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Nursing Facility Services

Nursing Facility Services are provided by Medicare and Medicaid certified nursing facilities.

What's New

Attention Long-Term Care Providers

The revised September 2012 Documentation Guidelines will go into effect with the Oct. 1, 2012 RUG Audit Review process. The documentation guidelines have been updated to reflect the April 2012 RAI Manual revisions. These revisions will not impact the requirements used to validate the MDS items, as conducted by Carewise Health, Inc. This document is available under the Policy Information Section location on the right.

Attention: Significant Change in Condition/Disposition Form

To review this change recently approved by Medicaid for nursing facility use, refer to the revised (MAP-4095) - PASRR Significant Change/Discharge Data.

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What are Medicaid Nursing Facility Services?

Nursing facility services included in per diem rate are room and board, dietary services, nutritional supplements, social services, activities, respiratory therapy and supplies, nursing services, the use of equipment and facilities, medical and surgical supplies, prosthetic devices, laundry services, drugs ordered by the physician and personal items routinely provided by the facility.

Other services, if medically necessary and if ordered by the physician, are X-rays, physical therapy, speech therapy, occupational therapy, laboratory services, oxygen and related oxygen supplies and may be billed separately from the per diem rate.

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Who is eligible for Nursing Facility Services?

You may be eligible for nursing facility services if:

  • You reside in a facility participating in the Kentucky Medicaid Program and are placed in a Medicaid-certified bed;
  • You require and meet the nursing facility level of care criteria (as defined by Section 4 of 907 KAR 1:022) giving consideration for the medical diagnosis, age-related dependencies, care needs, services and health personnel required to meet these needs and the feasibility of meeting the needs through alternative institutional or non-institutional services; and
  • You meet the income and resource limitations required by the program.

Pre-Admission Screening and Resident Review (PASSR) Information

For information on completing the Level I Screening and Level II evaluation, visit the Department for Behavioral Health, Developmental and Intellectual Disabilities PASSR website. You may access forms, manual and regulations from this site.

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How Can I Apply?

An application for Medicaid may be filed at your local Department for Community Based Services Office. At the time of application, an individual or family should bring proof of:

  • Social Security Number;
  • Proof of identity (drivers license);
  • Proof of citizenship (birth certificate);
  • Health insurance;
  • Medical bills
  • Income
  • Resources
  • Life insurance policies or burial reserves

A Medicaid application is more likely to be processed sooner if the individual or family provides the above information.

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What if I Want to Stay in my Home?

There are Medicaid Waiver programs that can provide Medicaid coverage for many different services that help you stay in your home. For more information, click here.

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Archive Fee Schedules

Nursing Facility (NF) Laboratory Fee Schedule

  • NF Laboratory Fee Schedule as of Jan. 2012: PDF - Excel
  • NF Laboratory Fee Schedule as of Jan. 2011: PDF - Excel
  • NF Laboratory Fee Schedule as of Jan. 2010: PDF - Excel

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Archive Rate Schedule

2013 Nursing Facility (NF) Rate Schedule

2012 Nursing Facility (NF) Rate Schedule

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2011 Nursing Facility (NF) Rate Schedule

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2010 Nursing Facility (NF) Rate Schedule

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2009 Nursing Facility (NF) Rate Schedule

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2008 Nursing Facility (NF) Rate Schedule

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2007 Nursing Facility (NF) Rate Schedule

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Regulations, Policy Information, Forms, Provider Letters, Billing Information and Publications
 

Regulations

Policy Information

Provider Letters

To view older provider letters, refer to the Provider Letter page.

Forms

  • Census Cover Sheet and Instructions and Medicaid Reserved Bed Days Q and A's
  • MAP-350NF - Certification Form and Instructions (03/09)
  • MAP-409 - Pre-Admission Screening and Resident, Review (PASRR) Nursing Facility Identification Screen (LEVEL I)
  • MAP-4092 - Exempted Hospital Discharge Physician Certification of Need for Nursing Facility Service
  • MAP-4093 - Provisional Admission To A Nursing Facility
  • MAP-4094 - Notification of Intent To Refer For LEVEL II PASRR
  • MAP-4095 - PASRR Significant Change/Discharge Data
  • MAP-524 - Medicaid Nursing Facility Services Fact Sheet
  • MAP-575 - Request for Reconsideration of Resource Utilization Group (RUG) Audit Determination Form and Instructions
  • MAP-703 - Request for Reconsideration Ancillary Therapy Billing (rev 3/14)  
  • Map -726A - Nursing Level of Care Request for Admission (Rev. 09/03)

Billing Information

Publications
Nursing Facility Listing

 

For questions regarding
 

Policy contact:
Division of Policy and Operations
Benefits Branch
275 East Main St
6W-D
Frankfort, KY 40621
Phone: (502) 564-6890
E-mail:
CHFS DMS Webmaster

Rates contact:
Division of Fiscal Management
Rate Setting Branch
275 East Main St
6W-C
Frankfort, KY 40621
Phone: (502) 564-8196

Nursing Home assistance contact:
(502) 564-6890

Billing issues contact (800) 807-1232

 

Last Updated 3/10/2014
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