reglab/statecodes huggingface dataset:
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:023 - Review and approval of selected therapies as ancillary services in nursing facilities

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO: 42 C.F.R. Parts 430, 431, 432, 433, 435, 440, 442,
				447, 455, 456,
				42 U.S.C.
				1396a, b, d
NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective
				July 9, 2004, reorganized the Cabinet for Health Services and placed the
				Department for Medicaid Services and the Medicaid Program under the Cabinet for
				Health and Family Services. The Cabinet for Health and Family Services,
				Department for Medicaid Services, has responsibility to administer the Medicaid
				Program.
				KRS
				205.520(3) authorizes 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 administration regulation
				establishes the provisions relating to the review and approval of selected
				therapies as ancillary services for Medicaid recipients in nursing
				facilities.
Section 1. Definitions.
(1) "Adult recipient" means an individual who
			 is:
(a) Eligible to participate in Kentucky's
			 Medicaid Program; and
(b) Age
			 twenty-one (21) or over.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:032 - Dual licensed pediatric facility services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520
NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective
				July 9, 2004, reorganized the Cabinet for Health Services and placed the
				Department for Medicaid Services and the Medicaid Program under the Cabinet for
				Health and Family Services. The Cabinet for Health and Family Services has
				responsibility to administer the program of Medical Assistance.
				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 the
				provisions relating to nursing services provided in a dual licensed pediatric
				facility for which payment shall be made by the Medicaid Program in behalf of
				both the categorically needy and medically needy.
Section 1. Definition. A dual licensed
			 pediatric facility is any facility providing both high intensity and low
			 intensity nursing facility services to children under age twenty-one (21) only
			 in the same beds.
Section 2.
			 Participation Requirements. Each facility desiring to participate as a dual
			 licensed pediatric facility shall meet the following requirements:
(1) An application for participation shall be
			 made to the cabinet using the procedures specified by the Commissioner,
			 Department for Medicaid Services, Cabinet for Health and Family Services. A
			 vendor number shall be assigned to the facility by the cabinet when
			 participation status is achieved.
(2) Any dual licensed pediatric facility
			 whose admission policies are such as to permit admission of patients who are
			 eligible for Medicare benefits shall be required to have thirty-five (35)
			 percent of its Medicaid participating beds (but not less than ten (10) beds; if
			 the facility has less than ten (10) beds, all beds) participate in the Medicare
			 health care program before the conditions of participation for Medicare shall
			 be deemed met. Any facility refusing to participate in the Medicaid program
			 shall not be certified to participate in the Medicaid program and shall not
			 receive reimbursement through the Medicaid program.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:037 - Hospital furnished nursing facility services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520
NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective
				July 9, 2004, reorganized the Cabinet for Health Services and placed the
				Department for Medicaid Services and the Medicaid Program under the Cabinet for
				Health and Family Services. The Cabinet for Health and Family Services has
				responsibility to administer the program of Medical Assistance.
				KRS
				205.520(3) 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 the provisions relating to nursing facility services
				furnished by a licensed hospital for which payment shall be made by the
				Medicaid Program in behalf of both the categorically needy and the medically
				needy.
Section 1. Definition. "Hospital
			 furnished nursing facility services" means nursing facility services provided
			 in a licensed hospital bed by a facility which has entered into an agreement
			 with the secretary, Department of Health and Human Services, pursuant to
			 Section 1883 of the Social Security Act, or nursing facility services provided
			 in a hospital bed which is licensed (in accordance with KRS Chapter 216B) for
			 provision of acute care and is appropriately certified for provision of nursing
			 facility services if the beds qualify for participation in the Medicaid Program
			 in accordance with usual Medicaid requirements for participation.
Section 2. Participation Requirements. The
			 hospital must be licensed and certified to participate in the Medicaid Program,
			 and any beds to be used for hospital furnished nursing facility services must
			 be appropriately certified. The requirements for Medicare participation shall
			 be the same as those Medicare participation requirements specified in
			 907
			 KAR 1:022.
Section
			 3. Provision of Service. Payment for services shall be limited to
			 those services provided to eligible individuals meeting the criteria for
			 provision of nursing facility services as determined in accordance with
			 907
			 KAR 1:022.
Section
			 4. Utilization Review. The facility shall have in place a program
			 of utilization review which meets the requirements specified in 42 CFR 456,
			 subparts C, E, and F, for hospitals, skilled nursing facilities, and
			 intermediate care facilities. The facility shall be responsible for cooperating
			 with the cabinet or its designated agents in the establishment of patient
			 status and performance of utilization review and control.
