reglab/statecodes huggingface dataset:
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 8 - Occupational, Physical, and Speech Therapy › Section 907 KAR 8:035 - Speech-language pathology service reimbursement provisions and requirements

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, 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 Department for
				Medicaid Services' reimbursement provisions and requirements regarding
				speech-language pathology services provided by an independent speech-language
				pathologist to Medicaid recipients who are not enrolled with a managed care
				organization.
Section 1. General
			 Requirements. For the department to reimburse for a speech-language pathology
			 service under this administrative regulation, the:
(1) Speech-language pathologist shall meet
			 the provider requirements established in
			 907
			 KAR 8:030; and
(2) Speech-language pathology service shall
			 meet the coverage and related requirements established in
			 907
			 KAR 8:030.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 8 - Occupational, Physical, and Speech Therapy › Section 907 KAR 8:040 - Coverage of occupational therapy, physical therapy, and speech-language pathology services provided by various entities

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.622,
				369.101-369.120,
				42 C.F.R.
				431.17,
				440.130,
				45 C.F.R. Part 164,
				42 U.S.C.
				1396a(a)(30)
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 Medicaid Program
				coverage provisions and requirements regarding occupational therapy services,
				physical therapy services, and speech-language pathology services provided by
				adult day health care programs, rehabilitation agencies, special health
				clinics, mobile health services, multi-therapy agencies, and comprehensive
				outpatient rehabilitation facilities to Medicaid recipients.
Section 1. Provider Participation. To be
			 eligible to provide and be reimbursed for services covered under this
			 administrative regulation, a provider shall be:
(1) Currently enrolled in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:672;
(2) Currently participating in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:671; and
(3)
(a) An
			 adult day health care program;
(b)
			 A multi-therapy agency;
(c) A
			 comprehensive outpatient rehabilitation facility;
(d) A mobile health service;
(e) A special health clinic; or
(f) A rehabilitation agency.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 9 - Psychiatric Residential Treatment Facility Services and Reimbursement › Section 907 KAR 9:005 - Non-outpatient level I and II psychiatric residential treatment facility service and coverage policies

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				216B.450,
				216B.455,
				216B.459
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 Medicaid program
				coverage policies regarding Level I and Level II psychiatric residential
				treatment facility services that are not provided on an outpatient
				basis.
Section 1. Definitions.
(1) "Active treatment" means a covered Level
			 I or II psychiatric residential treatment facility service provided:
(a) In accordance with an individual plan of
			 care as specified in
			 42 C.F.R.
			 441.154; and
(b) By an individual employed or contracted
			 by a Level I or II PRTF including a:
1.
			 Qualified mental health personnel;
2. Qualified mental health
			 professional;
3. Mental health
			 associate; or
4. Direct care staff
			 person.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 9 - Psychiatric Residential Treatment Facility Services and Reimbursement › Section 907 KAR 9:010 - Reimbursement for non-outpatient Level I and II psychiatric residential treatment facility services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				216B.450,
				216B.455,
				42 U.S.C.
				1395u
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) 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 Medicaid
				reimbursement policies for non-outpatient Level I and Level II psychiatric
				residential treatment facility services provided to a Medicaid recipient who is
				not enrolled in a managed care organization.
Section 1. Definition
(1) "Department" means the Department for
			 Medicaid Services or its designee.
(2) "Federal financial participation" is
			 defined by 42 C.F.R.
			 400.203.
(3) "Level I PRTF" means a psychiatric
			 residential treatment facility that meets the criteria established in
			 KRS
			 216B.450(5)(a).
(4) "Level II PRTF" means a psychiatric
			 residential treatment facility that meets the criteria established in
			 KRS
			 216B.450(5)(b).
(5) "Managed care organization" means an
			 entity for which the department has contracted to serve as a managed care
			 organization as defined in 42 C.F.R. 438.2.
(6) "Medicare Economic Index" or "MEI" means
			 the economic index referred to in
			 42 U.S.C.
			 1395u(b)(3)(L).
(7) "Percentage increase in the MEI" is
			 defined in 42 U.S.C.
			 1395u(i)(3).
(8) "Per diem rate" means a Level I or II
			 PRTF's total daily reimbursement as calculated by the department.
(9) "Recipient" is defined by
			 KRS
			 205.8451(9).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 9 - Psychiatric Residential Treatment Facility Services and Reimbursement › Section 907 KAR 9:010 - Reimbursement for non-outpatient Level I and II psychiatric residential treatment facility services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				216B.450,
				216B.455,
				42 U.S.C.
				1395u
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 Medicaid
				reimbursement policies for non-outpatient Level I and Level II psychiatric
				residential treatment facility services provided to a Medicaid recipient who is
				not enrolled in a managed care organization.
Section 1. Definition
(1) "Department" means the Department for
			 Medicaid Services or its designee.
(2) "Federal financial participation" is
			 defined by 42 C.F.R.
			 400.203.
(3) "Level I PRTF" means a psychiatric
			 residential treatment facility that meets the criteria established in
			 KRS
			 216B.450(5)(a).
(4) "Level II PRTF" means a psychiatric
			 residential treatment facility that meets the criteria established in
			 KRS
			 216B.450(5)(b).
(5) "Managed care organization" means an
			 entity for which the department has contracted to serve as a managed care
			 organization as defined by 42 C.F.R. 438.2.
(6) "Medicare Economic Index" or "MEI" means
			 the economic index referred to in
			 42 U.S.C.
			 1395u(b)(3)(L).
(7) "Percentage increase in the MEI" is
			 defined by 42 U.S.C.
			 1395u(i)(3).
(8) "Per diem rate" means a Level I or II
			 PRTF's total daily reimbursement as calculated by the department.
(9) "Recipient" is defined by
			 KRS
			 205.8451(9).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 10 - Hospital Service Coverage and Reimbursement › Section 907 KAR 10:012 - Inpatient hospital service coverage

