907 KAR 1:510. Payments for psychiatric residential treatment facility services.

RELATES TO: KRS 205.520, 216B.450, 216B.455, 216B.459

STATUTORY AUTHORITY: KRS 194.050, 42 CFR 440.160, 42 USC 1396a-d, EO 96-862

NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health Services, Department for Medicaid Services has responsibility to administer the Medicaid Program. Executive Order 96-862, effective July 2, 1996, reorganizes the Cabinet for Human Resources and places Department for Medicaid Services and the Medicaid Program under the Cabinet for Health Services. KRS 205.520 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 provisions relating to payments for psychiatric residential treatment facility services.

Section 1. Definition.

"Psychiatric residential treatment facility" (PRTF) means an appropriately licensed PRTF participating in the Medicaid Program.

Section 2. Payment Rates.

Covered inpatient psychiatric facility services for individuals under twenty-two (22) years of age provided in PRTFs of sixteen (16) beds or less shall be paid for in accordance with the following:

(1) The PRTFs shall be paid a fixed rate of $230 per diem which shall be adjusted upward each biennium by 2.22 percent, or usual and customary charge if less; however, the payment shall not exceed prevailing charges in the locality for comparable services provided under comparable circumstances.

(2) The fixed rate, or usual and customary charge if less, covers total facility costs for covered PRTF services, excluding the cost of drugs, as follows:

(a) All care and treatment costs;

(b)Costs for all ancillary services, excluding the cost of drugs which shall be reimbursed through the pharmacy program;

(c) Capital costs; and

(d) Room and board costs.

Section 3. Cost Reports and Audits.

PRTFs shall file a cost report annually using a uniform cost report form prescribed by the Department for Medicaid Services. The cabinet may audit the cost reports as it deems necessary.

Section 4. Access to PRTF Fiscal and Services Records.

Access shall be granted to PRTF fiscal and services records to the extent determined necessary by the cabinet, as follows:

(1) To assure accuracy of the cost report, that services are provided in accordance with the standards shown in this administrative regulation and in 907 KAR 1:505; and

(2) The PRTF is complying with all terms and conditions of the provider agreement between the cabinet and PRTF.

(3) Representatives of the United States Department of Health and Human Services, Inspector General's Office, and Attorney General's Office shall have access to PRTF records to the extent necessary to perform their functions which relate to the Medicaid Program.

Section 5. Implementation Date.

The provisions of this administrative regulation shall be applicable for services provided on or after November 1, 1995.

(18 Ky.R. 601; eff. 10-6-91; Am. 22 Ky.R. 1908; eff. 6-6-96.)