case mix adjusted base direct health care costs by the total days provided during the base cost data period. The median is located using a day-weighted methodology. That is, the median cost is the per diem cost for the facility in the array at which point the cumulative total of all resident days first equals or exceeds half the number of the total resident days for all providers. The facility with the median resident day in the array sets the median inflated direct health care cost. For example, if there are eight million resident days, the facility in the array with the 4 millionth day would set the median.

The final step in calculating the base Direct Health Care upper payment limit is to apply the percentage factor to the median cost. For example, if the median cost is $80 and the upper payment limit is based on 130% of the median, then the upper payment limit for the statewide average CMI would be $104 (D=130% x $80).

7) Quarterly Case Mix Rate Adjustment

The allowance for the Direct Health Care cost component will be based on the average Medicaid CMI in the facility. The first step in calculating the allowance is to determine the Allowable Direct Health Care Per Diem Cost. This is the lesser of the facility’s per diem cost from the base cost data period or the Direct Health Care upper payment limit. Because the direct health care costs were previously adjusted for the statewide average CMI, the Allowable Direct Health Care Per Diem Cost corresponds to the statewide average CMI.

The next step is to determine the Medicaid acuity adjusted allowable Direct Health Care cost. The facility’s Medicaid CMI is determined by averaging the facility average Medicaid CMI from the two quarters preceding the rate effective date. The facility’s Medicaid CMI is then divided by the statewide average CMI for the cost data period. Finally, this result, is then multiplied by the Allowable Direct Health Care per diem cost. The result is referred to as the Medicaid Acuity Adjustment.

The Medicaid Acuity Adjustment is calculated semi-annually to account for changes in the Medicaid CMI. To illustrate this calculation, take the following situation: The facility’s direct health care per diem cost is $80.00, the Direct Health Care per diem limit is $104.00, and these are both tied to a statewide average CMI of 1.000, and the facility’s current Medicaid CMI is 0.9000. Since the per diem costs are less than the limit the Allowable Direct Heath Care Cost is $80.00, and this is matched with the statewide average CMI of 1.0000. To calculate the Medicaid Acuity Adjustment, first divide the Medicaid CMI by the statewide average CMI, then multiply the result by the Allowable Direct Health Care Cost. In this case that would result in $72.00 (0.9000/1.0000 x $80.00). Because the facility’s current Medicaid CMI is less than the statewide average CMI the Medicaid Acuity Adjustment moves the direct health care per diem down proportionally. In contrast, if the Medicaid CMI for the next semi-annual adjustment rose to 1.1000, the Medicaid Acuity Adjustment would be $88.00 (1.1000/1.0000 x $80.00). Again the Medicaid Acuity Adjustment changes the Allowable Direct Health Care Per Diem Cost to match the current Medicaid CMI.

8) Real and Personal Property Fee

The property component of the reimbursement methodology consists of the real and personal property fee (property fee). The property fee is paid in lieu of an allowable cost of mortgage interest, depreciation, lease expense and/or amortization of leasehold improvements. The fee is facility specific and does not change as a result of a change of ownership, change in lease, or with re-enrollment in the Medicaid program. The original property fee was comprised of two components, a property allowance and a property value factor. The differentiation of the fee into these components was eliminated effective July 1, 2002. At that time each facility’s fee was re-established based on the sum of the property allowance and value factor. The providers receive the lower of the inflated property fee or the upper payment limit.

For providers re-enrolling in the Kansas Medical Assistance program or providers enrolling for the first time but operating in a facility that was previously enrolled in the program, the property fee shall be the sum of the last effective property allowance and the last effective value factor for that facility. The property fee will be inflated to 12/31/08 and then compared to the upper payment limit. The property fee will be the lower of the facility-specific inflated property fee or the upper payment limit.

Providers entering the Kansas Medical Assistance program for the first time, who are operating in a building for which a fee has not previously been established, shall have a property fee calculated from the ownership costs reported on the cost report. This fee shall include appropriate components for rent or lease expense, interest expense on real estate mortgage, amortization of leasehold improvements, and depreciation on buildings and equipment. The process for calculating the property fee for providers entering the Kansas Medical Assistance program for the first time is explained in greater detail in K.A.R. 129-10-25.

There is a provision for changing the property fee. This is for a rebasing when capital expenditure thresholds are met ($25,000 for homes under 51 beds and $50,000 for homes over 50 beds). The original property fee remains constant but the additional factor for the rebasing is added. The property fee rebasing is explained in greater detail in K.A.R. 129-10-25. The rebased property fee is subject to the upper payment limit.

9) Incentive Factors

An incentive factor will be awarded to both NF and NF-MH providers that meet certain outcome measures criteria. The criteria for NF and NF-MH providers will be determined separately based on arrays of outcome measures for each provider group.