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 U.S.C.
				1395ww,
				1396,
				1396a,
				1396b,
				1396d,
				1396r-4,
				42
				C.F.R. 440.10,
				Pub.L.
				111-148
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 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 inpatient hospital services for which payment shall
				be made by the Medicaid Program for a hospital inpatient service.
Section 1. Definitions.
(1) "Acute care hospital" is defined by
			 KRS
			 205.639(1).
(2) "Critical access hospital" means a
			 hospital meeting the licensure requirements established in
			 906 KAR
			 1:110 and designated as a critical access hospital by
			 the department.
(3) "Department"
			 means the Department for Medicaid Services or its designee.
(4) "Emergency" means a condition or
			 situation which requires an emergency service pursuant to
			 42 C.F.R.
			 447.53.
(5) "Federal financial participation" is
			 defined by
			 42 C.F.R.
			 400.203.
(6) "Hospital-acquired condition" means a
			 condition:
(a)
1. Associated with a diagnosis code selected
			 by the Secretary of the U.S. Department of Health and Human Services pursuant
			 to
			 42 U.S.C.
			 1395ww(d)(4)(D);
			 and
2. Not present upon the
			 recipient's admission to the hospital; or
(b) Which is recognized by the Centers for
			 Medicare and Medicaid Services as a hospital-acquired condition.
(7) "Long-term acute care
			 hospital" means a long term care hospital that meets the requirements
			 established in
			 42 C.F.R.
			 412.23(e).
(8) "Medical necessity" or "medically
			 necessary" means that a covered benefit is determined to be needed in
			 accordance with
			 907
			 KAR 3:130.
(9) "Never event" means:
(a) A procedure, service, or hospitalization
			 not reimbursable by Medicare pursuant to CMS Manual System Pub.L. 100-03
			 Medicare National Coverage Determinations Transmittal 101; or
(b) A hospital-acquired condition.
(10) "Nonemergency" means a
			 condition or situation which does not require an emergency service pursuant to
			 42 C.F.R.
			 447.53.
(11) "Psychiatric hospital" means a hospital
			 meeting the licensure requirements established in
			 902 KAR
			 20:180.
(12) "Rehabilitation hospital" means a
			 hospital meeting the licensure requirements established in
			 902
			 KAR 20:240.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 10 - Hospital Service Coverage and Reimbursement › Section 907 KAR 10:015 - Payments for outpatient hospital services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.637,
				216.380,
				42 C.F.R.
				400.203,
				413.70,
				440.2,
				440.20(a),
				447.321,
				42 U.S.C.
				1395l(h),
				1396r-8(a)(7)
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services, has the 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 outpatient hospital services.
Section 1. Definitions.
(1) "Critical access hospital" or "CAH" means
			 a hospital meeting the licensure requirements established in
			 906 KAR
			 1:110 and
			 KRS
			 216.380.
(2) "Department" means the Department for
			 Medicaid Services or its designee.
(3) "Emergency medical condition" is defined
			 by
			 42
			 U.S.C.
			 1395dd(e)(1).
(4) "Federal financial participation" is
			 defined in
			 42 C.F.R.
			 400.203.
(5) "Finalized" means approved or final as
			 determined by the Centers for Medicare and Medicaid Services (CMS).
(6) "Flat rate" means a set and final rate
			 representing reimbursement in entirety with no subsequent cost
			 settling.
(7) "Lock-in recipient"
			 means a recipient enrolled in the department's lock-in program pursuant to
			 907 KAR
			 1:677.
(8)
			 "Lock-in recipient's designated hospital" means the hospital designated to
			 provide nonemergency care for a lock-in recipient pursuant to
			 907 KAR
			 1:677.
(9)
			 "Nonemergency" means that a condition or situation does not require an
			 emergency service pursuant to
			 42 C.F.R.
			 447.53.
(10) "Outpatient cost-to-charge ratio" means
			 the ratio determined by dividing the costs reported on Supplemental Worksheet
			 E-3, Part III, Page 12 column 2, line 27 of the cost report by the charges
			 reported on column 2, line 20 of the same schedule.
(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 10 - Hospital Service Coverage and Reimbursement › Section 907 KAR 10:016 - Coverage provisions and requirements regarding inpatient psychiatric hospital 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 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 inpatient services provided by
				psychiatric hospitals.
Section 1.
			 Definitions.
(1) "Active treatment" means a
			 covered psychiatric hospital service provided:
(a) In accordance with
			 42 C.F.R.
			 441.154; and
(b) By professional staff employed or
			 contracted by a psychiatric hospital.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 10 - Hospital Service Coverage and Reimbursement › Section 907 KAR 10:183 - Supplemental payments to participating DRG hospitals

