Medicaid Nursing Home Rates by State

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Kentucky

Medicaid nursing facility payment · Peer-group price · researched October 2026

Kentucky’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Peer-group price

Case-mix level

Facility average

Classification

PDPM

Rate updates

Quarterly

Managed care (LTC)

No

Quality program

Nursing Facility Quality Program

Paid outside the rate

Small

Bed hold

Hospital and leave

Published rates

Rates only

Assisted living

Not covered

Personal needs allowance

$60 / month

Overview

• Kentucky pays most nursing facilities a 'price-based' per diem: one standard price for urban facilities and one for rural facilities (by federal CBSA metro/non-metro area), not each home's own costs.
• The nursing (case-mix) part of the price is multiplied by the facility's quarterly Medicaid acuity score (PDPM nursing index).
• On top of that each home gets its own capital add-on from a building appraisal, an ancillary add-on (therapy, oxygen, lab, x-ray), and a quality add-on.
• Specialty units (ventilator, brain injury), IMDs and pediatric homes are paid on cost under a different rule (907 KAR 1:025).

What matters in Kentucky

• Rates rose an average 30.3% on 7/1/2024, but about $31.79/day only offsets a roughly tripled provider tax.
• Prices are statewide urban and rural standards, not each home's costs; nursing is scaled by quarterly Medicaid PDPM acuity.
• Since 7/1/2024 therapy, oxygen, lab and x-ray are paid inside the per diem (907 KAR 1:065), so rates are not comparable with states that bill them separately.
• The quality add-on is self-funded: every home gives up to $6.36/day of tax allowance and earns back a points-based share.
• Off-rate revenue is small: the county-owned home supplemental may pay nothing today, and managed care plans never pay nursing homes.
• Bed hold pays a flat 75% of the rate, up to 30 hospital days and 10 leave days a year.
• MDS audit sanctions of $0.50-$0.70 per patient day apply when sampled assessment accuracy falls below 80%.

Frequently asked

How much of Kentucky's 2024 nursing home rate increase was new money?

Rates rose an average 30.3% on 7/1/2024, but about $31.79 per day only offsets the higher provider tax. The remaining increase is about $49.69 per day, roughly 18%.

Does a Kentucky home with low quality scores lose money under the quality program?

Yes. The add-on is self-funded: every home gives up part of its tax allowance, up to $6.36 per day, and earns back a points-based share.

Does Kentucky Medicaid managed care pay nursing homes after the first 30 days?

No. Managed care plans never pay nursing homes, and residents are disenrolled after 30 days.

How much is paid outside the posted rate in Kentucky?

Small; a county-owned home supplemental may pay nothing today, plus a $550,000/yr pediatric pool.

What does Kentucky Medicaid pay on Medicare coinsurance days?

Medicaid pays its allowed amount minus Medicare's payment, so homes usually receive $0 of the coinsurance.

Does Kentucky require a minimum share of spending on care?

No; there is no direct-care spending floor or recoupment of unspent rate.

How is the Kentucky nursing home provider tax charged?

$19.89 per non-Medicare day standard, $6.38 for large homes; offset by a flat $36.66/day allowance from July 2026.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

Medicare cost report (CMS-2540) plus the Kentucky Supplemental Medicaid Schedules (incl. Schedule NF-7: Medicaid days, occupancy) and, since July 2024, the Kentucky Medicaid Nursing Facility Ancillary Supplemental Schedule (907 KAR 1:065 Sections 11, 12, 17).

Base year and rebasing

Standard prices were rebased effective July 1, 2024 using 2022 cost reports inflated by market basket to SFY 2025 ('rebased wages at the 2024 level'); the regulation says the price 'may be' rebased effective July 1, 2024 and 'at least once every four (4) years thereafter', which points to July 1, 2028; the wording is permissive, not mandatory (907 KAR 1:065 Section 5(8)(b)). Prices come from an analysis of fair-market pricing and historical cost for staffing ratios, wage rates, benefits/absenteeism and 'other cost' percentages, not facility-specific cost. Sources: 907 KAR 1:065 Section 5(3),(7),(8); M&S May 2024 Q&A A5.