Nursing Facility Quality and Efficiency Incentive Factor:

The Nursing Facility Incentive Factor is a per diem amount determined by four per diem add-ons providers can earn for various outcomes measures. Providers that maintain a case mix adjusted staffing ratio at or above the 75th percentile will earn a $3.00 per diem add-on. Providers that fall below the 75th percentile staffing ratio but improve their staffing ratio by 10% or more will earn a $0.50 per diem add-on. Providers that achieve a staff retention rate at or above the 75th percentile will earn a $2.50 per diem add-on as long as contracted labor costs do not exceed 10% of the provider’s total direct health care labor costs. Providers that have a staff retention rate lower than the 75th percentile but that increase their staff retention rate by 10% or more will receive a per diem add-on of $0.50 as long as contracted labor costs do not exceed 10% of the provider’s total direct health care labor costs. Providers that have a Medicaid occupancy percentage of 65% or more will receive a $0.75 per diem add-on. Finally, providers that maintain quality measures at or above the 75th percentile will earn a $1.25 per diem add-on. The total of all the per diem add-ons a provider qualifies for will be their incentive factor.

The table below summarizes the incentive factor outcomes and per diem add-ons:

Incentive Outcome Incentive Add-Ons
CMI adjusted staffing ratio ≥ 75th percentile (5.80), or $3.00
CMI adjusted staffing < 75th percentile but improved ≥ 10% $0.50
Staff retention rate ≥ 75th percentile, 67%
Contracted labor < 10% of total direct health care labor costs
or $2.50
Staff retention rate < 75th percentile but increased ≥ 10%
Contracted labor < 10% of total direct health care labor costs $0.50
Medicaid occupancy ≥ 65% $0.75
Quality Measures ≥ 75th percentile (670) $1.25
Total Incentive Add-on Available $7.50

The Culture Change/Person-Centered Care Incentive Program

The Culture Change/Person-Centered Care Incentive Program (PEAK 2.0) includes six different incentive levels to recognize homes that are either pursuing culture change, have made major achievements in the pursuit of culture change, have met minimum competencies in person-centered care, have sustained person-centered care, or are mentoring others in person-centered care.

Each incentive level has a specific pay-for-performance incentive per diem attached to it that homes can earn by meeting defined outcomes. The first three levels (Level 0 – Level 2) are intended to encourage quality improvement for homes that have not yet met the minimum competency requirements for a person-centered care home. Homes can earn the Level 1 and Level 2 incentives simultaneously as they progress toward the minimum competency level.

Level 3 recognizes those homes that have attained a minimum level of core competency in person-centered care. Level 4 and Level 5 are reserved for those homes that have demonstrated sustained person-centered care for multiple years and have gone on to mentor other homes in their pursuit of person-centered care. The table below provides a brief overview of each of the levels.

Level & Per
Diem Incentive
Summary of Required Nursing Home Action Incentive Duration
Level 0

The Foundation

$0.50
Home completes the KCCI evaluation tool according to the application instructions. Home participates in all required activities noted in “The Foundation” timeline and workbook. Homes that do not complete the requirements will be dropped until they enroll to participate in the next fiscal year. Available beginning July 1 of enrollment year. Incentive granted for one full fiscal year, contingent upon participation.
Level 1

Pursuit of
Culture Change

$0.50
Homes should submit the KCCI evaluation tool (annually). Home submits an action plan addressing 4 PEAK 2.0 cores in Domains 1-4. The home self-reports progress on the action planned cores via phone conference with the PEAK team. The home may be selected for a random site visit. The home must participate in the random site visit, if selected, to continue incentive payment. Homes should demonstrate successful completion of 75% of core competencies selected. A home can apply for Levels 1 & 2 in the same year. Homes that do not achieve Level 2 with three consecutive years of participation at Level 1 may return to a Level 0 or sit out for two years depending on KDADS and KSU’s recommendation. Available beginning July 1 of enrollment year. Incentive granted for one full fiscal year.
Level 2

Culture Change
Achievement

$1.00
This is a bridge level to acknowledge achievement in Level 1. Homes may receive this level at the same time they are working on other PEAK core areas at Level 1. Homes may receive this incentive for up to 3 years. If Level 3 is not achieved at the end of the third year, homes may start back at Level 0 or 1 depending on KDADS and KSU’s recommendation. Available beginning July 1 following confirmed completion of action plan goals. Incentive is granted for one full fiscal year.
Level 3

Person-Centered
Care Home

$2.00
Demonstrates minimum competency as a person-centered care home (see KDADS full criteria). This is confirmed through a combination of the following: Demonstration of success in other levels of the program. Performing successfully on a Level 2 screening call with the KSU PEAK 2.0 team. Passing a full site visit. Available beginning July 1 following confirmed minimum competency as a person-centered care home. Incentive is granted for one full fiscal year. Renewable bi-annually.
Level 4

Sustained Person-
Centered Care Home

$2.50
Homes earn person-centered care home award two consecutive years. Available beginning July 1 following confirmation of the upkeep of minimum person-centered care competencies. Incentive is granted for two fiscal years. Renewable bi-annually.
Level 5

Person-Centered Care
Mentor Home

$3.00
Homes earn sustained person-centered care home award and successfully engage in mentoring activities suggested by KDADS (see KDADS mentoring activities). Mentoring activities should be documented. Available beginning July 1 following confirmation of mentor home standards. Incentive is granted for two fiscal years. Renewable bi-annually.