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.639,
				205.640,
				42
				C.F.R. 440.10,
				440.140,
				447.250-447.280,
				42 U.S.C.
				1395ww(d)(4)(C)(i),
				1395x(mm),
				1396a,
				1396b,
				1396d
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 a 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 provisions regarding supplemental payments totaling $195 million in
				aggregate to hospitals reimbursed via the diagnosis-related group (DRG)
				reimbursement methodology which agreed, in April 2009, to accept the
				supplemental payments.
Section 1.
			 Definitions.
(1) "Aggregate cost gap" means
			 the difference between a hospital's cost and Medicaid payments received by the
			 hospital for DRG services for the period beginning July 1, 2004 through June
			 30, 2007 trended to the midpoint of the January 2009 through December 2010
			 payment period.
(2) "Department"
			 means the Department for Medicaid Services or its designee.
(3) "DRG" means diagnosis-related
			 group.
(4) "Federal financial
			 participation" is defined by
			 42 C.F.R.
			 400.203.
(5) "Pediatric teaching hospital" is defined
			 by
			 KRS
			 205.565(1).
(6) "Related to the provider" is defined by
			 42 C.F.R.
			 413.17.
(7) "University hospital" is defined by
			 KRS
			 205.639(4).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 10 - Hospital Service Coverage and Reimbursement › Section 907 KAR 10:820 - Disproportionate share hospital distributions

