Agency 30, Article 5 — PROVIDER PARTICIPATION, SCOPE OF SERVICES, AND

(Authorized by K.S.A. 1980 Supp. 39-708c; effective Jan. 1, 1969; amended, E-70-9, Dec. 4, 1969; amended Jan. 1, 1971; amended, E- 72-1, Oct. 1, 1971; amended Jan. 1, 1972; amend- ed Jan. 1, 1974; amended May 1, 1975; amended Feb. 15, 1977; amended, E-79-20, Aug. 17, 1978; amende…

(Authorized by K.S.A. 1980 Supp. 39-708c, 75-3304; effective Jan. 1, 1969; amend- ed, E-70-9, Dec. 4, 1969; amended Jan. 1, 1971; amended, E-72-1, Oct. 1, 1971; amended, E-72-3, Nov. 5, 1971; amended, E-72-12, March 31, 1972; amended Jan. 1, 1973; amended Jan. 1, 1974; amended Ma…

(Authorized by K.S.A. 1970 Supp. 39-708; effective Jan. 1, 1969; revoked, E-70-9, Dec. 4, 1969; revoked Jan. 1, 1971.)

(Authorized by K.S.A. 75-5321; ef- fective Jan. 1, 1974; revoked May 1, 1981.) 30-5-37 and 30-5-38. (Authorized by K.S.A. 75-5321, 75-5375(s), K.S.A. 1980 Supp. 39-708c, 39-748; effective, E-78-19, July 8, 1977; effective May 1, 1978; revoked May 1, 1981.)

(Authorized by K.S.A. 75-5321, K.S.A. 1980 Supp. 39-708c, 39-748; effective, E-78-19, July 8, 1977; amended, E-79-1, Feb. 1, 1978; effective May 1, 1978; amended, E-79-20, Aug. 17, 1978; amended May 1, 1979; amended, E-81-19, July 16, 1980; revoked May 1, 1981.)

(Authorized by K.S.A. 1980 Supp. 39-708c; effective, E-78-19, July 8, 1977; effective May 1, 1978; amended, E-79-20, Aug. 17, 1978; amended May 1, 1979; amended, E-80-13, Aug. 8, 1979; amended May 1, 1980; revoked May 1, 1981.)

(Authorized by K.S.A. 75-5321, 75- 5375(s), K.S.A. 1980 Supp. 39-708c, 39-748; ef- fective, E-78-19, July 8, 1977; amended, E-79-1, Feb. 1, 1978; effective May 1, 1978; amended, E-79-20, Aug. 17, 1978; amended May 1, 1979; revoked May 1, 1981.)

(Authorized by K.S.A. 75-5321, K.S.A. 1980 Supp. 39-708c, 39-748; effective, E-79-1, Feb. 1, 1978; effective May 1, 1978; re- voked May 1, 1981.) 33 30-5-58 Medicaid Program

(Authorized by K.S.A. 1980 Supp. 39-708c; effective, E-79-30, Nov. 21, 1978; ef- fective May 1, 1979; amended, E-81-25, Aug. 27, 1980; revoked May 1, 1981.)

(Authorized by K.S.A. 1980 Supp. 39-708c; effective, E-79-33, Dec. 20, 1978; ef- fective May 1, 1979; amended, E-81-25, Aug. 27, 1980; revoked May 1, 1981.)

(Authorized by K.S.A. 1980 Supp. 39-708c; effective, E-79-30, Nov. 21, 1978; ef- fective May 1, 1979; amended, E-80-13, Aug. 8, 1979; amended May 1, 1980; amended, E-81-25, Aug. 27, 1980; revoked May 1, 1981.)

(Authorized by K.S.A. 1980 Supp. 39-708c; effective, E-79-30, Nov. 21, 1978; ef- fective May 1, 1979; amended, E-81-19, July 16, 1980; revoked May 1, 1981.)

