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 1:260 - Coordination of benefits between the Medicaid Program and the Crime Victims Compensation Board

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 (hereinafter
				called "Medicaid").
				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 methods and principles that will be used to determine
				the extent of Medicaid liability in situations involving Medicaid eligible
				individuals who are applicants for, or recipients of, award or grants from the
				Crime Victims Compensation Board (hereinafter called "the board").
Section 1. General Principles.
(1) The Medicaid Program is the payor of last
			 resort and complies with the requirement shown in
			 907 KAR
			 1:005, Nonduplication of payments. Any provisions
			 contained in this administrative regulation are subordinate to the provisions
			 of
			 907 KAR
			 1:005 and shall not be construed in a manner which
			 contravenes the policies contained in
			 907 KAR
			 1:005.
(2)
			 The cabinet recognizes that the Crime Victims Compensation Board ("the board")
			 has discretion in the making of awards or grants, and that until an award or
			 grant is made by the board, third-party liability pursuant to
			 907 KAR
			 1:005 cannot be presumed to exist.
(3) In the event the board makes a grant or
			 award to a Medicaid eligible individual for Medicaid covered services, the
			 amount payable by the Medicaid program shall be reduced by the amount of the
			 assumed third-party obligation; if the board makes no grant or award for
			 Medicaid covered services, Medicaid program payments for covered services shall
			 be made in accordance with usual program policy.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:270 - Podiatry program services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.560,
				42
				C.F.R. 440.60,
				42 U.S.C.
				1396a, b, 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 a requirement that may be
				imposed or opportunity presented by federal law to qualify for Medicaid funds.
				This administrative regulation establishes the coverage provisions relating to
				podiatry services for which payment shall be made by the Medicaid Program on
				behalf of both categorically needy and medically needy beneficiaries.
Section 1. Coverage. The Medicaid program
			 shall cover a medical or surgical service provided to an eligible Medicaid
			 recipient by a licensed, participating podiatrist if the service falls within
			 the scope of the practice of podiatry except as provided in Section 2 of this
			 administrative regulation.
Section
			 2. Exclusions From Coverage.
(1)
			 Except as provided in Section 3 of this administrative regulation, routine foot
			 care shall not be covered by the Medicaid program.
(2) Routine foot care excluded by this
			 section shall include:
(a) The cutting or
			 removal of a corn or callus;
(b)
			 The trimming of a nail; or
(c)
			 Other hygienic or preventive maintenance care in the realm of self-care
			 including:
1. Cleaning or soaking a
			 foot;
2. The use of a skin cream to
			 maintain skin tone of an ambulatory or bedfast patient; or
3. A service performed in the absence of
			 localized illness, injury, or symptom involving the foot.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:280 - Payments for podiatry program services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.560
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 Medicaid funds.
				This administrative regulation establishes the method for determining payments
				for podiatry services.
Section 1.
			 Payments for Podiatry Services.
(1)
(a) The department shall reimburse a
			 licensed, participating podiatrist for a covered podiatry service as
			 established in
			 907 KAR
			 1:270.
(b)
			 A laboratory service performed by a podiatrist pursuant to this section shall
			 be reimbursed as established in subsection (3) of this section.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:330 - Hospice services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42
				C.F.R. 418.3, 418.20-418.30,
				42 U.S.C.
				1395d,
				1395x(dd)(2),
				1396d(o)
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 terms and
				conditions under which the Medicaid Program shall provide hospice care to both
				the categorically and medically needy.
Section
			 1. Definitions.
(1) "Department
			 approved system" means a technology system in which:
(a) Providers electronically submit and track
			 level of care (LOC) requests through a self-service portal;
(b) The system triggers LOC tasks as
			 reminders to providers and allows them to submit reassessments electronically;
			 and
(c) Information is exchanged
			 electronically with Kentucky's:
1. Medicaid
			 Enterprise Management System (MEMS); and
2. Integrated eligibility
			 system.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:340 - Reimbursement for hospice services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				42 C.F.R.
				418.302,
				418.306,
				42 U.S.C.
				1396a,
				1396b,
				1396c,
				1396d
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 requirements for
				reimbursements for hospice services.
Section
			 1. Definitions.
(1) "Department"
			 means the Department for Medicaid Services or its designee.
(2) "Home" means:
(a) A primary residence that is based on a
			 recipient's county of Medicaid eligibility; or
(b) A nursing facility licensed in accordance
			 with
			 902 KAR
			 20:300.
(3) "Hospice provider" means an agency that
			 is:
(a) Licensed in accordance with
			 902 KAR
			 20:140; and
(b) Medicare- and
			 Medicaid-certified.
(4)
			 "Hospice recipient" means an individual who:
(a) Is eligible for Medicaid;
(b) Is certified by a physician as terminally
			 ill with a medical prognosis that life expectancy is six (6) months or less in
			 accordance with
			 907 KAR 1:330;
			 and
(c) Elects to receive hospice
			 services.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:350 - Coverage and payments for organ transplants