Nursing Facility for Mental Health Quality and Efficiency Incentive Factor

The Quality and Efficiency Incentive plan for Nursing Facilities for Mental Health (NFMH) will be established separately from nursing facilities. Nursing Facilities for Mental Health serve people who often do not need the NF level of care on a long-term basis. There is a desire to provide incentive for NFMHs to work cooperatively and in coordination with Community Mental Health Centers to facilitate the return of persons to the community.

The Quality and Efficiency Incentive Factor is a per diem add-on ranging from zero to seven dollars and fifty cents. It is designed to encourage quality care, efficiency and cooperation with discharge planning. The incentive factor is determined by five outcome measures: case-mix adjusted nurse staffing ratio; operating expense; staff turnover rate; staff retention rate; and occupancy rate. Each provider is awarded points based on their outcomes measures and the total points for each provider determine the per diem incentive factor included in the provider’s rate calculation.

Providers may earn up to two incentive points for their case mix adjusted nurse staffing ratio. They will receive two points if their case-mix adjusted staffing ratio equals or exceeds 3.88, which is 120% of the statewide NFMH median of 3.23. They will receive one point if the ratio is less than 120% of the NFMH median but greater than or equal to 3.55, which is 110% of the statewide NFMH median. Providers with staffing ratios below 110% of the NFMH median will receive no points for this incentive measure.

NFMH providers may earn one point for low occupancy outcomes measures. If they have total occupancy less than 90% they will earn a point.

NFMH providers may earn one point for low operating expense outcomes measures. The provider will earn one point if the per diem operating expenses are below $26.11, or 90% of the statewide median of $29.01.

NFMH providers may earn up to two points for the turnover rate outcomes measure. Providers with direct health care staff turnover equal to or below 41%, the 75th percentile statewide, will earn two points as long as contracted labor costs do not exceed 10% of the provider’s total direct health care labor costs. Providers with direct health care staff turnover greater than 41% but equal to or below 75%, the 50th percentile statewide, will earn one point as long as contracted labor costs do not exceed 10% of the provider’s total direct health care labor costs.

Finally, NFMH providers may earn up to two points for the retention rate outcomes measure. Providers with staff retention rates at or above 76%, the 75th percentile statewide will earn two points. Providers with staff retention rates below 76% but at or above 67%, the 50th percentile statewide, will earn one point.

The table below summarizes the incentive factor outcomes and points:

Quality/Efficiency Outcome Incentive Points
CMI adjusted staffing ratio ≥ 120% (3.88) of NF-MH median (3.23), or 2, or
CMI adjusted staffing ratio between 110% (3.55) and 120% 1
Total occupancy ≤ 90% 1
Operating expenses < $26.11, 90% of NF-MH median, $29.01 1
Staff turnover rate ≤ 75th percentile, 41% 2, or
Staff turnover rate ≤ 50th percentile, 75% 1
Contracted labor < 10% of total direct health care labor costs
Staff retention ≥ 75th percentile, 76% 2, or
Staff retention ≥ 50th percentile, 67% 1
Total Incentive Points Available 8

Schedule E is an array containing the incentive points awarded to each NFMH provider for each quality and efficiency incentive outcome. The total of these points will be used to determine each provider’s incentive factor based on the following table.

Total Incentive Points: Incentive Factor Per Diem:
Tier 1: 6-8 points $7.50
Tier 2: 5 points $5.00
Tier 3: 4 points $2.50
Tier 4: 0-3 points $0.00

The survey and certification performance of each NF and NFMH provider will be reviewed quarterly to determine each provider’s eligibility for incentive factor payments. In order to qualify for an incentive, factor a home must not have received any health care survey deficiency of scope and severity level “H” or higher during the survey review period. Homes that receive “G” level deficiencies, but no “H” level or higher deficiencies, and that correct the “G” level deficiencies within 30 days of the survey, will be eligible to receive 50% of the calculated incentive factor. Homes that receive no deficiencies higher than scope and severity level “F” will be eligible to receive 100% of the calculated incentive factor. The survey and certification review period will be the 12-month period ending one quarter prior to the incentive eligibility review date. The following table lists the incentive eligibility review dates and corresponding review period end dates.

Incentive Eligibility Effective Date: Review Period End Date:
July 1 March 31st
October 1 June 30th
January 1 September 30th
April 1 December 31st

10) Rate Effective Date

Rate effective dates are determined in accordance with K.A.R. 129-10-19. The rate may be revised for an add-on reimbursement factor (i.e., rebased property fee), desk review adjustment or field audit adjustment.

11) Retroactive Rate Adjustments

Retroactive adjustments, as in a retrospective system, are made for the following three conditions:

A retroactive rate adjustment and direct cash settlement is made if the agency determines that the base year cost report data used to determine the prospective payment rate was in error. The prospective payment rate period is adjusted for the corrections.

If a projected cost report is approved to determine an interim rate, a settlement is also made after a historic cost report is filed for the same period.