(Authorized by K.S.A. 1980 Supp. 39-708c; effective, E-79-30, Nov. 21, 1978; effec- tiveMay1,1979;amended,E-80-13,Aug.8,1979; amended May 1, 1980; revoked May 1, 1981.) 30-5-48 to 30-5-50. (Authorized by K.S.A. 1980 Supp. 39-708c; effective May 1, 1980; re- voked May 1, 1981.) 30…

Definitions. The following words and terms, when used in this article, shall have the following meanings, unless the context clearly indicates otherwise. (a) “Accept medicare assignment” means the provider will accept the medicare-allowed pay- ment rate as payment in full for ser…

Provider participation require- ments. The following shall be prerequisites for participation in and payment from the medicaid/ medikan program. Any provider of services to fos- ter care consumers, adoption support consumers, Kan Be Healthy consumers, or other consumers who have …

Provider termination/suspension. (a) Any provider’s participation in the medicaid/ medikan program may be terminated for one or more of the following reasons: (1) Voluntary withdrawal of the provider from participation in the program; (2) non-compliance with applicable state laws…

(Authorized by K.S.A. 1979 Supp. 39-708c; effective May 1, 1981; amended, T-84- 11, July 1, 1983; revoked May 1, 1984.)

Withholding of payments to medical providers. (a) Payments otherwise au- thorized to be made to medical providers shall be withheld, in full or in part, by the agency when: (1) The agency has determined that the provid- er to whom payments are to be made has been overpaid; (2) th…

Suspension of payment lia- bility to medical providers. (a) Suspension of payment liability because of determination by the secretary of health and human services. The agency shall suspend payment liability for ser- vices provided by any medical provider during any time period in…

Reinstatement of a provider previously terminated from the medicaid/ medikan program. A request for reinstatement by a provider terminated from participation in the medicaid/medikan program shall not be consid- ered for a period of 60 days following the effective date of the orde…

Medical necessity. Except as spe- cifically set forth in program policy, the agency shall not reimburse a provider for the provision of acoveredservicetoaprogramrecipientunlessthe provision of the service was medically necessary. (Authorized by and implementing K.S.A. 1985 Supp. …

(Authorized by K.S.A. 39-708c(b) and K.S.A. 2004 Supp. 39-7,120; implementing K.S.A. 2004 Supp. 39-7,120 and 39-7,121a; effec- tive May 1, 1981; amended May 1, 1983; amend- ed May 1, 1986; amended May 1, 1992; amended July 1, 1994; amended March 1, 1995; amended March 1, 1996; am…

(Authorized by and implementing K.S.A. 39-708c; effective May 1, 1981; amended, E-82-11, June 17, 1981; amended May 1, 1982; amended May 1, 1985; amended May 1, 1986; amended May 1, 1987; amended May 1, 1988; amended, T-30-12-28-89, Jan. 1, 1990; amend- ed, T-30-2-28-90, Feb. 28,…

Effective date of administrative regulations in relationship to provider cost reporting periods. The administrative regula- tions in effect at the beginning of a cost reporting period shall govern the treatment of costs that ac- crue during said period unless otherwise provid- ed…

Disallowance of claims for ser- vices generated by providers ineligible for participation in the medicaid/medikan pro- gram. The agency shall disallow payment, except for emergency services, if the service set forth on a claim was generated by a provider ineligible to participate…

Consultants to the medicaid/ medikan program. Consultants to the medicaid/ medikan program may be reimbursed if under contract with the Kansas department of social and rehabilitation services. The payment rate for con- sultants shall be a mutually negotiated amount. The effective…

Volume purchase and negotiat- ed contracts for medical services. The agen- cy may procure medical services from a single or multiple source through competitive bidding or negotiated fee. The agreed upon reimbursement shallsupersedetheusualreimbursementmethod- ology for the servic…

Payment of medical expenses for eligible recipients. (a) Payment for covered services shall be made only to those providers participating in the program pursuant to K.A.R.

Copayment requirements. (a) Except as set forth in subsection (b) of this reg- ulation, program recipients shall be obligated to the provider for the following copayment charges. (1) The copayment for inpatient general hos- pital and freestanding psychiatric facility services sha…

Medical contracts; funding. All medical contracts shall be subject to federal and state funding conditioned by appropriations made by congress and the state legislature. (Authorized by and implementing K.S.A. 1980 Supp. 39-708; effective May 1, 1981.)

Requirements for facilities to participate. (a) Medical services provided in community mental health centers, free-standing psychiatric facilities, state-operated hospitals, and general hospitals to be reimbursed by the medicaid/medikan program shall be under the effective contro…

(Authorized by and implementing K.S.A. 1980 Supp. 39-708c; effective May 1, 1981; revoked May 1, 1986.)