STATUTORY AUTHORITY:
				  KRS
				  194A.030(2),
				  194A.050(1),
				  205.520(3),
				  42
				  C.F.R. 440.140,
				  42 U.S.C.
				  1396a, b, d, EO
				  2004-726
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:038E - Hearing Program coverage provisions and requirements

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.622,
				205.8451(9),
				334.010(4),
				(9),
				334A.020(5),
				334A.030,
				42 C.F.R.
				400.203,
				438.20,
				457.310,
				42 U.S.C.
				1396a, b, d, 1396r-6
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health
				and Family Services, Department for Medicaid Services has responsibility to
				administer the Medicaid Program.
				KRS
				205.520(3) authorizes the
				cabinet, by administrative regulation, to comply with any requirement that may
				be imposed or opportunity presented by federal law to qualify for federal
				Medicaid funds. This administrative regulation establishes the Medicaid Program
				provisions and requirements regarding the coverage of audiology services and
				hearing instruments.
Section 1.
			 Definitions.
(1) "Audiologist" is defined by
			 KRS
			 334A.020(5).
(2) "CPT code" means a code used for
			 reporting procedures and services performed by medical practitioners and
			 published annually by the American Medical Association in Current Procedural
			 Terminology.
(3) "Department" means
			 the Department for Medicaid Services or its designee.
(4) "Enrollee" means a recipient who is
			 enrolled with a managed care organization.
(5) "Federal financial participation" is
			 defined by 42 C.F.R.
			 400.203.
(6) "Healthcare Common Procedure Coding
			 System" or "HCPCS" means a collection of codes acknowledged by the Centers for
			 Medicare and Medicaid Services (CMS) that represents procedures or
			 items.
(7) "Hearing instrument" is
			 defined by KRS
			 334.010(4).
(8) "Managed care organization" means an
			 entity for which the Department for Medicaid Services has contracted to serve
			 as a managed care organization as defined by
			 42 C.F.R.
			 438.2.
(9) "Medically necessary" or "medical
			 necessity" means that a covered benefit is determined to be needed in
			 accordance with
			 907 KAR 3:130.
(10) "Recipient" is defined by
			 KRS
			 205.8451(9).
(11) "Specialist in hearing instruments" is
			 defined by KRS
			 334.010(9).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:039 - Hearing Program reimbursement provisions and requirements

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				334.010,
				334.040,
				334.200,
				334A.020(5),
				42 C.F.R.
				447.200, 204
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services, has responsibility to
				administer the Medicaid Program.
				KRS
				205.520(3) authorizes the
				cabinet, by administrative regulation, to comply with any requirement that may
				be imposed, or opportunity presented, by federal law to qualify for federal
				Medicaid funds. This administrative regulation establishes the reimbursement
				provisions and requirements for covered audiology services, hearing
				instruments, and related items provided to a Medicaid recipient who is not
				enrolled with a managed care organization.
Section
			 1. Definitions.
(1)
			 "Audiologist" is defined by
			 KRS
			 334A.020(5).
(2) "CPT code" means a code used for
			 reporting procedures and services performed by medical practitioners and
			 published annually by the American Medical Association in Current Procedural
			 Terminology.
(3) "Department" means
			 the Department for Medicaid Services or its designee.
(4) "Federal financial participation" is
			 defined by
			 42 C.F.R.
			 400.203.
(5) "Healthcare Common Procedure Coding
			 System" or "HCPCS" means a collection of codes acknowledged by the Centers for
			 Medicare and Medicaid Services (CMS) that represents procedures or
			 time.
(6) "Hearing instrument" is
			 defined by
			 KRS
			 334.010(4).
(7) "Managed care organization" means an
			 entity for which the Department for Medicaid Services has contracted to serve
			 as a managed care organization as defined in
			 42
			 C.F.R. 438.2.
(8) "Medically necessary" means that a
			 covered benefit is determined to be needed in accordance with
			 907
			 KAR 3:130.
(9) "Participating audiologist" means an
			 audiologist who:
(a) Is enrolled in the
			 Medicaid Program pursuant to
			 907
			 KAR 1:672;
(b) Is currently participating in the
			 Medicaid Program pursuant to
			 907
			 KAR 1:671; and
(c) Meets the audiologist requirements
			 established in
			 907
			 KAR 1:038.
(10) "Participating specialist in hearing
			 instruments" means a specialist in hearing instruments who:
(a) Is enrolled in the Medicaid Program
			 pursuant to
			 907
			 KAR 1:672;
(b) Is currently participating in the
			 Medicaid Program pursuant to
			 907
			 KAR 1:671; and
(c) Meets the specialist in hearing
			 instruments requirements established in
			 907
			 KAR 1:038.