All settlements are subject to upper payment limits. A provider is considered to be in projection status if they are operating on a projected rate and they are subject to the retroactive rate adjustment.

II. Medicaid Per Diem Rates for Kansas Nursing Facilities

A. Cost Center Limitations: The state establishes the following cost center limitations which are used in setting rates effective July 1, 2021.

Cost Center Limit Formula Per Day Limit
Operating 110% of the Median Cost $39.13
Indirect Health Care 115% of the Median Cost $54.45
Direct Health Care 130% of the Median Cost $129.95
Real and Personal Property Fee 105% of the Median Fee $10.01

These amounts were determined according to the “Reimbursement Limitations” section. The Direct Healthcare Limit is calculated based on a CMI of 1.0314, which is the statewide average.

B. Case Mix Index: These proposed rates are based upon each nursing facility’s Medicaid CMI calculated as the average of the quarterly Medicaid CMI averages with cutoff dates of January 1, 2021 and April 1, 2021. The CMI calculations use the July 1, 2014 Kansas Medicaid/Medikan CMI Table. In Section II.C below, each nursing facility’s Medicaid average CMI is listed beside its per diem rate.

C. Rates: The following list includes the calculated Medicaid rate for each nursing facility provider currently enrolled in the Medicaid program and the Medicaid case mix index used to determine each rate.