Components

Component	Method	Notes
case-mix adjustable portion (direct care)	statewide price by urban/rural, multiplied by facility Medicaid CMI	Nursing personnel, activities, medical records, related supplies. 2024 level: urban $160.33, rural $136.05 per day before CMI (907 KAR 1:065 Section 5(7)).
noncase-mix adjustable portion	statewide price by urban/rural	Administration, food, professional support/consultation, and the allowance to offset the provider assessment. 2024 level (column 'without capital'): urban $133.70, rural $121.58; total standard price excluding capital urban $294.03, rural $257.63. Prices inflated each July 1.
noncapital facility-related component	uniform price	Listed separately in Section 6(1)(c); appears to be inside the noncase-mix figure in the Section 5(7) table (see open_questions).
capital rate component	facility-specific appraisal-based rental value (see capital)	Not inflated by the market basket; indexed by RS Means construction cost.
ancillary add-on	facility-specific pass-through-style per diem, reset each July 1	PT, OT, speech, oxygen, lab, x-ray. SFY2025: prior-year Medicaid ancillary payments / Medicaid days. SFY2026+: prior-year Medicaid ancillary volume priced at the lesser of charges or the posted ancillary fee schedule, / Medicaid days. Separate ancillary claims zero-pay since 7/1/2024 (SPA KY-25-0004; PL A-271).
quality add-on	pool distributed by points x Medicaid days	Started July 1, 2025; see quality_incentive.

Inflation

CMS Nursing Home without Capital Market Basket (version effective that July 1). The regulation says the standard price 'may be' adjusted for inflation every July 1 (Section 5(8)(a)), so the adjustment is permitted, not required, and budgets can withhold it; not applied to capital. Capital bed values indexed annually by RS Means Construction Cost Indexes (Kentucky cities). Source: 907 KAR 1:065 Sections 5(8)(a), 6(2).

Verified October 14, 2026

Case mix

System

PDPM

Applied at

Facility average

How it works

One rate per home: the case-mix part of the price x the home's quarterly time-weighted Medicaid average case-mix index, paid the same for every Medicaid resident (907 KAR 1:065 Sections 6(1)(a), 7(1)-(3); SPA KY-25-0004 Exhibit A).

Classification

PDPM nursing component (CMS PDPM nursing CMIs; no therapy CMI). Residents discharged before an MDS: LBC2 if died/hospitalized, otherwise CBC2.

Applies to

case-mix adjustable portion of the standard price only

Acuity measured from

Time-weighted average (days each MDS is active across the whole quarter, not a snapshot) for Medicaid residents plus dual-eligible residents in a Medicare Part A stay; MDS extracted on the last day of each calendar quarter. Statewide Medicaid average CMI for 7/1/2026 rates: 1.5293.

Updated

quarterly (Jan 1, Apr 1, Jul 1, Oct 1); a rate uses the quarter ending two quarters earlier (e.g., 7/1 rates use Jan-Mar MDS); corrections accepted until the day before the rate effective date

Move to PDPM

Moved off RUG-III 34-group: 7/1/2024 rates 25% PDPM / 75% RUG; 10/1/2024 50/50; 1/1/2025 75/25 (RUG portion frozen at the 1/1/2024 RUG CMI); 100% PDPM from 4/1/2025. April 2024 CMI was frozen at the prior quarter. Sources: 907 KAR 1:065 Section 7(15)-(16); KY_Medicaid_Average_CMI.pdf.