(11) "Recipient" is defined by
			 KRS
			 205.8451(9).
(12) "Specialist in hearing instruments" is
			 defined by
			 KRS
			 334.010(9).
(13) "Usual and customary charge" means the
			 uniform amount that a provider bills to the general public for a specific
			 covered benefit.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:044

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				194A.060,
				205.520(3),
				205.8451(9),
				422.317, 434.840-434.860,
				42 C.F.R.
				415.208,
				431.52,
				431 Subpart F
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services has responsibility to administer the Medicaid Program.
				KRS
				205.520(3) authorizes the
				cabinet, by administrative regulation, to comply with any requirement that may
				be imposed or opportunity presented by federal law to qualify for federal
				Medicaid funds. This administrative regulation establishes the Medicaid Program
				coverage provisions and requirements regarding community mental health center
				(CMHC) behavioral health services provided to Medicaid recipients.
Section 1. Definitions.
(1) "Community mental health center" or
			 "CMHC" means a facility which meets the community mental health center
			 requirements established in
			 902
			 KAR 20:091.
(2) "Department" means the Department for
			 Medicaid Services or its designee.
(3) "Enrollee" means a recipient who is
			 enrolled with a managed care organization.
(4) "Face-to-face" means occurring:
(a) In person; or
(b) If authorized by
			 907 KAR
			 3:170, via a real-time, electronic communication that
			 involves two (2) way interactive video and audio communication.
(5) "Federal financial
			 participation" is defined in
			 42 C.F.R.
			 400.203.
(6) "Medically necessary" means that a
			 covered benefit is determined to be needed in accordance with
			 907
			 KAR 3:130.
(7) "Mental health associate" means an
			 individual who meets the mental health associate requirements established in
			 the Community Mental Health Center Behavioral Health Services Manual.
(8) "Professional equivalent" means an
			 individual who meets the professional equivalent requirements established in
			 the Community Mental Health Center Behavioral Health Services Manual.
(9) "Provider" is defined by
			 KRS
			 205.8451(7).
(10) "Qualified mental health professional"
			 means an individual who meets the requirements established in KRS
			 202A.0011(12).
(11) "Recipient" is
			 defined by KRS
			 205.8451(9).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:048 - Family planning services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520
NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective
				July 9, 2004, reorganized the Cabinet for Health Services and placed the
				Department for Medicaid Services and the Medicaid Program under the Cabinet for
				Health and Family Services. The Cabinet for Health and Family has
				responsibility to administer the program of Medical Assistance.
				KRS
				205.520(3) 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 the provisions relating to the provision of family planning services
				for which payment shall be made by the Medicaid Program in behalf of both the
				categorically needy and the medically needy.
Section
			 1. Services Available. Services shall be provided through routine
			 physician visits or through family planning clinics and shall include
			 counseling services, medical services and supplies.
Section 2. Limitations. Family planning
			 services shall be made available to all persons of child bearing age, including
			 minors who can be considered to be sexually active, who desire the services and
			 supplies but there shall be freedom from coercion and freedom of choice of
			 method.
STATUTORY AUTHORITY:
				  KRS
				  194A.030(2),
				  194A.050(1),
				  205.520(3),
				  42 C.F.R.
				  441.20,
				  42 U.S.C.
				  1396a, b, d, EO
				  2004-726
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:049 - Payments for family planning services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Human
				Resources has responsibility to administer the program of Medical Assistance.
				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 the method for determining amounts payable by the cabinet for family
				planning services.
Section 1. Family
			 Planning Clinics. The cabinet shall reimburse family planning clinics or
			 agencies for covered services on the basis of a flat fee schedule.
Section 2. Amount of Payment. Reimbursement
			 in accordance with the flat fee schedule shall be at the following rates:
(1) For services provided by a physician:
			 initial clinic visit, fifty (50) dollars; annual clinic visit, sixty (60)
			 dollars; follow-up visit with pelvic examination, twenty-five (25) dollars; and
			 follow-up visit without pelvic examination, twenty (20) dollars.
(2) For services provided by an advanced
			 registered nurse practitioner with appropriate training as specified by the
			 cabinet: initial clinic visit, thirty-seven (37) dollars and seventy-five (75)
			 cents; annual clinic visit, forty-five (45) dollars; follow-up visit with
			 pelvic examination, eighteen (18) dollars and seventy-five (75) cents; and
			 follow-up visit without pelvic examination, fifteen (15) dollars.