Facility Name City Daily Rate Medicaid CMI
Village Manor Abilene 196.68 0.9207
Alma Manor Alma 173.66 0.8774
Life Care Center of Andover Andover 163.81 1.0724
Victoria Falls SNF Andover 184.69 1.0089
Anthony Community Care Center Anthony 168.53 0.9184
Medicalodges Health Care Ctr Arkansas Arkansas City 178.42 0.9840
Arkansas City Presbyterian Manor Arkansas City 199.88 1.1782
Arma Operator. LLC Arma 188.75 1.3896
Medicalodges Atchison Atchison 219.07 1.1255
Atchison Senior Village Atchison 218.30 0.9976
Dooley Center Atchison 212.81 0.8343
Attica Long Term Care Attica 206.22 0.8726
Good Samaritan Society-Atwood Atwood 224.47 1.0756
Lake Point Nursing Center Augusta 173.15 1.0451
Baldwin Healthcare and Rehab Center Baldwin City 195.40 1.2559
Quaker Hill Manor Baxter Springs 183.10 1.1186
Catholic Care Center Inc. Bel Aire 223.09 1.1480
Belleville Healthcare Center Belleville 183.08 1.2160
Mitchell County Hospital LTCU Beloit 216.76 0.9268
Hilltop Lodge Health and Rehab Beloit 216.25 1.2740
Bonner Springs Nursing and Rehab Center Bonner Springs 175.03 1.1112
Hill Top House Bucklin 227.09 0.9755
Buhler Sunshine Home, Inc. Buhler 224.62 0.9765
Life Care Center of Burlington Burlington 162.29 1.1014
Eastridge Nursing Home Centralia 266.73 1.0903
Heritage Health Care Center Chanute 178.90 1.2288
Diversicare of Chanute Chanute 183.22 1.2107
Chapman Valley Manor Chapman 170.82 0.8936
Cheney Golden Age Home Inc. Cheney 183.85 1.0981
Cherryvale Care Center Cherryvale 154.51 0.9579
Chetopa Manor Chetopa 164.13 0.8497
The Shepherd’s Center Cimarron 205.96 0.8699
Medicalodges Clay Center Clay Center 227.39 1.0680
Clay Center Presbyterian Manor Clay Center 194.75 1.0108
Clearwater Nursing and Rehab Clearwater 177.72 1.1080
Park Villa Nursing Home Clyde 177.49 1.0990
Windsor Place Coffeyville 190.44 1.1154
Medicalodges Coffeyville Coffeyville 212.89 1.0779
Windsor Place at Iola, LLC Coffeyville 183.16 1.0942
Colby Operator, LLC Colby 178.30 1.2000
Prairie Senior Living Complex Colby 227.63 0.9998
Pioneer Lodge Coldwater 174.32 0.7966
Medicalodges Columbus Columbus 205.19 1.1114
Mt Joseph Senior Village, LLC Concordia 176.09 1.0785
Sunset Home, Inc. Concordia 194.18 1.0340
Spring View Manor Conway Springs 193.14 1.1201
Chase County Operator LLC Cottonwood Falls 218.59 1.0818
Diversicare of Council Grove Council Grove 177.53 1.1598
Hilltop Manor Nursing Center Cunningham 164.57 0.9337
Westview of Derby Derby 129.90 0.9144
Derby Health and Rehabilitation Derby 209.24 1.1452
Hillside Village DeSoto 186.84 0.9830
Trinity Manor Dodge City 186.81 1.1605
Sunporch of Dodge City Dodge City 191.23 0.8559
Manor of the Plains Dodge City 216.22 1.0882
Downs Operator LLC Downs 213.69 1.3185
Country Care Home Easton 174.44 1.0408
Parkway Operator LLC Edwardsville 193.90 1.1805
Kaw River Operator, LLC Edwardsville 229.96 1.2503
Edwardsville Operator LLC Edwardsville 179.96 0.8279
Lakepoint Nursing Center-El Dorado El Dorado 173.87 0.9614
El Dorado Operator LLC El Dorado 221.29 1.1529
Morton Co Senior Living Community Elkhart 180.88 0.9975
Azria Health Woodhaven Ellinwood 229.25 1.3226
Good Samaritan Society-Ellis Ellis 182.84 1.0360
Good Sam Society-Ellsworth Village Ellsworth 184.49 1.0339
Emporia Presbyterian Manor Emporia 205.96 1.0217
Holiday Resort Emporia 172.21 1.0261
Flint Hills Care and Rehab Center Emporia 172.95 1.1647
Enterprise Estates Nursing Center, Inc Enterprise 176.16 1.0160
Eskridge Operator LLC Eskridge 180.88 1.0029
Medicalodges Eudora Eudora 196.45 1.1254
Eureka Nursing Center Eureka 173.92 1.0352
Kansas Soldiers’ Home Fort Dodge 233.53 0.9633
Medicalodges Fort Scott Fort Scott 183.37 1.0378
Fowler Residential Care Fowler 220.99 0.9860
Frankfort Community Care Home, Inc. Frankfort 193.86 1.0006
Medicalodges Frontenac Frontenac 181.10 0.9923
Galena Nursing Home Galena 190.26 1.2424
Garden Valley Retirement Village Garden City 187.44 1.2008
Ranch House Senior Living Garden City 199.56 1.0675
Recover Care Meadowbrook Rehab, LLC Gardner 293.32 1.4685
Medicalodges Gardner Gardner 183.25 0.8967
Anderson County Hospital Garnett 215.99 0.8605
Parkview Heights Garnett 212.31 1.0434
Medicalodges Girard Girard 181.97 1.0151
The Nicol Home, Inc. Glasco 165.25 0.8213
Medicalodges Goddard Goddard 200.86 0.9466
Bethesda Home Goessel 209.97 0.9378
Topside Manor, Inc. Goodland 199.40 1.0545
Medicalodges Great Bend Great Bend 188.65 0.9782
Great Bend Health and Rehab Center Great Bend 195.59 1.0410
Halstead Health and Rehab Center Halstead 212.18 1.0492
Haviland Operator, LLC Haviland 147.90 0.6712
Good Samaritan Society-Hays Hays 206.37 1.1344
Via Christi Village-Hays Hays 194.27 1.0875
Diversicare of Haysville Haysville 177.93 1.1967
Legacy at Herington Herington 176.05 1.1087
Schowalter Villa Hesston 241.94 1.0065
Maple Heights of Hiawatha Hiawatha 146.51 0.9053
Highland Healthcare and Rehab Center Highland 185.70 1.1612
Dawson Place, Inc. Hill City 181.06 0.9281
Salem Home Hillsboro 203.46 1.0091
Parkside Homes, Inc. Hillsboro 197.41 0.9253
Medicalodges Jackson County Holton 207.27 1.0713
Mission Village Living Center Horton 157.33 1.1337
Sheridan County Hospital Hoxie 223.68 0.9675
Pioneer Manor Hugoton 208.94 0.8139
Diversicare of Hutchinson Hutchinson 197.81 1.2594