Scope of services for eligible aliens. The scope of services shall be limited to emergency medical services for otherwise el- igible aliens pursuant to K.A.R. 30-6-54 who do not qualify under the citizenship and alienage re- quirements. (Authorized by and implemmenting K.S.A. 39-…

Scope of coverage and reim- bursementforservicesforqualifiedmedicare beneficiaries. The scope of coverage for QMBs shall be the reimbursement of medicare premi- ums and coinsurance under part A and part B of medicare, for covered and noncovered medicaid/ medikan services. The rei…

Scope of home- and community- based services for technology-assisted chil- dren. The scope of home- and community-based services for technology-assisted children shall consist of those services provided under the au- thority of a federally approved waiver. Home- and community-bas…

(Authorized by and implement- ing K.S.A. 39-708c; effective, T-30-8-9-91, Aug. 30, 1991; effective Oct. 28, 1991; amended Oct. 1, 1998; amended Jan. 1, 2004; revoked July 18, 2008.)

Scope of and reimbursement for home- and community-based services for persons with mental retardation or oth- er developmental disabilities. The scope of home- and community-based services for persons with mental retardation or other developmental disabilities shall consist of th…

This regulation shall be revoked on and after July 1, 1997. (Authorized by and imple- menting K.S.A. 1996 Supp. 39-708c; effective July 31, 1992; amended Dec. 29, 1995; revoked July 1, 1997.)

Scope of hospital services. (a) Each hospital shall be medicare-certified and shall annually update medicaid enrollment information. (b) Outpatient services shall be covered with the following limitations. (1) Services shall be ordered by an attending physician who is not serving…

Participation in the diagno- sis related group reimbursement system. As a prerequisite for participation in the medicaid/ medikan program, a general hospital shall par- ticipate in the Kansas department of social and rehabilitation services’ diagnosis related group reimbursement …

The basis of reimbursement for hospital services. (a) Payment for hospital services provided to program participants shall be made to those hospitals filing cost reports with the Kansas department of social and rehabilitation services. Cost reports shall be due 30 days after 51 3…

(Authorized by and implementing K.S.A. 1980 Supp. 39-708c; effective May 1, 1981; amended, E-82-6, May 1, 1981; amended May 1, 1982; revoked, T-84-7, March 29, 1983; revoked May 1, 1984.)

This rule and regulation shall ex- pire on July 1, 1989. (Authorized by and imple- menting K.S.A. 1985 Supp. 39-708c; effective May 1, 1981; amended, E-82-6, May 1, 1981; amended May 1, 1982; amended, T-84-7, May 1, 1983; amended May 1, 1984; amended May 1, 1985; amended May 1, 1…

(Authorized by and implementing K.S.A. 1979 Supp. 39-708c; effective May 1, 1981; revoked, T-84-7, March 29, 1983; revoked May 1, 1984.) 30-5-81f to 30-5-81i. (Authorized by and implementing K.S.A. 1980 Supp. 39-708c; effec- tive May 1, 1981; amended, E-82-6, May 1, 1981; amended…

(Authorized by and implementing K.S.A. 1979 Supp. 39-708c; effective May 1, 1981; revoked, T-84-7, March 29, 1983; revoked May 1, 1984.) 30-5-81k and 30-5-81l. (Authorized by and implementing K.S.A. 1980 Supp. 39-708c; effective May 1, 1981; amended, E-82-6, May 1, 1981; amended …

(Authorized by and implementing K.S.A. 1980 Supp. 39-708c; effective May 1, 1981; amended, E-82-6, May 1, 1981; amended May 1, 1982; revoked, T-84-7, March 29, 1983; revoked May 1, 1984.)

(Authorized by and implementing K.S.A. 1979 Supp. 39-708c; effective May 1, 1981; revoked, T-84-7, March 29, 1983; revoked May 1, 1984.)

This rule and regulation shall expire on July 1, 1989. (Authorized by and im- plementing K.S.A. 1985 Supp. 39-708c; effec- 52 DEPARTMENT FOR CHILDREN AND FAMILIES 30-5-81r tive, T-84-9, May 1, 1983; effective May 1, 1984; amended May 1, 1985; amended May 1, 1986; re- voked July 1…

This rule and regulation shall ex- pire on July 1, 1989. (Authorized by and imple- menting K.S.A. 1985 Supp. 39-708c; effective, T-84-9, May 1, 1983; effective May 1, 1984; amended May 1, 1985; amended May 1, 1986; re- voked July 1, 1989.)

This rule and regulation shall ex- pire on July 1, 1989. (Authorized by and imple- menting K.S.A. 1985 Supp. 39-708c; effective, T-84-9, May 1, 1983; effective May 1, 1984; amended May 1, 1985; amended May 1, 1986; re- voked July 1, 1989.)