(3) The fee for the counseling visit shall be
			 thirteen (13) dollars; for a counseling visit with three (3) months
			 contraceptive supply the fee shall be seventeen (17) dollars; for a counseling
			 visit with six (6) months contraceptive supply the fee shall be twenty (20)
			 dollars; for a supply only visit, the fee shall be the actual acquisition cost
			 of contraceptive supplies dispensed. The supply only visit fee shall not be
			 paid as an addition to a fee for another type of visit, since the fee for other
			 types of visits includes an amount for contraceptives.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:060 - Ambulance transportation

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520
NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective
				July 9, 2004, reorganized the Cabinet for Health Services and placed the
				Department for Medicaid Services and the Medicaid Program under the Cabinet for
				Health and Family Services. The Cabinet for Health and Family Services,
				Department for Medicaid Services has responsibility to administer the Medicaid
				Program.
				KRS
				205.520(3) authorizes 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 establishes the provisions relating to coverage of ambulance
				transportation services to access a medical service for which payment shall be
				made by the Medicaid Program.
Section
			 1. Definitions.
(1) "Ambulance
			 transportation" means ground or air transportation provided at advanced life
			 support level or basic life support level by a carrier licensed by the Kentucky
			 Board of Emergency Medical Services.
(2) "Appropriate medical facility or
			 provider" means a local medical provider other than an emergency room of a
			 hospital who can provide necessary emergency care if a hospital emergency room
			 is not located within the medical service area.
(3) "Attending physician" means a physician
			 who provided medical care to the recipient at the time ambulance transportation
			 was needed and may include:
(a) The physician
			 that the ambulance provider was in contact with to determine where the
			 recipient needed to be transported for immediate care;
(b) The physician at the facility that
			 treated the patient on arrival from the ambulance transportation;
(c) The physician at the care facility that
			 recommended the recipient be transported to another facility for care not
			 available at the original care facility; or
(d) The physician at a nursing facility that
			 determined that the recipient needed to be transported to a hospital.
(4) "Department" means the
			 Department for Medicaid Services or its designated agent.
(5) "Medical service area" means a
			 recipient's county of residence or a contiguous county.
(6) "Medically necessary" or "medical
			 necessity" means a covered benefit is determined to be needed in accordance
			 with
			 907
			 KAR 3:130.
(7) "Other medical professional" means a
			 physician assistant, advanced registered nurse practitioner, licensed nurse, or
			 qualified mental health professional who is approved to practice by the
			 appropriate professional licensure board.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:061 - Payments for ambulance transportation

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.8451,
				42
				C.F.R. 440.170, 447.200 -447.205,
				42 U.S.C.
				1396,
				2005
				Acts ch. 173 Parts I., A.22.(i), I., H.3.b.(19)
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services has responsibility to
				administer the Medicaid Program.
				KRS
				205.520(3) authorizes 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 establishes the method for determining amounts payable by the
				Department for Medicaid Services for ambulance transportation services.
Section 1. Definitions.
(1) "Advanced life support (ALS) emergency
			 ambulance transportation" means an ambulance service meeting the standards for
			 advanced life support services established in accordance with
			 202 KAR
			 7:501.
(2)
			 "Advanced Life Support (ALS) Medical First Response Provider" means an
			 emergency medical professional licensed in accordance with
			 202 KAR
			 7:501 to provide ALS care.
(3) "Air ambulance provider" means an air
			 ambulance service licensed in accordance with
			 202 KAR
			 7:510.
(4)
			 "Appropriate medical facility or provider" means a local medical provider other
			 than an emergency room of a hospital who can provide necessary emergency care
			 if a hospital emergency room is not located within a recipient's county of
			 residence or a contiguous county.
(5) "Basic life support (BLS) emergency
			 ambulance transportation" means an ambulance service which meets the standards
			 for basic life support services established in
			 202 KAR
			 7:501.
(6)
			 "Department" means the Department for Medicaid Services or its designated
			 agent.
(7) "Membership or
			 subscription fee" means a payment collected from a recipient by a provider
			 which entitles the recipient to free or discounted ambulance transportation
			 services.
(8) "Recipient" is
			 defined in
			 KRS
			 205.8451(9).