Good Sam Society-Hutchinson Village Hutchinson 226.63 1.0750
Hutchinson Operator, LLC Hutchinson 180.47 1.2448
Wesley Towers Hutchinson 246.53 1.0775
Medicalodges Independence Independence 187.99 1.0262
Montgomery Place Nursing Center, LLC Independence 179.24 1.0403
Pleasant View Home Inman 195.42 0.9512
Stanton County Hospital-LTCU Johnson 217.71 0.8860
Valley View Senior Life Junction City 199.61 1.0069
Medicalodges Post Acute Care Center Kansas City 188.93 1.0152
Riverbend Post Acute Rehabilitation Kansas City 202.92 1.1767
Lifecare Center of Kansas City Kansas City 173.93 0.9908
Providence Place LTCU Kansas City 239.09 1.2005
Ignite Medical Resort Kansas City 218.64 1.3967
Golden Oaks Healthcare, Inc. Kansas City 237.70 1.1979
The Wheatlands Kingman 176.36 0.9767
Medicalodges Kinsley Kinsley 221.60 1.1032
Kiowa District Manor Kiowa 213.08 0.9398
Locust Grove Village Lacrosse 200.86 1.0081
High Plains Retirement Village Lakin 228.07 0.9354
Lansing Operator LLC Lansing 216.86 1.2925
Twin Oaks Health & Rehab Lansing 222.75 1.2293
Diversicare of Larned Larned 158.52 1.0165
Lawrence Presbyterian Manor Lawrence 208.83 1.0099
Brandon Woods at Alvamar Lawrence 206.55 1.0384
Pioneer Ridge Retirement Community Lawrence 211.19 1.0697
Medicalodges Leavenworth Leavenworth 196.14 1.1282
The Healthcare Resort of Leawood Leawood 269.53 1.3776
Delmar Gardens of Lenexa Lenexa 175.53 1.0045
Lakeview Village Lenexa 262.57 1.2390
Westchester Village of Lenexa Lenexa 247.34 1.1593
Leonardville Nursing Home Leonardville 179.76 0.9399
Wichita County Health Center Leoti 260.32 0.8525
Good Samaritan Society-Liberal Liberal 184.31 1.1541
Wheatridge Park Care Center Liberal 208.40 1.2451
Lincoln Park Manor, Inc. Lincoln 200.67 0.9487
Bethany Home Association Lindsborg 222.12 1.0234
Linn Community Nursing Home Linn 175.04 1.0366
Sandstone Heights Nursing Home Little River 242.01 1.0721
Logan Manor Community Health Service Logan 176.36 0.9870
Louisburg Healthcare and Rehab Center Louisburg 191.18 1.3189
Good Samaritan Society-Lyons Lyons 196.59 1.0021
Meadowlark Hills Retirement Community Manhattan 234.00 1.0285
Stoneybrook Retirement Community Manhattan 184.30 1.0200
Via Christi Village Manhattan, Inc. Manhattan 198.57 1.0842
St. Luke Living Center Marion 200.32 0.9060
Riverview Estates, Inc. Marquette 183.60 0.9011
Cambridge Place Marysville 173.30 1.0548
McPherson Operator, LLC McPherson 176.12 1.1937
The Cedars, Inc. McPherson 217.51 1.0260
Meade District Hospital, LTCU Meade 213.37 0.8825
Merriam Gardens Healthcare and Rehab Merriam 220.60 1.2515
Minneapolis Health and Rehabilitation Minneapolis 170.68 1.1670
Minneola District Hospital-LTCU Minneola 218.63 0.8931
Bethel Home, Inc. Montezuma 199.25 0.9692
Moran Manor Moran 155.30 1.0465
Pine Village Moundridge 208.95 1.0315
Moundridge Manor, Inc. Moundridge 206.75 0.8779
Mt. Hope Nursing Center Mt. Hope 193.71 1.0683
Villa Maria, Inc. Mulvane 214.52 1.1192
Neodesha Operator LLC Neodesha 197.57 1.2804
Ness County Hospital Dist.#2 Ness City 213.80 0.9211
Asbury Park Newton 208.28 0.9344
Kansas Christian Home Newton 210.52 1.0283
Newton Presbyterian Manor Newton 223.11 1.0477
Bethel Care Center North Newton 231.99 0.9589
Andbe Home, Inc. Norton 177.75 0.9994
Village Villa Nortonville 185.17 1.1466
Logan County Manor Oakley 236.67 1.1020
Good Samaritan Society-Decatur Co. Oberlin 214.73 0.9744
Villa St. Francis Catholic Care Ctr. Olathe 232.23 1.2106
Azria Health at Olathe Olathe 227.14 1.2163
Good Samaritan Society-Olathe Olathe 225.75 1.0641
Evergreen Community of Johnson Count Olathe 233.74 1.0107
Aberdeen Village, Inc. Olathe 245.78 1.1070
Nottingham Health & Rehab Olathe 225.87 1.2211
The Healthcare Resort of Olathe Olathe 246.59 1.3381
Onaga Operator, LLC Onaga 184.00 1.3348
Osage Nursing & Rehab Center Osage City 180.19 1.0620
Life Care Center of Osawatomie Osawatomie 188.02 1.3501
Parkview Care Center Osborne 161.46 0.9992
Hickory Pointe Care and Rehab Center Oskaloosa 205.96 1.0622
Oswego Operator, LLC Oswego 183.05 1.2572
Rock Creek of Ottawa Ottawa 206.88 1.2620
Brookside Manor Overbrook 164.00 1.0378
Brookdale Overland Park Overland Park 254.53 1.0706
Garden Terrace at Overland Park Overland Park 181.81 1.2263
KPC Promise Hospital of Overland Park Overland Park 252.51 1.5856
Overland Park Center for Rehab & HC Overland Park 232.54 1.2290
Villa Saint Joseph Overland Park 226.01 1.0452
Delmar Gardens of Overland Park Overland Park 204.63 1.0818
Overland Park Nursing and Rehab Overland Park 238.04 1.2217
Indian Creek Health and Rehab Overland Park 206.89 1.1899
Village Shalom, Inc. Overland Park 232.28 1.1387
Tallgrass Creek, Inc. Overland Park 213.76 1.2625
Shawnee Post Acute Rehab Center Overland Park 247.00 1.2406
Stratford Commons Rehab and HCC Overland Park 249.80 1.2116
Colonial Village Overland Park 229.69 1.1530
ML-OP Oxford, LLC Oxford 183.35 1.0526
Medicalodges Paola Paola 134.88 0.7310
North Point Skilled Nursing Center Paola 196.90 1.0897
Elmhaven East Parsons 173.76 1.0036
Parsons Presbyterian Manor Parsons 216.94 1.0733
Good Samaritan Society-Parsons Parsons 186.00 1.0044
Peabody Operator, LLC Peabody 155.06 1.0621
Access Mental Health Peabody 130.00 0.6335
Phillips County Retirement Center Phillipsburg 197.52 1.0084
