8184 Payment Certification and Related Policies for Facilities -

 

8184.1 The MS-2126 - The MS-2126, The Notification of Nursing Facility Admission/Discharge - This form is used by the facility to communicate specific information to the eligibility worker regarding status which may impact payment to the facility. In most instances, the facility is required to maintain a copy of all MS-2126 forms sent and received. The facility is required to send a new MS-2126 in the following situations:
 

  1. An eligible customer is initially admitted to or discharged from the nursing facility (NF), nursing facility for mental health (NF/MH), intermediate care facility for the mentally retarded (ICF/MR), Psychiatric Residential Treatment Facility (PRTF), or other long term care facility.
     
  2. As requested by the eligibility worker, when a resident of an NF, NF/MH, ICF/MR, PRTF, or other long term care facility will likely become an eligible customer.
     
  3. A customer's eligibility has been reinstated after suspension for more than two months. (If two calendar months or less, a new form will not be needed).
     
  4. An eligible customer is out of the facility for more than 30 days. When a customer return to the facility on or before the 31st day, a new form will not be required. When customer fails to return after the 31st day, a new form MS-2126 is required to document the date of return.
     
  5. An eligible customer has a change in their level care.
     
  6. When an eligible recipient is discharged from the facility.
     
  7. An eligible customer transfer from one facility to another facility.

The nursing facility is responsible for submitting the completed MS-2126 to the KanCare Clearinghouse within 5 days of the events/request described above.  Failure to timely submit the form may cause a delay or denial of payment to the facility.  See also Section 7030 of the Nursing/Intermediate Care Facility Provider Manual.

 

 

8184.2 Decertification of Facility - KDADS or its designee and eligibility staff shall take appropriate steps to ensure that if an NF loses Medicaid certification help is given in the transition to the Medicaid customers who will need to find new residence. Specific instructions for eligibility staff will be given by KDHE-DHCF Policy if this need should arise.  Eligibility staff are responsible for notifying the resident and the resident's family or guardian of any continuing financial responsibility.

 

8184.3 Private Rooms - Generally, private rooms are not covered except when medically necessary or when utilized at the discretion of the facility. However, if a private room is not medically necessary or is not occupied at the discretion of the facility, a family member, guardian, conservator other third party may reimburse the difference between the usual and customary charge the Medicaid payment rate.

 

8184.4 Additional Charges - Because the NF program provides for room and board and all services and supplies required by residents in an NF, the NF may not charge program customers for providing routine services and supplies . The cost of providing such items is included in the home's per diem rate and is not to be billed or reimbursed.

 

In addition, a nursing facility may not charge an eligible recipient any amount in addition to the patient liability in order to expedite entry into the nursing facility or as a condition of entry or continued stay in the nursing facility. A nursing facility may charge for services required by the customer which are not considered by the agency to be part of the per diem rate, such as newspapers, smoking materials, etc. In addition, non-covered medical services (see 8172.1 (2)(b)) are also the responsibility of the client.