(9) "Upper limit" means the maximum
			 reimbursement rate the department shall pay an ambulance transportation
			 provider for the service provided.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:065 - Payments for price-based nursing facility services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				142.361,
				142.363,
				216.380,
				42 C.F.R. Parts
				430,
				431,
				432,
				433,
				435,
				440,
				441,
				442,
				447,
				455,
				456,
				482.58,
				483.10,
				42 U.S.C.
				1395tt,
				1396,
				1396a,
				1396b,
				1396c,
				1396d,
				1396g,
				1396l,
				1396n,
				1396o,
				1396p,
				1396r,
				1396r-2,
				1396r-5
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services, has responsibility to
				administer the Medicaid program.
				KRS
				205.520(3) authorizes 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 establishes the method for determining amounts payable by the
				Medicaid program for services provided by a price-based nursing
				facility.
Section 1. Definitions.
(1) "Ancillary service" means a direct
			 service for which a charge is customarily billed separately from the per diem
			 rate including:
(a) Ancillary services
			 pursuant to
			 907 KAR 1:023; or
(b) If ordered by a physician:
1. Laboratory procedures; or
2. X-rays.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:065E - Payments for price-based nursing facility services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				142.361,
				142.363,
				216.380,
				42 C.F.R. Parts
				430,
				431,
				432,
				433,
				435,
				440,
				441,
				442,
				447,
				455,
				456,
				482.58,
				483.10,
				42 U.S.C.
				1395tt,
				1396,
				1396a,
				1396b,
				1396c,
				1396d,
				1396g,
				1396l,
				1396n,
				1396o,
				1396p,
				1396r,
				1396r-2,
				1396r-5
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services, has responsibility to
				administer the Medicaid program.
				KRS
				205.520(3) authorizes 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 establishes the method for determining amounts payable by the
				Medicaid program for services provided by a price-based nursing
				facility.
Section 1. Definitions.
(1) "Ancillary service" means a direct
			 service for which a charge is customarily billed separately from the per diem
			 rate including:
(a) Ancillary services
			 pursuant to
			 907 KAR 1:023; or
(b) If ordered by a physician:
1. Laboratory procedures; or
2. X-rays.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:075 - Hearings and appeals for individuals with an intellectual disability

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				194A.060,
				205.175,
				205.231,
				205.237,
				210.270
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				205.231 and
				210.270
				require the Cabinet for Health and Family Services, Department for Medicaid
				Services, to establish a system of hearings to be available to Medicaid
				recipients.
				KRS
				194A.050(1) requires the
				cabinet to promulgate administrative regulations necessary to operate the
				programs and fulfill the responsibilities vested in the cabinet; or to comply
				with federal law. This administrative regulation establishes the hearing
				procedures for Medicaid-eligible individuals with an intellectual disability
				lodged in state institutions who are proposed by the cabinet to be reclassified
				and transferred. In accordance with
				KRS
				205.237, this administrative regulation also
				establishes the maximum fees that may be charged to the recipient for
				representation by attorneys with regard to the hearings or further resultant
				appeals.
Section 1. Definitions.
(1) "At the time of any action affecting a
			 recipient's claim" means at the time that the cabinet proposes to:
(a) Reclassify the level of care of a
			 recipient; or
(b) Transfer the
			 recipient from the state institution in which the recipient is
			 lodged.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:084 - Payment for medical assistance services furnished out of state

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520
NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective
				July 9, 2004, reorganized the Cabinet for Health Services and placed the
				Department for Medicaid Services and the Medicaid Program under the Cabinet for
				Health and Family Services. The Cabinet for Health and Family Services has
				responsibility to administer the program of Medical Assistance.
				KRS
				205.520(3) 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 the conditions under which the Medicaid Program shall pay
				for covered medical services furnished eligible recipients who are out of
				state.
Section 1. General. Medicaid
			 services provided to an eligible Medicaid recipient who is a resident of
			 Kentucky while that resident is in another state shall be reimbursed in
			 accordance with Section 2 of this administrative regulation.
Section 2. Criteria for Coverage while Out of
			 State.
(1) Payment shall be made if covered
			 medical services are needed because of a medical emergency.
(2) Payment shall be made if medical services
			 are needed because the recipient's health would be endangered if he were
			 required to travel to Kentucky for the medical service. With regard to
			 long-term care patients, it shall be the policy of the cabinet to pay for the
			 medical services only until the time when the patient's medical condition has
			 stabilized so the patient return to Kentucky; it is expected that the period of
			 coverage shall be sixty (60) days or less; continuation of payment shall be
			 contingent upon presentation of medical evidence acceptable to the cabinet
			 which justifies an additional stay in a facility outside the state.
(3) Payment shall be made when the state
			 determines, on the basis of medical advice, that the needed medical services,
			 or necessary supplementary resources, are more readily available in the other
			 state; provided, however, that this provision shall not be construed or
			 interpreted in a manner which circumvents or negates the provisions and intent
			 of this administrative regulation.
