Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:010 - Coverage provisions and requirements regarding behavioral health services provided by individual approved behavioral health practitioners, behavioral health provider groups, and behavioral health multi-specialty groups

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.622,
				309.0831,
				Chapter 319, 369.101-369.120,
				42 C.F.R. Part 2,
				431.17, 45 C.F.R. Parts 160, 164,
				20 U.S.C.
				1400 et seq.,
				21 U.S.C
				823(g)(2),
				29 U.S.C.
				701 et seq.,
				42
				U.S.C. 290ee-3,
				1320d-2 -
				1320d-8,
				1396a(a)(10)(B),
				1396a(a)(23),
				12101 et
				seq.
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services, has a 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 coverage
				provisions and requirements regarding Medicaid Program behavioral health
				services provided by certain licensed individual behavioral health
				professionals who are independently enrolled in the Medi-caid Program,
				practitioners working for or under the supervision of the individual behavioral
				health providers, and individual behavioral health professionals and
				practitioners under supervision working in behavioral health provider groups or
				in behavioral health multi-specialty groups.
Section
			 1. General Coverage Requirements.
(1) For the department to reimburse for a
			 service covered under this administrative regulation, the service shall:
(a) Be medically necessary;
(b) Meet the coverage requirements
			 established in Section 3 of this administrative regulation;
(c) Be provided to a recipient by:
1. An individual approved behavioral health
			 practitioner who:
a. Is enrolled in the
			 Kentucky Medicaid Program in accordance with
			 907
			 KAR 1:672;
b. Except as established in Section 2(1) of
			 this administrative regulation, currently participates in the Kentucky Medicaid
			 Program in accordance with
			 907
			 KAR 1:671; and
c. Is an approved behavioral health practitioner;
2. An individual approved
			 behavioral health practitioner who is working for:
a. A behavioral health provider group that
			 is:
(i) Currently enrolled in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:672; and
(ii) Except as established in Section 2(1) of
			 this administrative regulation, currently participating in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:671; or
b. A behavioral health multi-specialty group
			 that is:
(i) Currently enrolled in the
			 Kentucky Medicaid Program in accordance with
			 907
			 KAR 1:672; and
(ii) Except as established in Section 2(1) of
			 this administrative regulation, currently participating in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:671;
3. An approved behavioral health practitioner
			 under supervision working for:
a. An
			 individual approved behavioral health practitioner who is:
(i) Currently enrolled in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:672; and
(ii) Except as established in Section 2(1) of
			 this administrative regulation, currently participating in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:671;
b. A behavioral health provider group that
			 is:
(i) Currently enrolled in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:672; and
(ii) Except as established in Section 2(1) of
			 this administrative regulation, currently participating in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:671; or
c. A behavioral health multi-specialty group
			 that is:
(i) Currently enrolled in the
			 Kentucky Medicaid Program in accordance with
			 907
			 KAR 1:672; and
(ii) Except as established in Section 2(1) of
			 this administrative regulation, currently participating in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:671;
4. An adult peer support specialist, family
			 peer support specialist, youth peer support specialist, or registered alcohol
			 and drug peer support specialist working for:
a. A behavioral health provider group that
			 is:
(i) Currently enrolled in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:672; and
(ii) Except as established in Section 2(1) of
			 this administrative regulation, currently participating in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:671; or
b. A behavioral health multi-specialty group
			 that is:
(i) Currently enrolled in the
			 Kentucky Medicaid Program in accordance with
			 907
			 KAR 1:672; and
(ii) Except as established in Section 2(1) of
			 this administrative regulation, currently participating in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:671; or
5. A community support associate working for
			 a behavioral health multi-specialty group that is:
a. Currently enrolled in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:672; and
b. Except as established in Section 2(1) of
			 this administrative regulation, currently participating in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:671; and
(d) Be billed to the department by the:
1. Individual approved behavioral health
			 practitioner who provided the service or under whose supervision the service
			 was rendered in accordance with Section 3 of this administrative
			 regulation;
2. Behavioral health
			 provider group on behalf of which the service was rendered in accordance with
			 Section 3 of this administrative regulation; or
3. Behavioral health multi-specialty group on
			 behalf of which the service was rendered in accordance with Section 3 of this
			 administrative regulation.