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 C.F.R.
				447.53
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family 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 provisions related
				to Medicaid Program coverage of organ transplants for Medicaid recipients and
				related to Department for Medicaid Services' reimbursement regarding organ
				transplants provided to Medicaid recipients who are not enrolled with a managed
				care organization.
Section 1.
			 Definitions.
(1) "Department" means the
			 Department for Medicaid Services or its designee.
(2) "Emergency" means that a condition or
			 situation requires an emergency service pursuant to
			 42 C.F.R.
			 438.114(a).
(3) "Enrollee" means a recipient who is
			 enrolled with a managed care organization.
(4) "Experimental" means that a procedure has
			 not previously been proven effective by the U.S. Food and Drug Administration
			 in treating a patient's health condition.
(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) "Medical necessity" or "medically
			 necessary" means that a covered benefit is determined to be needed in
			 accordance with
			 907
			 KAR 3:130.
(7) "Nonemergency" means that a condition or
			 situation does not require an emergency service pursuant to
			 42 C.F.R.
			 438.114(a).
(8) "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 1:400 - Incorporation by reference of the Renal Dialysis Center Services Manual

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 the
				responsibility to administer the Medical Assistance Program. The cabinet is
				empowered to comply with any requirement that is imposed or opportunity
				presented by federal law for the provision of medical assistance to Kentucky's
				indigent citizenry. This administrative regulation incorporates into regulatory
				form, by reference, materials used by the cabinet in the implementation of the
				renal dialysis center services component of the Medical Assistance Program. In
				the event of a conflict between manual materials incorporated by reference in
				this administrative regulation and the primary subject administrative
				regulations of the cabinet relating to this component, the latter shall
				prevail.
Section 1. Incorporation by
			 Reference. The cabinet incorporates by reference the Renal Dialysis Center
			 Services Manual, revised April 1, 1991, used in the implementation of this
			 component of the Kentucky Medical Assistance Program. This manual contains the
			 policies and procedures issued by the cabinet for the implementation of this
			 program element including benefit descriptions and operating instructions used
			 by agency staff and participating providers.
Section 2. This manual incorporated by
			 reference may be reviewed Monday through Friday between the hours of 8 a.m. and
			 4:30 p.m., Eastern time, Department for Medicaid Services, 275 East Main
			 Street, Frankfort, Kentucky. Copies may be obtained from that office upon
			 payment of an appropriate fee which shall not exceed approximate
			 cost.
STATUTORY AUTHORITY:
				  KRS
				  194A.030(2),
				  194A.050(1),
				  205.520(3),
				  42 U.S.C.
				  1396a, c, 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 1:434 - Incorporation by reference of the Family Planning Services Manual

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520, Pub.L. 89-97
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 the
				responsibility to administer the Medical Assistance Program in accordance with
				Title XIX of the Social Security Act and
				KRS
				205.520(3).
				KRS
				205.520(3) empowers the
				cabinet to comply with any requirement that is imposed or opportunity presented
				by federal law for the provision of medical assistance to Kentucky's indigent
				citizenry. This administrative regulation incorporates into regulatory form, by
				reference, materials used by the cabinet in the implementation of the family
				planning services component of the Medical Assistance Program. In the event of
				a conflict between manual materials incorporated by reference in this
				administrative regulation and the primary subject administrative regulations of
				the cabinet relating to this component, the latter shall prevail.
Section 1. Incorporation by Reference. The
			 cabinet incorporates by reference the Family Planning Services Manual, revised
			 September 1, 1988, used in the implementation of this component of the Kentucky
			 Medical Assistance Program. This manual contains the policies and procedures
			 issued by the cabinet for the implementation of this program element including
			 benefit descriptions and operating instructions used by agency staff and
			 participating providers.
Section 2.
			 This manual incorporated by reference may be reviewed Monday through Friday
			 between the hours of 8 a.m. and 4:30 p.m., Eastern time, Department for
			 Medicaid Services, 275 East Main Street, Frankfort, Kentucky. Copies may be
			 obtained from that office upon payment of an appropriate fee which will not
			 exceed approximate cost.
STATUTORY AUTHORITY:
				  KRS
				  194A.030(2),
				  194A.050(1),
				  205.520(3),
				  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 1:440 - Case management 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 in accordance
				with Title XIX of the Social Security Act.
				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 scope of services for case management and the method
				for determining amounts payable by the cabinet for case management
				services.
Section 1. Definition of
			 Services. Case management is a service instrument by which service agencies
			 assist an individual in accessing needed medical, social, educational, and
			 other support services. Case management providers are required to monitor to
			 assure that recipients of case management services receive the services for
			 which they are referred. Case management activities include:
(1) Assessment of client's medical, social,
			 and functional status, and identification of client service needs;
(2) Arranging for service delivery from the
			 client's chosen provider to insure access to required services;
(3) Insure access to needed services by
			 explaining the need and importance of services in relation to the client's
			 condition;
(4) Insure access,
			 quality and delivery of necessary services; and
(5) Preparation and maintenance of case
			 record documentation to include service plans, forms, reports, and narratives,
			 as appropriate.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:450 - Nurse aide training criteria and registry

