Rate Setting C5987

2026-11-03

For all providers , facilities , and / or practitioners receiving a “ rate ”, either per diem , per service , per hour , or per elapsed time period ; or a “ cost settlement ” in lieu of a rate , the Vendor is expected to provide analytical services that result in a rate or cost settlement that is in compliance with Code of Federal Regulations ( CFR ), Kentucky Revised Statutes ( KRS ), State Plan Amendments ( SPA ), Kentucky Administrative Regulations ( KAR ) and material ( s ) incorporated by reference , billing manuals , transmittal letters , policies and procedures and an Ancillary Settlement Adjustment Report ( if applicable ), and the budget bill or expenditure targets as provided by the Department . Perform the following responsibilities for all aforementioned facilities and additional facilities , clinics , and provider types as requested by the Department . 1 . Conduct desk audits / reviews of cost reports submitted by Medicaid providers and / or revision of or creation of cost reports and cost report instructions required by Medicaid . Further , when requested , the Vendor is expected to perform approximately , but not limited to , 80 field audits ( expected to be broken down as approximate 50 field audits for Hospitals and Nursing Facilities , and approximately 30 field audits for Primary Care and Rural Health ) of Medicaid providers who are required to submit a cost report . Department reserves the right to make a request for field audits of any cost - based provider type . a . Review and approve alternate cost report forms ; b . Maintain Provider facility information database and provide listing to the Department ; c . Monitor Provider ’ s fiscal year end dates , prepare and mail cost report request letters , forms and instructions to providers and the Department within 10 calendar days following fiscal year end ; d . Mail “ At Risk of Delinquency ” letters to any providers who have not submitted their cost report two weeks prior to the cost report due date . The letter should indicate their deadline , the consequences of not meeting the deadline , and the information on how to apply for an extension ; e . Communicate with the Department regarding the status of delinquent cost reports ; f . Upon receipt of a delinquent cost report , notify the Department within three ( 3 ) days , g . Receive , track , and review Provider cost reports monthly ;

Kentucky

2026-05-08