Verified October 11, 2026

Low-acuity residents

None found. Kentucky has no reduced or flat rate for residents in the lowest PDPM nursing groups: every Medicaid resident in a price-based NF is paid the home's single rate, and low-acuity residents only pull down the facility's average case-mix index. Checked 907 KAR 1:065 (current, eff. 1-22-2026) including Sections 5-7, SPA KY-25-0004 (Attachment 4.19-D Exhibits A-B), and 907 KAR 1:022 (patient status). The nearest rule is level-of-care, not price: a resident must meet low-intensity or high-intensity nursing 'patient status' (907 KAR 1:022 Section 4); if a reevaluation finds they no longer qualify, payment continues only 10 calendar days, then stops (Section 5(3)), except long-stay residents protected by the transfer-trauma rule. Sources: https://apps.legislature.ky.gov/law/kar/titles/907/001/065/; https://www.chfs.ky.gov/agencies/dms/Documents/250004NursingF… https://apps.legislature.ky.gov/law/kar/titles/907/001/022/

Verified October 11, 2026

Capital

Appraisal-based rental value: depreciated replacement cost from appraisal (CoreLogic Commercial Express; statewide reappraisal 2009 then every 5 years, plus reappraisal after renovations >= $75K for <=60 beds or >= $150K for >60 beds), divided by licensed beds and capped at $80,278 per bed effective 7/1/2024 (indexed each July 1 by RS Means); plus land at 10% of bed value and $2,000/bed equipment; times a rate of return = 20-yr Treasury + 2% (floor 9%, ceiling 12%); divided by the greater of actual bed days or 90% occupancy. Sources: 907 KAR 1:065 Sections 4, 6(2); SPA KY-25-0004 Exhibit A p.2.

Verified October 11, 2026

Budget adjustment factor

None found. Rates are not scaled by a budget-neutrality factor; the reg allows DMS to adjust the standard price for new mandated minimum wages/staffing ratios or new licensure requirements (Section 5(9)). County-owned hospital-based NFs have a floor at their 6/30/2002 rate (Section 10).

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

small

Estimate

Section 15 UPL amount unconfirmed (no public payment figure found). Eligibility is frozen to NF-7 data as of 12/31/2000 and payment is 'subject to state funding made available ... by a transfer of funds from a governmental entity', so it is likely zero or near-zero today. Pediatric NF supplemental pool $550,000/yr (907 KAR 1:025). NFs are carved out of managed care, so no MCO directed payments.

Components

907 KAR 1:065 Section 15: UPL supplemental for NFs owned/operated by a local unit of government with >=140 Medicaid-certified beds and >=75% Medicaid occupancy, split by share of Medicaid days, quarterly, capped at the 42 CFR 447.272 UPL, IGT-funded. Whether any home currently receives it could NOT be confirmed. Quality pool (Section 13; 15% of the 7/1/2024 provider-assessment increase for 7/1-12/31/2026, 20% from 1/1/2027) is funded by reducing the assessment offset and paid in the per diem, not off-rate.

Source

https://apps.legislature.ky.gov/law/kar/titles/907/001/065/

Verified October 11, 2026

Payments by owner type

Applies

yes

Detail

Section 15 UPL supplemental payments are limited to non-state government-owned or operated NFs with at least 140 Medicaid-certified beds and at least 75% Medicaid occupancy, split by share of Medicaid days and capped at the UPL. County-owned hospital-based NFs also keep a rate floor at their 6/30/2002 rate (Section 10). Whether any home currently qualifies for Section 15 was not confirmed, so the real gap may be zero.

Funding

IGT from the governmental owner. No lease or management arrangement described.

Source

https://apps.legislature.ky.gov/law/kar/titles/907/001/065/

Verified October 11, 2026

Quality program

Program

Kentucky Medicaid Nursing Facility Quality Program (quality add-on), 907 KAR 1:065 Section 13; SPA KY-25-0004 approved 8/21/2025, effective 7/1/2025

Funding

Carved from the provider-tax allowance in the rate (budget neutral to the state): the $41.43/day assessment allowance is reduced by the pool amount; pool = 5% -> 10% -> 15% -> 20% of the July 2024 assessment increase. Unspent funds roll into the next SFY pool. Source: 907 KAR 1:065 Section 13(1)-(3).