(4) Payment shall be made when it is general
			 practice for recipients in a particular locality to use medical resources in
			 another state.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:104 - Reimbursement for advanced practice registered nurse services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				314.011,
				42 C.F.R.
				438.2,
				42 U.S.C.
				1396s
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services, has responsibility to
				administer the Medicaid Program.
				KRS
				205.520(3) authorizes the
				cabinet, by administrative regulation, to comply with any requirement that may
				be imposed, or opportunity presented, by federal law to qualify for federal
				Medicaid funds. This administrative regulation establishes the reimbursement
				provisions and requirements regarding services provided to Medicaid recipients
				who are not enrolled with a managed care organization by individual advanced
				practice registered nurses (APRNs) enrolled in the Medicaid program or APRN
				provider groups enrolled in the Medicaid program.
Section 1. Definitions.
(1) "Advanced practice registered nurse" or
			 "APRN" is defined by KRS
			 314.011(7).
(2) "Department" means the Department for
			 Medicaid Services or its designated agent.
(3) "Managed care organization" means an
			 entity for which the Department for Medicaid Services has contracted to serve
			 as a managed care organization as defined by
			 42 C.F.R.
			 438.2.
(4) "Physician administered drug" or "PAD"
			 means any rebateable covered outpatient drug that is:
(a) Provided or administered to a Medicaid
			 recipient;
(b) Billed by a provider
			 other than a pharmacy provider through the medical benefit, including a
			 provider that is a physician office or another outpatient clinical setting;
			 and
(c) An injectable or
			 non-injectable drug furnished incident to provider services that are billed
			 separately to Medicaid.
(5) "Provider group" means a group of at
			 least two (2) individually licensed APRNs who:
(a) Are enrolled with the Medicaid program
			 individually and as a group; and
(b) Share the same Medicaid group provider
			 number.
(6) "Usual and
			 customary charge" means the uniform amount the provider charges in the majority
			 of cases for the service or procedure.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:145 - Supports for community living services for an individual with an intellectual or developmental disability

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.5605,
				205.5606,
				205.5607,
				42 C.F.R. 441 Subpart G,
				42 U.S.C.
				1396a, b, d, n
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services, has responsibility to
				administer the Medicaid Program.
				KRS
				205.520(3) authorizes the
				cabinet, by administrative regulation, to comply with any requirement that may
				be imposed, or opportunity presented, by federal law to qualify for federal
				Medicaid funds.
				KRS
				205.5606(1) requires the
				cabinet to promulgate administrative regulations to establish a consumer
				directed services program to provide an option for the home and community based
				services waivers. This administrative regulation establishes the covered
				service policies and requirements relating to home and community-based services
				provided to an individual with an intellectual or developmental disability as
				an alternative to placement in an intermediate care facility for an individual
				with an intellectual or developmental disability, including a consumer directed
				option pursuant to
				KRS
				205.5606 until individuals transition to
				receiving services via
				907
				KAR 12:010.
Section
			 1. Definitions.
(1) "Assessment"
			 or "reassessment" means a comprehensive evaluation of abilities, needs, and
			 services that is:
(a) Completed on a MAP-351;
			 and
(b) Submitted to the
			 department:
1. For a level of care
			 determination; and
2. Annually
			 thereafter.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:155 - Payments for supports for community living services for an individual with an intellectual or developmental disability

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520, 42 C.F.R. 441, Subpart G, 447.272,
				42 U.S.C.
				1396a, b, d, n
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health
				and Family Services, Department for Medicaid Services, is required to
				administer the Medicaid Program.
				KRS
				205.520(3) authorizes the
				cabinet, by administrative regulation, to comply with any requirement that may
				be imposed, or opportunity presented, by federal law to qualify for federal
				Medicaid funds. This administrative regulation establishes the reimbursement
				policies relating to home and community based waiver services provided to an
				individual with an intellectual or developmental disability as an alternative
				to placement in an intermediate care facility for an individual with an
				intellectual disability.
Section 1.
			 Definitions.
(1) "Department" means the
			 Department for Medicaid Services or its de-signee.
(2) "Developmental disability" means a
			 disability that:
(a) Is manifested prior to
			 the age of twenty-two (22);
(b)
			 Constitutes a substantial disability to the affected individual; and
(c) Is attributable either to an intellectual
			 disability or a condition related to an intellectual disability:
1. Results in an impairment of general
			 intellectual functioning and adaptive behavior similar to that of a person with
			 an intellectual disability; and
2.