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.565,
				205.637,
				205.639,
				205.640,
				216.380,
				42 C.F.R. Parts 412, 413,
				440.10,
				440.140,
				447.250-447.280,
				42 U.S.C.
				1395f(l),
				1395ww(d)(5)(f),
				1395x(mm),
				1396a,
				1396b,
				1396d,
				1396r-4
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 a 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 disproportionate share hospital fund distribution provisions in
				accordance with
				KRS
				205.639,
				205.640,
				205.6401,
				and
				205.6403.
Section 1. Definitions.
(1) "Base year" means the year of historical
			 Medicaid DSH survey data used to determine initial DSH payments.
(2) "Department" is defined by
			 KRS
			 205.639(4).
(3) "Disproportionate share hospital" or
			 "DSH" means an in-state hospital that:
(a)
			 Has a Medicaid inpatient utilization rate of one (1) percent or higher;
			 and
(b) Meets the criteria
			 established in
			 42 U.S.C.
			 1396r-4(d).
(4) "Final disproportionate share hospital
			 payment" or "final DSH payment" is defined by
			 KRS
			 205.639(6).
(5) "Hospital-specific disproportionate share
			 hospital limit" or "hospital-specific DSH limit" is defined by
			 KRS
			 205.639(7).
(6) "Initial disproportionate share hospital
			 payment" or "initial DSH payment" is defined by
			 KRS
			 205.639(8).
(7) "Medicaid disproportionate share hospital
			 survey" or "Medicaid DSH survey" is defined by
			 KRS
			 205.639(12), and may include
			 an attestation by a hospital that information has not changed from the
			 submission of an original Medicaid DSH survey.
(8) "Medicaid inpatient utilization rate" or
			 "MIUR" is defined by
			 KRS
			 205.639(14).
(9) "Total uncompensated care costs" is
			 defined by
			 KRS
			 205.639(19).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 10 - Hospital Service Coverage and Reimbursement › Section 907 KAR 10:840 - Hospital Rate Improvement Program

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				45.229,
				142.303,
				205.565,
				205.637,
				205.638,
				205.639,
				205.640,
				205.6405,
				205.6406,
				205.6407,
				205.6408,
				216.380,
				42 C.F.R.
				413.17,
				433.51,
				438.340,
				440.140,
				447.271,
				447.272,
				42 U.S.C.
				1396a,
				1395ww
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 a requirement that may be
				imposed, or opportunity presented, by federal law to qualify for federal funds.
				KRS
				205.6406(13) requires the
				department to promulgate an administrative regulation to implement the Hospital
				Rate Improvement Program,
				KRS
				205.6405 to
				205.6408.
				This administrative regulation establishes the requirements for implementing
				the Hospital Rate Improvement Program for qualifying hospitals.
Section 1. Definitions.
(1) "Assessment" is defined by
			 KRS
			 205.6405(1).
(2) "Department" means the Department for
			 Medicaid Services or its designee.
(3) "Federal financial participation" is
			 defined by
			 42 C.F.R.
			 400.203.
(4) "Program year" is defined by
			 KRS
			 205.6405(14).
(5) "Qualifying hospital" is defined by
			 KRS
			 205.6405(16).
(6) "Received date" means the date a claim is
			 accepted and approved into the Medicaid Management Information System and does
			 not mean the date a claim is actually paid.
(7) "Upper payment limit" or "UPL" is defined
			 by
			 KRS
			 205.6405(19).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 11 - Early and Periodic Screening › Section 907 KAR 11:034 - Early and periodic screening, diagnosis, and treatment services and early and periodic screening, diagnosis, and treatment special services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				605.115,
				42 C.F.R.
				441.50-441.62,
				42
				U.S.C. 1396d
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 Medicaid Program.
				KRS
				205.520 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 Medicaid to
				Kentucky's indigent citizenry. This administrative regulation establishes the
				provisions relating to the early and periodic screening, diagnosis and
				treatment service and early and periodic screening, diagnosis and treatment
				special services for which payment shall be made by the Medicaid Program on
				behalf of both categorically needy and medically needy children under age
				twenty-one (21).
Section 1. Definition.
(1) "By report" means a service or item for
			 which a maximum allowance has not been established because the item is rarely
			 billed to the Kentucky Medicaid Program or because the service is unusual,
			 variable, or new.
(2) "Department"
			 means the Department for Medicaid Services or its designated agency.
(3) "EPSDT" means early and periodic
			 screening, diagnosis, and treatment.
(4) "Periodicity" means the frequency with
			 which an individual may be screened or rescreened.
(5) "Recipient" means a Medicaid eligible
			 child under the age of twenty-one (21), including the month in which the child
			 becomes twenty-one (21).
(6)
			 "Screening" means the review of the health and health-related conditions of a
			 recipient by a health care professional to determine if further diagnosis or
			 treatment is needed.
(7) "Service"
			 means health care, treatment, a procedure, supply, item, or
			 equipment.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 11 - Early and Periodic Screening › Section 907 KAR 11:035 - Payments for early and periodic screening, diagnosis, and treatment services and early and periodic screening, diagnosis, and treatment special services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				605.115,
				42
				C.F.R. 440.40(b),
				441.50-441.62,
				447.201-447.205,
				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
				Medicaid to Kentucky's indigent citizenry. This administrative regulation
				establishes the method for determining amounts payable by the Department for
				Medicaid Services for early and periodic screening, diagnosis, and treatment
				services and early and periodic screening, diagnosis, and treatment special
				services.
Section 1. Definitions.
(1) "Department" means the Department for
			 Medicaid Services or its designated agent.
(2) "EPSDT" means early and periodic
			 screening, diagnosis, and treatment in accordance with
			 42
			 C.F.R. 440.40(b),
			 441.56(b)-(c),
			 441.57,
			 and
			 441.58.
(3) "EPSDT special services" means a service
			 that is:
(a) Allowable under
			 42 C.F.R.
			 441.50 through
			 441.62
			 and 42 U.S.C.
			 1396d(r);
(b) Not otherwise covered under the Kentucky
			 Medicaid Program; and
(c) Medically
			 necessary in accordance with
			 907
			 KAR 3:130 to correct or ameliorate a defect, physical
			 or mental illness, or condition of a recipient.
(4) "Medicaid physician fee schedule" means a
			 list of current reimbursement rates for physician services established in
			 accordance with
			 907 KAR
			 3:010, Section 3(1).
(5) Recipient" means a Medicaid eligible
			 individual under the age of twenty-one (21), which includes the month in which
			 the child becomes twenty-one (21).
(6) "Usual and customary charge" means the
			 uniform amount a physician charges to the general public for a specific medical
			 procedure or service.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 13 - Private Duty Nursing › Section 907 KAR 13:005 - Definitions for 907 KAR Chapter 13