Size

$1.59 x Medicaid days (Jul-Dec 2025, ~$2M/quarter); $3.18 (Jan-Jun 2026, ~$4M/quarter); $4.77 (Jul-Dec 2026, ~$6M/quarter); $6.36 from Jan 2027 (~$8M/quarter, ~$32M/yr at full phase-in). Sources: SPA KY-25-0004 Exhibit A p.3(a); M&S QIP presentation slide 6.

Paid as

per-diem add-on on the facility rate (added to standard price + ancillary add-on)

Measures

Measure	Source	Weight	How points are earned
Long-stay residents with a urinary tract infection (QM 407)	MDS QM via CMS Care Compare	100 of 700 points (1/7)	CMS Five-Star Technical Users' Guide QM cut points, 5 tiers (points per tier not published; see open_questions)
Long-stay residents with one or more falls with major injury (QM 410)	MDS QM via CMS Care Compare	100 of 700 points (1/7)	CMS Five-Star Technical Users' Guide QM cut points, 5 tiers (points per tier not published; see open_questions)
Long-stay residents with pressure ulcers (QM 479)	MDS QM via CMS Care Compare	100 of 700 points (1/7)	CMS Five-Star Technical Users' Guide QM cut points, 5 tiers (points per tier not published; see open_questions)
Long-stay residents who received an antipsychotic medication (QM 419)	MDS QM via CMS Care Compare	100 of 700 points (1/7)	CMS Five-Star Technical Users' Guide QM cut points, 5 tiers (points per tier not published; see open_questions)
Occupancy percentage	state: Supplemental Medicaid Schedule NF-7 (cost report)	100 of 700 points (1/7)	5 tiers at 25% / 60% / 80% / 90% / 95% occupancy (points per tier not published)
Medicaid utilization (Medicaid share of days)	state: Supplemental Medicaid Schedule NF-7 (cost report)	100 of 700 points (1/7)	5 tiers at 25% / 60% / 80% / 90% / 95% (points per tier not published); meant to offset QM results for homes taking complex Medicaid residents
Behavioral Health Center of Excellence-NF (COE-NF) participation	state: Behavioral Health Metric Attestation Statement + documents uploaded to the M&S portal	100 of 700 points (1/7); 25 points per completed tier	4 progressive tiers: 1 Engage (annual 1:1 consult); 2 Assess (annual behavioral health needs assessment + action plan); 3 Educate (3 BH champions, 3 trainings each per year); 4 Champion (2+ staff per department complete MH101/suicide prevention/de-escalation training). Each tier expires 1 year after completion.
Pneumococcal (QM 415) and influenza (QM 454) vaccination	MDS QM via CMS Care Compare	0 (informational only on score card)	not scored

Scoring period

Updated quarterly using the most recent information as of the day before the rate effective date (Section 13(6)): latest CMS Care Compare QM values; occupancy, Medicaid utilization and Medicaid days from the Supplemental Medicaid Schedules (NF-7) filed with the latest cost report; behavioral health attestations due June 30 / Sept 30 / Dec 31 / Mar 31 for July / Oct / Jan / Apr rates (late items roll to the next quarter). The exact Care Compare release used each quarter is not stated.

Payment formula

Pro-rata share: total points / 700 x facility Medicaid days = quality-adjusted Medicaid days; facility share = its quality-adjusted days / statewide total (2,946,459 in the Mar/Apr 2025 draft cards); add-on per day = annualized pool x share / facility annualized Medicaid days. No minimum score.

Eligibility

Price-based NFs under 907 KAR 1:065 (cost-based ventilator/brain injury/IMD/pediatric/ICF-IID facilities excluded). No disqualifiers (e.g., immediate jeopardy, SFF) found in the regulation or SPA.