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520, 42 C.F.R. 438.75, 438.150 -438.158,
				42 U.S.C.
				1395i-3 and
				1396r
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 requirements for the nurse aide training and competency evaluation
				program and specifies the establishment and function of the nurse aide
				registry.
Section 1. Definitions.
(1) "Cabinet" means the Cabinet for Health
			 and Family Services.
(2)
			 "Competency examination" means a written or oral examination that is:
(a) Described by
			 42 C.F.R.
			 483.154; and
(b) Used as a standard for determining
			 satisfactory completion of a nurse aide training and competency evaluation
			 program.
(3) "Department"
			 means the Department for Medicaid Services or its designee.
(4) "Licensed health professional" means a:
(a) Physician;
(b) Physician assistant;
(c) Nurse practitioner;
(d) Physical, speech, or occupational
			 therapist;
(e) Registered
			 nurse;
(f) Licensed practical
			 nurse;
(g) Registered dietician;
			 or
(h) Licensed or certified social
			 worker.
(5) "Nurse aide"
			 means an individual who has successfully completed the nurse aide training and
			 competency evaluation program and may include a nursing student, medication
			 aide, or a person employed through a nursing pool who provides nursing or
			 nursing-related services to a resident in a nursing facility, excluding:
(a) An individual who is a licensed health
			 professional;
(b) A volunteer who
			 provides the nursing or nursing-related services without monetary compensation;
			 or
(c) A person who is hired by the
			 resident or family to sit with the resident and who does not perform nursing or
			 nursing-related services.
(6) "Nurse aide training and competency
			 evaluation program" means a competency evaluation program that meets the
			 requirements of
			 42
			 C.F.R. 483.152.
(7) "Supervised practical training" means
			 training in a laboratory or other setting in which the trainee demonstrates
			 knowledge while performing tasks on an individual under the direct supervision
			 of a registered nurse or a licensed practical nurse.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:560 - Medicaid hearings and appeals regarding eligibility

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO: KRS Chapter 13B, 205.231, 205.237, 205.520,
				205.531, 42 C.F.R. 431 subpart E,
				42
				C.F.R. 431.233, 42 C.F.R. part 456,
				42 U.S.C.
				1396
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 for the provision of medical
				assistance to Kentucky's indigent citizenry. This administrative regulation
				establishes provisions relating to the Medicaid grievance, hearing and appeal
				process regarding Medicaid eligibility issues.
Section 1. Definitions.
(1) "Appeal board" means the secretary, or
			 entity or individual designated by the secretary of the Cabinet for Health and
			 Family Services to hear appeals following a recommended order by a designated
			 hearing agency.
(2) "Applicant"
			 means an individual applying for Medicaid.
(3) "Authorized representative" means an
			 individual acting on behalf of an applicant or recipient.
(4) "Department" means the Department for
			 Medicaid Services or its designee.
(5) "Designated hearing agency" means the
			 entity designated by the secretary of the Cabinet for Health and Family
			 Services to adjudicate administrative hearings.
(6) "Recipient" means an individual who
			 receives Medicaid.
(7) "Secretary"
			 means the secretary of the Cabinet for Health and Family Services.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:575 - Compliance with laboratory certification requirements