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				194A.025(3)
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 definitions for
				907 KAR Chapter 13.
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) "Home health agency" or "HHA" means a
			 Medicare and Medicaid-certified agency licensed in accordance with
			 902 KAR
			 20:081.
(5) "Immediate family member" is defined by
			 KRS
			 205.8451(3).
(6) "Licensed practical nurse" is defined by
			 KRS
			 314.011(9).
(7) "Managed care organization" or "MCO"
			 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) "Prior authorized" means authorized by:
(a) The department, if the service is for a
			 recipient who is not an enrollee; or
(b) A managed care organization, if the
			 service is for an enrollee.
(10) "Private duty nursing agency" means an
			 agency licensed in accordance with
			 902
			 KAR 20:370.
(11) "Provider" is defined by
			 KRS
			 205.8451(7).
(12) "Recipient" is defined by
			 KRS
			 205.8451(9).
(13) "Registered nurse" is defined by
			 KRS
			 314.011(5).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 13 - Private Duty Nursing › Section 907 KAR 13:010 - Private duty nursing service coverage provisions and requirements

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, 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 Medicaid Program
				coverage provisions and requirements regarding private duty nursing
				services.
Section 1. Provider
			 Participation.
(1) To be eligible to provide
			 services under this administrative regulation, a provider shall be:
(a) Currently enrolled in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:672;
(b) Except as established in subsection (2)
			 of this section, currently participating in the Kentucky Medicaid Program in
			 accordance with
			 907
			 KAR 1:671; and
(c)
1. A
			 private duty nursing agency; or
2.
			 A licensed home health agency.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 13 - Private Duty Nursing › Section 907 KAR 13:015 - Private duty nursing service or supply reimbursement provisions and requirements