Cadence

scored and paid quarterly through the rate (Jan 1, Apr 1, Jul 1, Oct 1)

Scores published

No. Per-facility quality score cards (name, Medicaid #, cut points, points, per diem) go to each facility on the Myers and Stauffer portal (https://kycasemixreports.mslc.com/); public rate files show only the final rate. Sample layout: https://myersandstauffer.com/documents/KY/Downloads/Nursing%2…

Notes

Redistributive: every price-based home loses the allowance cut ($1.59 rising to $6.36/day) and earns back its pro-rata share, so low scorers net less than before. Sources: https://apps.legislature.ky.gov/law/kar/titles/907/001/065/ Section 13; https://www.chfs.ky.gov/agencies/dms/Documents/250004NursingF… https://myersandstauffer.com/documents/KY/Downloads/Nursing%2…

Verified October 11, 2026

Provider tax

Charged

per non-Medicare day

Standard amount

$19.89 per non-Medicare bed day for NFs with < 60,000 days (eff. 7/1/2024; was $12.85)

Tiers

Who	Test	Amount
NFs with > 60,000 days (volume test on total days, not Medicaid days)	volume	$6.38 per non-Medicare day (was $4.12)
hospital-based NFs	hospital_based	$5.63 per non-Medicare day (was $3.64)
NFs with ICF and < 60 beds	size	$2.82 per non-Medicare day (was $1.82)

Lower for high-Medicaid homes

no

Returned in the rate

Flat assessment allowance in the noncase-mix price: $41.43/day from 7/1/2024 (was $9.64), cut to fund the quality pool: $39.84 (Jul-Dec 2025), $38.25 (Jan-Jun 2026), $36.66 (Jul-Dec 2026), $35.07 (from Jan 2027).

Source

https://www.chfs.ky.gov/agencies/dms/ProviderLetters/PL-NF%20…).pdf

Verified October 11, 2026

Provider tax notes

Nursing Facility Services Assessment (KRS 142.361/142.363), per non-Medicare bed day, eff. 7/1/2024: hospital-based NF $5.63 (was $3.64); NF with ICF and < 60 beds $2.82 (was $1.82); NF with < 60,000 days $19.89 (was $12.85); NF with > 60,000 days $6.38 (was $4.12). Returned through a flat allowance in the noncase-mix price: $41.43/day from 7/1/2024 (was $9.64), reduced to fund the quality pool: $39.84 (Jul-Dec 2025), $38.25 (Jan-Jun 2026), $36.66 (Jul-Dec 2026), $35.07 (from Jan 2027). Sources: PL A-271; M&S May 2024 Q&A A21; SPA KY-25-0004 Exhibit A p.2.

Verified October 11, 2026

Supplemental payments

907 KAR 1:065 Section 15: UPL supplemental payments to non-state government-owned/operated NFs with >= 140 Medicaid-certified beds and >= 75% Medicaid occupancy, funded by IGT from the governmental owner, distributed quarterly by share of Medicaid days, capped at the 42 CFR 447.272 UPL. No MCO directed payments (NF is carved out of managed care). Whether any facility currently qualifies/receives Section 15 payments was not confirmed.

Verified October 11, 2026

Other add-ons

Ancillary add-on (facility-specific; see components and per_diem_inclusions) and quality add-on. No ventilator, brain-injury, behavioral or bariatric add-ons inside the price-based system (those units are paid under 907 KAR 1:025; see special_payment_systems). No COVID-era add-ons found in the current regulation.

Verified October 11, 2026

Units paid separately

Paid under 907 KAR 1:025, not the price system. Distinct-part ventilator units (min 20 beds, census 15) get an all-inclusive fixed rate: hospital-based $583.82/day; freestanding $317.29/day plus a KRS 142.363 provider-tax add-on (both SFY2006 bases, inflated yearly by the IHS Markit NF index). Distinct-part brain injury units (10+ beds, CARF/Joint Commission accredited) get an all-inclusive $530/day, or a negotiated rate capped at usual and customary charges for neurobehavioral cases. Drugs are excluded from both and paid by pharmacy. IMDs, dually-licensed pediatric facilities and ICF/IID get facility-specific prospective cost-based rates (latest cost data trended to July 1, subject to class maximums and the UPL); pediatric facilities share a $550,000/yr supplemental pool (>= 85% Medicaid occupancy). Critical access hospital swing beds have their own rate (907 KAR 1:065 Section 3(2)). Current-year ventilator/brain injury dollar amounts are not in the public rate file. Sources: https://apps.legislature.ky.gov/law/kar/titles/907/001/025/ Sections 3, 6, 7, 10, 11; https://apps.legislature.ky.gov/law/kar/titles/907/001/065/ Section 2(3).

