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

Hospital change of ownership. (a) Agency notification and provider agreements. (1) Each hospital shall notify the agency in writ- ingatleast60dayspriortotheeffectivedateofthe change of ownership. Failure to do so shall result in the forfeiture of rights to payment for covered ser…

General hospital groups un- der the diagnosis-related group (DRG) re- imbursement system. (a) Each general hospital participating in the Kansas medicaid/medikan program shall be assigned by the Kansas depart- ment of social and rehabilitation services to one of four groups. Each …

Reimbursement for general hospital inpatient services under the diag- nosis related group (DRG) reimbursement system. (a) The Kansas department of social and rehabilitation services shall reimburse general hospitals for inpatient services provided to recip- ients covered pursuant…

Scope of rural health clinic ser- vices.Ruralhealthclinicservicesandotherambu- latory services shall be covered under the Kansas 54 DEPARTMENT FOR CHILDREN AND FAMILIES 30-5-82a medical assistance program pursuant to 42 CFR 447.371, effective September 30, 1986, when provided by …

Reimbursement for rural health clinic services. Reimbursement for ru- ral health clinic services and other ambulatory services covered by the Kansas medical assistance program shall be at reasonable cost pursuant to 42 CFR 447.371, effective September 30, 1986; 42 CFR Part 413, r…

Scope of services for ambulato- ry surgical centers. Coverage shall be limited to non-elective surgical services, except for steriliza- tion operations or for participants in the Kan Be Healthy program. (Authorized by and implement- ing K.S.A. 39-708c; effective May 1, 1981; amen…

Reimbursement for ambula- tory surgical centers. Reimbursement shall be made as a fee for service established by the secre- tary. No fee shall be paid in excess of reasonable cost or charges, whichever is less. (Authorized by and implementing K.S.A. 39-708c; effective May 1, 1981…

This rule and regulation shall expire on January 1, 1990. (Authorized by and imple- menting K.S.A. 39-708c; effective May 1, 1981; amended May 1, 1983; amended May 1, 1986; amended May 1, 1988; amended July 1, 1989; re- voked Jan. 1, 1990.)

This rule and regulation shall expire on January 1, 1990. (Authorized by and implementing K.S.A. 39-708c; effective May 1, 1981; amended May 1, 1982; amended May 1, 1983; amended May 1, 1986; amended May 1, 1988; revoked Jan. 1, 1990.)

Scope of independent laborato- ry services. The services of independent labora- tories shall be available to program recipients if: (a) the laboratory has been certified by medicare to perform the services; (b) the laboratory is independent from the of- fice of the ordering physi…

Reimbursement for indepen- dent laboratory services. Reasonable fees as related to customary charges shall be paid for independent laboratory services, except no fee shall be paid in excess of the range maximum. The range of charges shall provide the base for computations. (Autho…

Scope of services by community mental health centers. (a) Community mental health center services shall be available to pro- gram recipients in: (1) Outpatient treatment programs licensed by mental health and retardation services; 56 DEPARTMENT FOR CHILDREN AND FAMILIES 30-5-86a …

Reimbursement for commu- nity mental health centers. Reasonable fees as related to customary charges shall be paid for community mental health center services, except no fee shall be paid in excess of the range max- imum. The range of charges shall provide the base for computatio…

Existing provider rates for community mental health centers. (a) For an existing provider and those providers resulting from a separation from or a division of an existing provider, the agency shall review the fee sched- ule retained for cost auditing and supplied annu- ally to t…

New provider rates for com- munity mental health centers. (a) Rates for the first 18 months of a new community mental health center shall be computed from projected costs. The first projection, based on 12-month projected cost data, shall apply to the first six months of operatio…

Financial recordkeeping for community mental health centers. (a) Records shall be maintained by the provider to document income and expenditures, hours of services pro- vided, allocation methodologies, and fees charged to and paid by private patient resources. (b) Each provider r…

Modification of prospective rates for community mental health centers. (a) Each community mental health center partic- ipating in the prospective payment system may re- quest that the rate review committee set forth in paragraph (g) modify its reimbursement rate if its current me…

Scope of the Kan Be Healthy program. Kan Be Healthy screenings shall be available at intervals designated by the Kansas de- partmentofsocialandrehabilitationservicesandat other medically necessary intervals for all program 58 DEPARTMENT FOR CHILDREN AND FAMILIES 30-5-87a recipien…

Reimbursement for Kan Be Healthy program services. (a) Reimbursement for screening and appropriate referral shall be made as a fee for service established by the secre- tary. No fee shall be paid in excess of reasonable cost or charges, whichever is less. (b) Reimbursement for di…

(Authorized by and implementing K.S.A. 1997 Supp. 39-708c; effective May 1, 1981; amended May 1, 1982; amended May 1, 1983; amended May 1, 1984; amended, T-85-9, April 11, 1984; amended May 1, 1985; amended May 1, 1986; amended May 1, 1988; amended, T-89-24, May 27, 1988; amended…

Reimbursement for physician services. (a) Reasonable fees as related to cus- tomary charges shall be paid for physician ser- vices, except no fee shall be paid in excess of the range maximum. The range of charges shall pro- vide the base for computations. (b) The maximum rate for…

Scope of home health services. (a) Covered home health services shall be avail- able to program recipients if both of the following conditions are met: (1) A physician has developed a plan of treat- ment and has certified the need for the service. (2) The service is determined to…

Reimbursement for home health services. (a) Reimbursement shall be based upon the fee for services and at a rate es- tablished by the secretary. (b) Reimbursement for medical supplies shall be pursuant to K.A.R. 30-5-108a. (Authorized by and implementing K.S.A. 39-708c; effective…

This rule and regulation shall expire on August 1, 1990. (Authorized by and implementing K.S.A. 1985 Supp. 39-708c; effec- tive May 1, 1981; amended May 1, 1983; amended May 1, 1986; revoked Aug. 1, 1990.)

(Authorized by and implementing K.S.A. 1982 Supp. 39-708c; effective May 1, 1981; amended May 1, 1982; amended May 1, 1983; re- voked May 1, 1986.)

(Authorized by and implementing K.S.A. 1983 Supp. 39-708c; effective May 1, 1981; amended May 1, 1985; revoked May 1, 1986.)

Scope of pharmacy services. (a) The medical services provided to program recipi- ents shall include pharmacy services. (1) Kan Be Healthy participants shall be limit- ed to those prescription-only and over-the-counter drugs, supplies, and devices that have been accept- ed for inc…

(Authorized by and implementing K.S.A. 1980 Supp. 39-708c; effective May 1, 1981; revoked May 1, 1985.)

Reimbursement for pharmacy services. (a) Each pharmacy provider shall be reimbursed for covered pharmacy services on the basis of product acquisition cost plus a dispensing fee. In no case shall reimbursement for a prescrip- tion exceed the lesser of the provider’s usual and cust…

Cost report requirement for pharmacy services. (a) The cost reports filed by pharmacy providers for professional fee determi- nation shall reflect data which coincides with the immediate fiscal year used for federal income taxes that ends prior to the cost report filing due date,…

Cost report data and record keepingrequirementsforpharmacyservices. (a) The principles of cost related reimbursement require that providers maintain sufficient financial and prescription records to facilitate appropriate cost reporting and professional fee determination. Standard…

Cost report data limitations and allowances for pharmacy services. (a) Allow- able costs for cost related reimbursement and professional fee determination shall be limited to those that arise from arms length transactions be- tween unrelated parties. Related parties shall exist w…