907 Ky. Admin. Regs. 18:001

Current through Register Vol. 51, No. 6, December 1, 2024

Section 907 KAR 18:001 - Definitions for 907 KAR Chapter 18

RELATES TO: 42 U.S.C. 1396a(a)(13)(A), 42 U.S.C. 1396a(a)(30)(A), 42 C.F.R. Part 413, 42 C.F.R. 447.204

NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and Family Services, Department for Medicaid Services has responsibility to administer the Medicaid Program. KRS 205.520(3) authorizes the cabinet, by administrative regulation, to comply with any requirement that may be imposed, or opportunity presented, by federal law to qualify for federal Medicaid funds. This administrative regulation establishes the definitions for 907 KAR Chapter 18.

Section 1. Definitions.

(1) "Allowable cost" means that portion of a facility's cost which may be allowed by the department for reimbursement purposes.

(2) "Ancillary service" means an ancillary service as established in 907 KAR 1:023.

(3) "Capital costs" means capital costs as established in 42 C.F.R. 413.130 through 157.

(4) "Cost report" means a copy of the cost report that a VA NF submits to the Medicare program.

(5) "Department" means the Department for Medicaid Services or its designee.

(6) "Federal financial participation" is defined by 42 C.F.R. 400.203.

(7) "Global Insight Index" means an indication of changes in health care costs from year to year developed by Global Insights Index.

(8) "Pro forma cost data" means estimated cost data for a specific future period of time.

(9) "Prospective payment rate" means a payment rate for services based on allowable costs and other factors.

(10) "Recipient" is defined by KRS 205.8451(9).

(11) "Regular part-time employee" means an employee who works part-time:

(a) On a continual basis; and

(b) Not on a short-term or temporary basis.

(12) "State fiscal year" means the twelve (12) month period beginning on July 1 of one year and ending on June 30 of the following year.

(13) "Upper payment limit" means an amount of reimbursement that:

(a) Equates to a Veterans Affairs nursing facility's Medicaid-allowable cost; and

(b) Does not exceed the limit established in 42 C.F.R. 447.272.

(14) "VA NF" means a nursing facility that meets the requirements of 907 KAR 18:005, Section 1.

907 KAR 18:001

40 Ky.R. 2658; 41 Ky.R. 44; eff. 8-1-2014; Cert eff. 5-27-2021.

STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.520(3)