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

no

Detail

Fee-for-service; plan members are disenrolled after 30 days in a home and plans never pay the nursing home

Verified October 11, 2026

Who pays

fee_for_service (MCO enrollees are disenrolled after 30 days in a nursing facility, and MCOs are not responsible for nursing facility services even in the first 30 days; NF per diem is paid by DMS FFS)

Verified October 11, 2026

Managed care rate floor

Not applicable: nursing facility services are carved out of Kentucky Medicaid managed care. 907 KAR 17:020 Section 3(3)(i) says an MCO is not responsible for 'a nursing facility service for an enrollee during the first thirty (30) days of a nursing facility admission', and 907 KAR 17:010 Section 2(3) bars MCO enrollment for anyone residing in a nursing facility more than 30 days. Sources: https://apps.legislature.ky.gov/law/kar/titles/907/017/020/ and https://apps.legislature.ky.gov/law/kar/titles/907/017/010/

Verified October 11, 2026

Included in the daily rate

Included: room and board, dietary, nutritional supplements, social services/activities, nursing, respiratory therapy and supplies (routine), equipment and facility use, medical-surgical supplies, laundry, personal items, over-the-counter drugs, and DME/supplies (must be furnished by the NF, not billed separately). Since 7/1/2024 also PT, OT, speech therapy, oxygen, lab and x-ray, through the facility ancillary add-on (separate claims zero-pay). Paid separately: prescription drugs (pharmacy program). Dentures, lenses/frames and hearing aids come from patient liability/spend-down. Transport not addressed in 907 KAR 1:065 (see open_questions). Sources: https://apps.legislature.ky.gov/law/kar/titles/907/001/065/ Sections 8(5)-(6), 12; https://www.chfs.ky.gov/agencies/dms/Documents/250004NursingF… https://myersandstauffer.com/documents/KY/Downloads/Nursing%2… (A27-A28).

Verified October 11, 2026

Bed hold

Hospital stays

Paid, up to 30 days per resident per calendar year, at 75% of the facility rate; the day count follows the resident if they move to another NF within the year.

Leave days

Paid, up to 10 days per resident per calendar year (non-hospital leave of absence), at 75% of the facility rate.

Occupancy rule

None since 7/1/2024. Before that, bed-reserve days were paid at 75% only if the home's occupancy was >= 95%, otherwise 50% (Jan 2024 rate file: 240 homes at 50%, 13 at 75%; July 2024: all 252 at 75%).

Notes

Applies to NF and NF-with-waiver. Rate files list 'Percent of Rate for Bed Reserve Days' = 75% for every facility. Conflicting older text in 907 KAR 1:022 Section 9 (14 hospital days; 75%/50% by 95% occupancy) has not been conformed; 907 KAR 1:065 Section 8(4) and rate files show 30 days at 75%.

Source

https://apps.legislature.ky.gov/law/kar/titles/907/001/065/ (Section 8(4))

Verified October 11, 2026

Personal needs allowance

Per month

60

Effective

2024 (HB 6, 2024-26 budget; likely 2024-07-01)

Notes

907 KAR 20:035: PNA $60 (up from $40), required by HB 6 of 2024 (Acts Ch. 175); NF base rate includes it. $90 of VA benefits excluded from income; VA aid and attendance/UME excluded post-eligibility in non-state NFs. Not COLA-indexed.

Confidence

confirmed

Source

https://apps.legislature.ky.gov/law/kar/titles/907/020/035/

Verified October 11, 2026

Medicare coinsurance days

Method

lesser_of

Rule

Lesser-of. 907 KAR 1:006 Sec. 3: Part A deductible/coinsurance paid = the lesser of (a) the Medicaid-allowed amount minus the Medicare payment, or (b) the Medicare coinsurance and deductible, up to the Medicaid-allowed amount. Sec. 4: the department pays premiums, deductibles, coinsurance and copays for a QMB enrolled in a Medicare managed care organization (MA). It sets no separate pricing for those, so the lesser-of cap presumably applies (likely).