			 Is a direct result of, or is influenced by, the person's cognitive
			 deficits.
(3)
			 "Intellectual disability" or "ID" means a demonstration:
(a)
1. Of
			 significantly sub-average intellectual functioning and an intelligence quotient
			 (IQ) of approximately seventy (70) or below; and
2. Of concurrent deficits or impairments in
			 present adaptive functioning in at least two (2) of the following areas:
a. Communication;
b. Self-care;
c. Home living;
d. Social or interpersonal skills;
e. Use of community resources;
f. Self-direction;
g. Functional academic skills;
h. Work;
i. Leisure; or
j. Health and safety; and
(b) Which occurred prior
			 to the individual reaching eighteen (18) years of age.
(4) "North Carolina Support Needs Assessment
			 Profile" or "NC-SNAP" means a standardized tool used for the measurement of
			 supportive services needed by an individual with a disability.
(5) "Overall level of eligible support" means
			 the highest of three (3) scores from the daily living domain, health care
			 domain, or behavior domain, as established by the NC-SNAP.
(6) "Supports for community living services"
			 or "SCL services" means community-based waiver services for an individual with
			 an intellectual or developmental disability.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:170 - Reimbursement for home and community based waiver services version 1

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO: 42 C.F.R. 441 Subparts B, G,
				42 U.S.C.
				1396a,
				1396b,
				1396d,
				1396n
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services, is required to administer
				the Medicaid Program.
				KRS
				205.520(3) authorizes the
				cabinet, by administrative regulation, to comply with any requirement that may
				be imposed, or opportunity presented, by federal law to qualify for federal
				Medicaid funds. This administrative regulation establishes the Medicaid Program
				reimbursement provisions and requirements regarding home and community based
				waiver services version 1.
Section 1.
			 Definitions.
(1) "ADHC" means adult day
			 health care.
(2) "ADHC center"
			 means an adult day health care center that is:
(a) Licensed in accordance with
			 902 KAR 20:066; and
(b) Certified for Medicaid participation by
			 the department.
(3)
			 "Cost report" means the Home Health and Home and Community Based Cost Report
			 and the Home Health and Home and Community Based Cost Report
			 Instructions.
(4) "DD" means
			 developmentally disabled.
(5)
			 "Department" means the Department for Medicaid Services or its
			 designee.
(6) "Fixed upper payment
			 limit" means the maximum amount the department shall reimburse for a unit of
			 service.
(7) "HCB" means home and
			 community based waiver.
(8) "Level
			 I reimbursement" means a reimbursement rate paid to an ADHC center for a basic
			 unit of service provided by the ADHC center to a participant.
(9) "Level II reimbursement" means a
			 reimbursement rate paid to an ADHC center for a basic unit of service provided
			 by the ADHC center to a participant, if the ADHC center meets the criteria
			 established in Sections 5 and 6 of this administrative regulation.
(10) "Medically necessary" or "medical
			 necessity" means that a covered benefit is determined to be needed in
			 accordance with
			 907 KAR 3:130.
(11) "Occupational therapist" is defined by
			 KRS
			 319A.010(3).
(12) "Occupational therapy assistant" is
			 defined by KRS
			 319A.010(4).
(13) "Participant" means a recipient who
			 meets the:
(a) Nursing facility level of care
			 criteria established in
			 907 KAR 1:022; and
(b) Eligibility criteria for HCB services
			 established in
			 907 KAR 1:160, Section
			 4.
(14) "Physical
			 therapist" is defined by
			 KRS
			 327.010(2).
(15) "Physical therapist assistant" means a
			 skilled health care worker who:
(a) Is
			 certified by the Kentucky Board of Physical Therapy; and
(b) Performs physical therapy and related
			 duties as assigned by the supervising physical therapist.
(16) "Quality improvement organization" or
			 "QIO" is defined in 42
			 C.F.R. 475.101.
(17) "Speech-language pathologist" is defined
			 by KRS
			 334A.020(3).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:180 - Freestanding birth center services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services has responsibility to administer the program of Medical
				Assistance.
				KRS
				205.520(3) empowers the
				cabinet, by administrative regulation, to comply with any requirement that may
				be imposed, or opportunity presented, by federal law to qualify for federal
				Medicaid funds. This administrative regulation establishes the coverage
				provisions for services provided by freestanding birth centers for which
				payment shall be made by the Medicaid Program in behalf of both the
				categorically needy and the medically needy.
Section
			 1. Definitions.
(1) "Advanced
			 practice registered nurse" is defined by
			 KRS
			 314.011(7).