Pittsburg Operator LLC Pittsburg 202.13 1.1754
Medicalodges Pittsburg South Pittsburg 190.99 1.0615
Via Christi Village Pittsburg, Inc Pittsburg 209.22 1.2636
Rooks County Senior Services, Inc. Plainville 206.50 1.0204
Brighton Gardens of Prairie Village Prairie Village 249.64 1.3623
Grand Plains–Skilled Nursing Pratt 138.15 1.0706
Pratt Operator, LLC Pratt 158.98 1.1780
Prairie Sunset Manor Pretty Prairie 226.32 1.3576
Protection Valley Manor Protection 147.77 0.8080
Gove County Medical Center Quinter 234.28 0.9849
Richmond Healthcare and Rehab Center Richmond 185.27 1.2945
Fountainview Nursing and Rehab Center Rose Hill 191.46 1.1030
Rossville Healthcare and Rehab Center Rossville 188.32 1.2030
Wheatland Nursing and Rehab Center Russell 170.36 1.0296
Russell Regional Hospital Russell 239.07 0.9659
Sabetha Nursing Center Sabetha 166.82 1.0345
Apostolic Christian Home Sabetha 178.88 0.9466
Smoky Hill Rehabilitation Center Salina 156.76 1.0110
Kenwood View Health and Rehab Center Salina 180.68 1.2829
Salina Windsor SNF OPCO, LLC Salina 171.01 1.1008
Pinnacle Park Nursing and Rehabilitation Salina 163.96 1.2327
Salina Presbyterian Manor Salina 183.85 1.0291
Holiday Resort of Salina Salina 191.35 1.0462
Satanta Dist. Hosp. LTCU Satanta 213.27 0.9224
Park Lane Nursing Home Scott City 224.54 1.0059
Pleasant Valley Manor Sedan 155.26 0.9399
Diversicare of Sedgwick Sedgwick 191.49 1.1747
Crestview Nursing and Residential Living Seneca 167.63 1.0753
Life Care Center of Seneca Seneca 149.25 1.1210
Wallace County Community Center Sharon Springs 229.44 1.0524
Shawnee Gardens Healthcare and Rehab Shawnee 183.60 1.3093
Sharon Lane Health and Rehabilitation Shawnee 204.51 1.2311
Brookdale Rosehill Shawnee 272.15 1.3543
Smith Center Operator, LLC Smith Center 174.02 1.1789
Sunporch of Smith County Smith Center 196.56 0.8648
Mennonite Friendship Manor, Inc. South Hutchinson 209.91 1.0672
Spring Hill Operator LLC Spring Hill 219.66 1.2299
Cheyenne County Village, Inc. St. Francis 229.62 0.9991
Leisure Homestead at St. John St. John 182.02 0.9482
Community Hospital of Onaga, LTCU St. Mary’s 210.96 0.9610
Prairie Mission Retirement Village St. Paul 165.08 1.0103
Leisure Homestead at Stafford Stafford 177.24 0.9346
Sterling Village Sterling 235.93 1.0466
Solomon Valley Manor Stockton 207.07 1.0695
Legend Healthcare Tonganoxie 180.40 1.0447
Brewster Health Center Topeka 232.47 1.0204
Topeka Presbyterian Manor Inc. Topeka 239.73 1.1307
Legacy on 10th Ave. Topeka 159.54 0.9920
McCrite Plaza Health Center Topeka 234.38 1.1900
Rolling Hills Health Center Topeka 201.95 1.1200
Topeka Center for Rehab and Healthcare Topeka 199.45 1.4356
Tanglewood Nursing and Rehabilitation Topeka 167.39 1.1396
Brighton Place West Topeka 139.17 0.9586
Countryside Health Center Topeka 109.84 0.7075
Providence Living Center Topeka 126.65 0.8154
Brighton Place North Topeka 117.00 0.7120
Aldersgate Village Topeka 227.13 1.1068
Recover-Care Plaza West Care Center Topeka 209.27 1.4012
Lexington Park Nursing and Post Acute Topeka 224.85 1.0871
Top City Healthcare, Inc. Topeka 228.46 1.2548
Greeley County Hospital, LTCU Tribune 202.10 0.8508
Western Prairie Senior Living Ulysses 205.68 0.9470
Valley Health Care Center Valley Falls 155.99 0.6440
Trego Co. Lemke Memorial LTCU Wakeeney 216.58 0.9477
Wakefield Operator LLC Wakefield 233.24 1.3220
Good Samaritan Society-Valley Vista Wamego 194.57 0.9974
The Centennial Homestead, Inc. Washington 184.13 1.0505
Wathena Healthcare and Rehab Center Wathena 184.13 1.3659
Coffey County Hospital Waverly 202.16 0.9359
Wellington Operator LLC Wellington 190.99 1.2186
Sumner Operator, LLC Wellington 176.52 1.1887
Wellsville Manor Wellsville 150.75 1.0683
Westy Community Care Home Westmoreland 166.87 0.9549
Wheat State Manor Whitewater 182.16 0.9150
Medicalodges Wichita Wichita 187.64 0.9565
Meridian Rehab and Health Care Center Wichita 152.62 1.0003
Kansas Masonic Home Wichita 203.70 1.0450
Homestead Health Center, Inc. Wichita 243.91 1.1689
Orchard Gardens LLC Wichita 176.28 1.0908
Wichita Presbyterian Manor Wichita 219.27 1.1367
Sandpiper Healthcare and Rehab Center Wichita 164.21 1.2244
Lakepoint Wichita LLC Wichita 186.63 1.1538
Wichita Center for Rehab and Healthcare Wichita 201.24 1.3146
Legacy at College Hill Wichita 164.20 1.0382
Seville Operator, LLC Wichita 189.89 1.1938
Wichita Operator LLC Wichita 219.44 1.3072
The Health Care Center atLarksfield Place Wichita 221.90 1.1236
Life Care Center of Wichita Wichita 195.58 1.1987
Family Health and Rehabilitation Center Wichita 209.46 1.1430
Caritas Center Wichita 211.39 0.7993
Regent Park Rehab and Healthcare Wichita 230.82 1.1841
Avita Health and Rehab of Reeds Cove Wichita 201.10 1.1358
Via Christi Village Ridge Wichita 221.38 1.1876
Via Christi Village McLean, Inc. Wichita 217.39 1.2043
Mount St Mary Wichita 239.30 1.0560
Healthcare Resort of Wichita Wichita 202.09 1.4178
Wilson Operator LLC Wilson 217.47 1.3857
F W Huston Medical Center Winchester 159.20 0.9524
Winfield Senior Living Community Winfield 203.07 1.0246
Cumbernauld Village, Inc. Winfield 225.50 0.9198
Winfield Rest Haven II LLC Winfield 224.51 1.0541
Kansas Veterans’ Home Winfield 219.32 1.0406
Yates Operator, LLC Yates Center 180.85 1.3818