Effect

The home is paid only if its KY Medicaid rate is above Medicare's payment, so for most SNF coinsurance days it gets $0.

Confidence

confirmed

Source

https://apps.legislature.ky.gov/law/kar/titles/907/001/006/

Medicare Advantage

lesser-of: 907 KAR 1:006 Sec. 4: the department pays Part A and B premiums, deductibles, coinsurance and copays for a QMB enrolled in a Medicare managed care organization, and '(2) The department shall reimburse deductibles and coinsurance in accordance with Section 3.' Section 3 sets lesser-of for Part A and for listed services including nursing facilities: the lesser of Medicaid-allowed minus Medicare payment, or the coinsurance and deductible up to the Medicaid-allowed amount. Explicit text, but it covers QMBs only.

Medicare Advantage source

https://apps.legislature.ky.gov/law/kar/titles/907/001/006/

Verified October 11, 2026

Required care spending

Applies

no

Rule

No direct-care or staffing spending floor and no recoupment of unspent rate in 907 KAR 1:065 (full text checked: no spend/expend/pass-through requirement). The only staffing link runs the other way: the department adjusts the standard price if a government imposes a mandatory minimum wage or staffing ratio increase (Section 5(9)). A KRS-level requirement was not separately checked (search budget exhausted).

Source

https://apps.legislature.ky.gov/law/kar/downloads/docs/16691/…

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

(1) Capital (appraisal-based rental value) is divided by the greater of actual bed days or 90% occupancy. (2) Section 15 UPL payments require 75%+ Medicaid occupancy, and the pediatric pool 85%+ Medicaid occupancy. (3) The old bed-hold occupancy test (75% of rate only if occupancy >= 95%, else 50%) ended 7/1/2024 for price-based homes; bed hold is now a flat 75%.

Source

https://apps.legislature.ky.gov/law/kar/titles/907/001/065/

Verified October 11, 2026

MDS accuracy penalties

Myers and Stauffer validates a stratified random sample (greater of 30% of Medicaid residents or 15 MDS assessments; at least 15 reviewed) against medical records. Sanctions per patient day: 65-79% accurate = $0.50; 40-64% = $0.60; below 40% = $0.70 (so 80%+ is the implied passing threshold), applied on the rate effective date after the review starts. Since rates effective 7/1/2025 the CMI is also recalculated on the review findings and payments adjusted. Reconsideration within 10 business days, then appeal under 907 KAR 1:671; suspected after-the-fact documentation is referred to OIG for fraud review. Earlier text deferring sanctions was removed by the 1/22/2026 amendment. Sources: https://apps.legislature.ky.gov/law/kar/titles/907/001/065/ Section 7(3)-(14); https://www.chfs.ky.gov/agencies/dms/Documents/907-001-065-SS…

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

quarterly

When

Case mix and quality add-on quarterly; prices, capital and add-ons Jul 1

Verified October 11, 2026

When rates change

Standard price inflation and rebasing (both permissive: the price 'may be' adjusted), capital and ancillary add-ons reset July 1 (SFY). Case-mix and quality add-on recomputed quarterly (Jan 1, Apr 1, Jul 1, Oct 1). July rates are usually issued the last week of July and claims reprocessed.

Verified October 14, 2026

Posted rates

Home-level rates published

Yes

Where

https://www.chfs.ky.gov/agencies/dms/Pages/feesrates.aspx (current) and https://www.chfs.ky.gov/agencies/dms/Pages/feerateschedulearc… (archive)

Format

xlsx and pdf (current); pdf only in archive

Cadence

quarterly (Myers and Stauffer prepares; e.g. July 1, 2026 file dated 7/27/2026)

History

Archive has quarterly files from Oct 2022: Oct22, Jan23, Apr23, Jul23, Oct23, Jan24, Jul24, Oct24, Jan25, Apr25, Jul25, Oct25; current page has Jul 2026. Apr 2024, Jan 2026 and Apr 2026 not found on either page as of 2026-10-11. URL pattern https://www.chfs.ky.gov/agencies/dms/DMSFeeRateSchedules/NFRa… (Mon = Jan/April/July/Oct).