(2) "Department" means the Department for
			 Medicaid Services or its designee.
(3) "Enrollee" means a recipient who is
			 enrolled with a managed care organization.
(4) "Freestanding birth center" means a:
(a) Freestanding birth center as defined by
			 42
			 U.S.C. 1396d(l)(3)(B);
			 and
(b) Facility that is:
1. Licensed as an alternative birth center in
			 accordance with
			 902 KAR
			 20:150; and
2. Accredited by the Commission for the
			 Accreditation of Birth Centers.
(5) "Freestanding birth center services" is
			 defined by
			 42
			 U.S.C. 1396d(28) and
			 42
			 U.S.C.
			 1396d(l)(3)(A).
(6) "Managed care organization" means an
			 entity for which the Department for Medicaid Services has contracted to serve
			 as a managed care organization as defined in
			 42
			 C.F.R. 438.2.
(7) "Participating freestanding birth center"
			 means a freestanding birth center that is:
(a)
			 Currently enrolled in the Medicaid program pursuant to
			 907
			 KAR 1:672;
(b) Currently participating in the Medicaid
			 program pursuant to
			 907
			 KAR 1:671;
(c) Licensed in accordance with
			 902 KAR
			 20:150; and
(d) Authorized to provide the service in
			 accordance with this administrative regulation.
(8) "Provider" is defined by
			 KRS
			 205.8451(7).
(9) "Recipient" is defined by
			 KRS
			 205.8451(9).
(10) "Registered nurse" is defined by
			 KRS
			 314.011(5).
(11) "Rendering provider" means a provider
			 who:
(a) Provides a service for which
			 reimbursement is:
1. Made to the provider;
			 and
2. Not made to a freestanding
			 birth center; and
(b) Is:
1. A physician who provides a service
			 associated with a freestanding birth center;
2. A physician assistant who provides a
			 service associated with a freestanding birth center;
3. An advanced practice registered nurse who
			 provides a service associated with a freestanding birth center; or
4. A registered nurse who provides a service
			 associated with a freestanding birth center.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:190 - Payments for freestanding birth center services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services has responsibility to administer the program of Medical
				Assistance.
				KRS
				205.520(3) 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 establishes the Department for Medicaid Services' reimbursement
				provisions and requirements for freestanding birth center services provided to
				Medicaid recipients who are not enrolled with a managed care
				organization.
Section 1. Definitions.
(1) "Advanced practice registered nurse" is
			 defined by
			 KRS
			 314.011(7).
(2) "Department" means the Department for
			 Medicaid Services or its designee.
(3) "Enrollee" means a recipient who is
			 enrolled with a managed care organization.
(4) "Freestanding birth center" means a:
(a) Freestanding birth center as defined by
			 42
			 U.S.C. 1396d(l)(3)(B);
			 and
(b) Facility that is:
1. Licensed as an alternative birth center in
			 accordance with
			 902 KAR
			 20:150; and
2. Accredited by the Commission for the
			 Accreditation of Birth Centers.
(5) "Freestanding birth center services" is
			 defined by
			 42
			 U.S.C. 1396d(28) and
			 42
			 U.S.C.
			 1396d(l)(3)(A).
(6) "Managed care organization" means an
			 entity for which the Department for Medicaid Services has contracted to serve
			 as a managed care organization as defined in
			 42
			 C.F.R. 438.2.
(7) "Participating freestanding birth center"
			 means a freestanding birth center that is:
(a)
			 Currently enrolled in the Medicaid program pursuant to
			 907
			 KAR 1:672;
(b) Currently participating in the Medicaid
			 program pursuant to
			 907
			 KAR 1:671;
(c) Licensed in accordance with
			 902 KAR
			 20:150; and
(d) Authorized to provide the service in
			 accordance with
			 907 KAR
			 1:180.
(8) "Provider" is defined by
			 KRS
			 205.8451(7).
(9) "Recipient" is defined by
			 KRS
			 205.8451(9).
(10) "Registered nurse" is defined by
			 KRS
			 314.011(5).
(11) "Rendering provider" means a provider
			 who:
(a) Provides a service for which
			 reimbursement is:
1. Made to the provider;
			 and
2. Not made to a freestanding
			 birth center; and
(b) Is:
1. A physician who provides a service
			 associated with a freestanding birth center;
2. A physician assistant who provides a
			 service associated with a freestanding birth center;
3. An advanced practice registered nurse who
			 provides a service associated with a freestanding birth center; or
4. A registered nurse who provides a service
			 associated with a freestanding birth center.