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, 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 Department for
				Medicaid Services' reimbursement provisions and requirements regarding private
				duty nursing services and supplies.
Section
			 1. General Requirements. For the department to reimburse for a
			 private duty nursing service or supply under this administrative regulation,
			 the:
(1) Provider shall meet the provider
			 requirements established in
			 907
			 KAR 13:010; and
(2) The service or supply shall meet the
			 coverage and related requirements established in
			 907
			 KAR 13:010.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 14 - Health Care-acquired Conditions and Provider Preventable Conditions › Section 907 KAR 14:005 - Health care-acquired conditions and other provider preventable conditions

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.560,
				42
				C.F.R. 447.26
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
				policies, including managed care and non-managed care, regarding health
				care-acquired conditions and provider preventable conditions.
Section 1. Definitions.
(1) "Department" means the Department for
			 Medicaid Services or its designee.
(2) "Health care-acquired condition" is
			 defined by
			 42
			 C.F.R. 447.26.
(3) "In writing" means on paper or by
			 electronic means.
(4) "Inpatient
			 hospital" means an acute care hospital, critical access hospital, long-term
			 acute care hospital, psychiatric hospital, rehabilitation hospital, psychiatric
			 distinct part unit in an acute care hospital, or rehabilitation distinct part
			 unit in an acute care hospital.
(5)
			 "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.
(6) "Provider" is defined by
			 KRS
			 205.8451(7).
(7) "Recipient" is defined by
			 KRS
			 205.8451(9).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:015 - Reimbursement provisions and requirements for behavioral health services provided by individual approved behavioral health practitioners, behavioral health provider groups, or behavioral health multi-specialty groups

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 U.S.C.
				1396a(a)(10)(B),
				1396a(a)(23),
				1396a(a)(30)(A)
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 reimbursement
				provisions and requirements regarding Medicaid Program behavioral health
				services provided by individual approved behavioral health practitioners who
				are independently enrolled in the Medicaid Program, practitioners working for
				or under the supervision of the individual approved behavioral health
				practitioners, and approved behavioral health practitioners under supervision
				working in behavioral health provider groups or in behavioral health
				multi-specialty groups, to Medicaid recipients who are not enrolled with a
				managed care organization.
Section 1.
			 General Requirements. For the department to reimburse for a service covered
			 under this administrative regulation, the service shall be:
(1) Covered in accordance with
			 907
			 KAR 15:010; and
(2) Billed to the department by an individual
			 approved behavioral health practitioner, behavioral health provider group, or
			 behavioral health multi-specialty group recognized as a Medi-caid Program
			 provider in accordance with
			 907
			 KAR 15:010.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:020 - Coverage provisions and requirements regarding services provided by behavioral health service organizations for mental health treatment

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				369.101
				- 369.120,
				20 U.S.C.
				1400 et seq.,
				29 U.S.C.
				701 et seq.,
				42
				U.S.C. 290 ee-3, 1320d-2 - 1320d-8,
				1396a(a)(10)(B), 1396a(a)(23),
				42 C.F.R. Part 2,
				431.17, 45 C.F.R. Parts 160, 164
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 tier I behavioral health services organizations.
Section 1. General Coverage Requirements.
(1) For the department to reimburse for a
			 service covered under this administrative regulation, the service shall be:
(a) Medically necessary; and
(b) Provided:
1. To a recipient; and
2. By a behavioral health services
			 organization that meets the provider participation requirements established in
			 Section 2 of this administrative regulation.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:022 - Coverage provisions and requirements regarding services provided by behavioral health services organizations for substance use disorder treatment and co-occurring disorders

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.622,
				309.0831,
				369.101
				- 369.120,
				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,
				42 C.F.R. Part 2,
				431.17,
				435.1010,
				45 C.F.R. Parts 160, 164
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 tier II and III behavioral health services
				organizations.
Section 1. General
			 Coverage Requirements.
(1) For the department
			 to reimburse for a service covered under this administrative regulation, the
			 service shall be:
(a) Medically necessary;
			 and
(b) Provided:
1. To a recipient; and
2. By a behavioral health services
			 organization that meets the provider participation requirements established in
			 Section 2 of this administrative regulation.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:025 - Reimbursement provisions and requirements regarding behavioral health services provided by behavioral health service organizations