Home identifier

Facility name only (no Medicaid provider #, NPI or CCN). Columns: Facility, Final Medicaid Rate, Percent of Rate for Bed Reserve Days. ~253 price-based facilities in the July 2026 file. Total rate only, no component breakdown.

Verified October 11, 2026

Rate build-ups

Published

No

Where

Not public. Facility-specific files (rate/CMI rosters, appraisal reports, quality score cards) are posted to each facility on the Myers and Stauffer Kentucky Web Portal (login, two-factor, PHI). Public supporting files at https://myersandstauffer.com/provider-resources/kentucky/: statewide average CMI history, ancillary fee schedule, supplemental schedules, a sample quality score card layout (KYQualityIncentiveProgram.pdf).

What they show

Public: nothing per facility beyond the final rate. Portal score cards show provider name, Medicaid #, measure cut points, points, Medicaid days and quality per diem; rate build-up sheet contents not confirmed.

Example file

https://myersandstauffer.com/documents/KY/Downloads/Nursing%2… (sample score card only; no per-facility rate calculation file is public)

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

no

Program

None. Kentucky's Home and Community Based (HCB) 1915(c) waiver serves people in their own homes; residents of assisted living communities or personal care homes are not served under it.

What is paid

Medicaid pays for neither ALF services nor room and board. Kentucky State Supplementation (a state cash payment, not Medicaid) helps low-income residents of personal care homes and family care homes.

Rate

n/a

Limits

n/a

Source

https://www.payingforseniorcare.com/kentucky

Verified October 11, 2026

Sources

1. 907 KAR 1:065 Payments for price-based nursing facility services (eff. 1-22-2026) · regulation
2. 907 KAR 1:065 Suggested Substitute, Final 12-3-2025 · regulation
3. KY SPA 25-0004, Attachment 4.19-D (quality program, ancillary), approved 8/21/2025 eff. 7/1/2025 · state plan
4. DMS Provider Letter A-271: NF Assessment Rates, Allowance and Ancillary Change (7/8/2024) · agency page
5. DMS Nursing Facility rates effective July 1, 2026 (xlsx) · rate file
6. DMS Fee and Rate Schedules / Archive (Nursing Facility) · agency page
7. DMS Nursing Facility Services provider page (PT 12) · agency page
8. Myers and Stauffer (DMS contractor) Kentucky provider resources · agency page
9. Kentucky Medicaid Statewide Average CMI (July 2026) · agency page
10. Nursing Facility Rate Updates Q&A, May 30, 2024 · agency page
11. KY Quality Incentive Program presentation · agency page
12. 907 KAR 17:010 Managed care organization requirements (NF exclusion) · regulation
13. 907 KAR 17:020 MCO service coverage (NF services not MCO responsibility) · regulation
14. DMS filing statement for 907 KAR 1:065 amendment (1/11/2024) · agency page
15. 907 KAR 1:025 Payment for ICF/IID, dually-licensed pediatric facility, IMD, or NF with an all-inclusive rate unit · regulation
16. M&S MDS Electronic Posting Schedule (March 2026) · agency page
17. 907 KAR 1:022 Nursing facility services and ICF/IID services (patient status, 10-day payment after loss of status, transfer trauma, reserved bed days) · regulation
18. DMS Nursing Facility rates effective January 1, 2024 (Myers and Stauffer, 1/23/2024) · rate file
19. DMS Nursing Facility rates effective July 1, 2024, revised (Myers and Stauffer, 8/12/2024) · rate file
20. Medicare crossover / coinsurance rule · regulation
21. spending_requirements source · regulation
22. Personal needs allowance · regulation
23. PayingForSeniorCare: Kentucky assisted living and Medicaid · secondary

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