III. Justifications for the Rates

  1. The proposed rates are calculated according to the rate-setting methodology in the Kansas Medicaid State Plan and pending amendments thereto.
  2. The proposed rates are calculated according to a methodology which satisfies the requirements of K.S.A. 39-708c(x) and the DHCF regulations in K.A.R. Article 129-10 implementing that statute and applicable federal law.
  3. The State’s analyses project that the rates:
    1. Would result in payment, in the aggregate of 91.80% of the Medicaid day weighted average inflated allowable nursing facility costs statewide; and
    2. Would result in a maximum allowable rate of $233.54 (for a CMI of 1.0314); with the total average allowable cost being $195.25.
  4. Estimated annual aggregate expenditures in the Medicaid nursing facility services payment program will not change substantially as the FY 2021 reimbursement parameters are being continued.
  5. The state estimates that the rates will continue to make quality care and services available under the Medicaid State Plan at least to the extent that care and services are available to the general population in the geographic area. The state’s analyses indicate:
    1. Service providers operating a total of 318 nursing facilities and hospital-based long-term care units (representing 96.5% of all the licensed nursing facilities and long-term care units in Kansas) participate in the Medicaid program;
    2. There is at least one Medicaid-certified nursing facility and/or nursing facility for mental health, or Medicaid-certified hospital-based long-term care unit in 99 of the 105 counties in Kansas;
    3. The statewide average occupancy rate for nursing facilities participating in Medicaid is 77.74%;
    4. The statewide average Medicaid occupancy rate for participating facilities is 60.11%; and
    5. The rates would cover 93.11% of the estimated Medicaid direct health care costs incurred by participating nursing facilities statewide.
  6. Federal Medicaid regulations at 42 C.F.R. 447.272 impose an aggregate upper payment limit that states may pay for Medicaid nursing facility services. The state’s analysis indicates that the methodology will result in compliance with the federal regulation.

IV. Request for Comments; Request for Copies

The state Requests providers, beneficiaries and their representatives, and other concerned Kansas residents to review and comment on the proposed rates, the methodology used to calculate the proposed rates, the justifications for the proposed rates, and the intent to amend the Medicaid State Plan. Persons and organizations wishing to submit comments must mail, deliver, or fax their signed, written comments before the close of business on May 17, 2021 to:

Georgianna Correll
Facility Program and Finance Director
Kansas Department for Aging and Disability Services
New England Building
503 S. Kansas Ave.
Topeka, KS 66603-3404
Fax: 785-296-0256

V. Notice of Intent to Amend the Medicaid State Plan

The state intends to submit Medicaid State Plan amendments to CMS on or before September 30, 2021.

Laura Howard
Secretary
Department for Aging and Disability Services

Sarah Fertig
Medicaid Director
Division of Health Care Finance

Doc. No. 049040