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 U.S.C.
				1396a(a)(10)(B),
				42 U.S.C.
				1396a(a)(23),
				18022(b)(1)(E)
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 reimbursement
				provisions and requirements regarding Medicaid Program behavioral health
				services provided by behavioral health services organizations to Medicaid
				recipients who are not enrolled with a managed care organization.
Section 1. General Requirements. For the
			 department to reimburse for a service covered under this administrative
			 regulation, the service shall:
(1) Meet the
			 requirements established in
			 907
			 KAR 15:020 or
			 907
			 KAR 15:022; and
(2) Be covered in accordance with
			 907
			 KAR 15:020 or
			 907
			 KAR 15:022.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:040 - Coverage provisions and requirements regarding targeted case management for individuals with a substance use disorder

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 U.S.C.
				1396a(a)(10)(B), 42 U.S.C.
				1396a(a)(23)
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 targeted case management
				services for individuals with a substance use disorder.
Section 1. General Coverage Requirements. For
			 the department to reimburse for a service covered under this administrative
			 regulation, the service shall be:
(1)
			 Medically necessary; and
(2)
			 Provided:
(a) To a recipient; and
(b) By a provider that meets the provider
			 participation requirements established in Section 3 of this administrative
			 regulation.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:045 - Reimbursement provisions and requirements for targeted case management services for individuals with a substance use disorder

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 U.S.C.
				1396a(a)(10)(B),
				42 U.S.C.
				1396a(a)(23)
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 reimbursement
				provisions and requirements regarding Medicaid Program targeted case management
				services for individuals with a substance use disorder who are not enrolled
				with a managed care organization.
Section
			 1. General Requirements. For the department to reimburse for a
			 service covered under this administrative regulation, the service shall be:
(1) Medically necessary;
(2) Provided:
(a) To a recipient;
(b) By a provider that meets the provider
			 participation requirements established in
			 907
			 KAR 15:040; and
(c) In accordance with the requirements
			 established in
			 907
			 KAR 15:040; and
(3) Covered in accordance with
			 907
			 KAR 15:040.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:050 - Coverage provisions and requirements regarding targeted case management for individuals with a mental health or substance use disorder and chronic or complex physical health issues

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 U.S.C.
				1396a(a)(10)(B),
				42 U.S.C.
				1396a(a)(23)
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 targeted case management
				services for individuals with a co-occurring mental health or substance use
				disorder and chronic or complex physical health issues.
Section 1. General Coverage Requirements. For
			 the department to reimburse for a service covered under this administrative
			 regulation, the service shall be:
(1)
			 Medically necessary; and
(2)
			 Provided:
(a) To a recipient; and
(b) By a provider that meets the provider
			 participation requirements established in Section 3 of this administrative
			 regulation.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:055 - Reimbursement provisions and requirements regarding targeted case management for individuals with a mental health or substance use disorder and chronic or complex physical health issues

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 U.S.C.
				1396a(a)(10)(B),
				42 U.S.C.
				1396a(a)(23)
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 reimbursement
				provisions and requirements regarding Medicaid Program targeted case management
				services for individuals with a mental health or substance use disorder and
				chronic or complex physical health issues who are not enrolled with a managed
				care organization.
Section 1. General
			 Requirements. For the department to reimburse for a service covered under this
			 administrative regulation, the service shall be:
(1) Medically necessary;
(2) Provided:
(a) To a recipient;
(b) By a provider that meets the provider
			 participation requirements established in
			 907
			 KAR 15:050; and
(c) In accordance with the requirements
			 established in
			 907
			 KAR 15:050; and
(3) Covered in accordance with
			 907
			 KAR 15:050.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:060 - Coverage provisions and requirements regarding targeted case management for individuals with a severe mental illness and children with a severe emotional disability

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 U.S.C.
				1396a(a)(10)(B),
				42 U.S.C.
				1396a(a)(23)
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 targeted case management
				services for individuals with a severe mental illness and children with a
				severe emotional disability.
Section 1.
			 General Coverage Requirements. For the department to reimburse for a service
			 covered under this administrative regulation, the service shall be:
(1) Medically necessary; and
(2) Provided:
(a) To a recipient; and
(b) By a provider that meets the provider
			 participation requirements established in Section 3 of this administrative
			 regulation.