Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:030 - Home health agency services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.622,
				216.935,
				216.936,
				216.937,
				216.9375,
				216.939,
				369.101369.120,
				42 C.F.R.
				431.17,
				440.70,
				447.325,
				484.115,
				45 C.F.R.
				164.316,
				42 U.S.C.
				1396a -d
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 coverage
				provisions and requirements relating to Medicaid Program home health care
				services.
Section 1. Definitions.
(1) "Department" means the Department for
			 Medicaid Services or its designee.
(2) "Electronic signature" is defined by
			 KRS
			 369.102(8).
(3) "Enrollee" means a recipient who is
			 enrolled with a managed care organization.
(4) "Federal financial participation" is
			 defined by
			 42 C.F.R.
			 400.203.
(5) "Home health agency" or "HHA" means:
(a) An agency defined pursuant to
			 42 C.F.R.
			 440.70(d); and
(b) A Medicare and Medicaid-certified agency
			 licensed in accordance with
			 902 KAR
			 20:081.
(6) "Home health aide" is defined by
			 KRS
			 216.935(3).
(7) "Licensed practical nurse" or "LPN" means
			 a person who is licensed in accordance with
			 KRS
			 314.051.
(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 in
			 42
			 C.F.R. 438.2.
(9) "Medical social worker" means a person
			 who meets the medical social worker requirements as established in
			 902 KAR
			 20:081.
(10) "Medically necessary" or "medical
			 necessity" means that a covered benefit is determined to be needed in
			 accordance with
			 907
			 KAR 3:130.
(11) "Nursing service" means the delivery of
			 medication, or treatment by a registered nurse or a licensed practical nurse
			 supervised by a registered nurse, consistent with KRS Chapter 314 scope of
			 practice provisions and the Kentucky Board of Nursing scope of practice
			 determination guidelines.
(12)
			 "Occupational therapist" is defined by
			 KRS
			 319A.010(3).
(13) "Occupational therapy assistant" is
			 defined by
			 KRS
			 319A.010(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 services and
			 related duties as assigned by the supervising physical therapist.
(16) "Place of residence" means,
			 excluding a hospital or nursing facility, the location at which a recipient
			 resides.
(17) "Plan of care" means
			 a written plan which shall:
(a) Stipulate the
			 type, nature, frequency and duration of a service; and
(b) At least every sixty (60) days, be
			 reviewed and signed by a HHA staff person and physician, advanced practice
			 registered nurse, or physician assistant.
(18) "Provider" is defined by
			 KRS
			 205.8451(7).
(19) "Qualified medical social worker" means
			 a person who meets the qualified medical social worker requirements as
			 established in
			 902 KAR
			 20:081.
(20) "Qualified social work assistant" means
			 a social work assistant as defined in
			 42 C.F.R.
			 484.115.
(21) "Recipient" is defined by
			 KRS
			 205.8451(9).
(22) "Registered nurse" or "RN" is defined by
			 KRS
			 314.011(5).
(23) "Speech-language pathologist" is defined
			 by
			 KRS
			 334A.020(3).
(24) "Speech-language pathology assistant" is
			 defined by
			 KRS
			 334A.020(8).