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520, 42 C.F.R. 493,
				42 U.S.C.
				1396a -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 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 provisions relating to compliance by Medicaid providers
				with requirements for certification for performance of laboratory testing and
				implements the Clinical Laboratory Improvement Amendments of 1988.
Section 1. Definitions.
(1) "Certificate" means the appropriate
			 certificate of waiver, certificate of registration, or certificate of
			 accreditation issued by the United States Department of Health and Human
			 Services (HHS) which authorizes the performance of laboratory testing by a
			 provider of medical services.
(2)
			 "Medicaid provider" means a participating provider of medical services under
			 the Medicaid Program.
(3)
			 "State-exempt" means the state laboratory licensing program has been approved
			 by HHS.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:604 - Cost-sharing prohibited within the Medicaid program

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.560,
				205.6312,
				205.6485,
				205.8451,
				319A.010,
				327.010,
				334A.020,
				42 C.F.R. 430.10,
				431.51,
				447.15,
				447.20,
				447.21,
				447.50,
				447.52,
				447.54,
				447.55,
				447.56,
				447.57,
				457.224,
				457.310,
				457.505,
				457.510,
				457.515,
				457.520,
				457.530,
				457.535,
				457.570,
				42 U.S.C.
				1396a,
				1396b,
				1396c,
				1396d,
				1396o,
				1396r-6,
				1396r-8,
				1396u-1,
				1397aa -1397jj
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 prohibits cost-sharing within
				the Medicaid program, and extends the
				KRS
				205.6312 prohibition of cost-sharing to
				providers as well as the department and managed care organizations.
Section 1. Definitions.
(1) "Copayment" means a dollar amount
			 representing the portion of the cost of a Medicaid benefit that a recipient is
			 required to pay.
(2) "Department"
			 means the Department for Medicaid Services or its designee.
(3) "Enrollee" means a Medicaid recipient who
			 is enrolled with a managed care organization.
(4) "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 by
			 42
			 C.F.R. 438.2.
(5) "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 1:615 - Supplemental policy for the Medicaid Program

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 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 for the provision of medical
				assistance to Kentucky's indigent citizenry. This administrative regulation
				incorporates into regulatory form, by reference, materials used by the cabinet
				in the implementation of the Medicaid Program. The content of this
				administrative regulation shall be considered the agency statement of policy
				and procedures with regard to issues not otherwise addressed in Kentucky
				administrative regulations.
Section 1.
			 Material Incorporated by Reference.
(1) The
			 following material necessary to the administration of the Medicaid Program is
			 incorporated by reference:
(a) Field Services
			 Operation Manual Volume I, effective November 1993;
(b) Field Services Operation Manual Volume
			 IV, effective November 1993; and
(c) Field Services Operation Manual Volume X,
			 effective November 1993.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:631 - Vision Program reimbursement provisions and requirements

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42
				C.F.R. 440.40,
				440.60,
				447 Subpart B,
				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 Medicaid Program
				reimbursement provisions and requirements for vision services provided to a
				Medicaid recipient who is not enrolled in a managed care organization.
Section 1. Definitions.
(1) "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.
(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) "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
			 items.
(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) "Medically necessary" or "medical
			 necessity" means that a covered benefit is determined to be needed in
			 accordance with
			 907
			 KAR 3:130.
(8) "Ophthalmic dispenser" means an
			 individual who is qualified to engage in the practice of ophthalmic dispensing
			 in accordance with
			 KRS 326.030 or
			 326.040.
(9) "Optometrist" means an individual who is
			 licensed as an optometrist in accordance with KRS Chapter 320.
(10) "Provider" is defined by
			 KRS
			 205.8451(7).
(11) "Recipient" is defined by
			 KRS
			 205.8451(9).
(12) "Usual and customary charge" means the
			 uniform amount the provider charges in the majority of cases for the service or
			 item.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:632E - Vision program coverage provisions and requirements

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.622,
				205.8451(7),
				(9), Chapter 320, Chapter 326, 326.030,
				326.040, 369.101 to 369.120, 42 C.F.R. 400.203,
				431.17,
				438.2,
				440.40,
				440.60,
				447 Subpart B,
				45 C.F.R.
				147.126, Parts
				160 and
				164,
				164.306,
				164.316,
				42 U.S.C. 1320d to 1320d-8,
				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 Kentucky
				Medicaid Program provisions and requirements regarding the coverage of vision
				services.
Section 1. Definitions.
(1) "Current procedural terminology code" or
			 "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.
(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) "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
			 items.
(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) "Medicaid basis" means a scenario in
			 which:
(a) A provider provides a service to a
			 recipient as a Medicaid-participating provider in accordance with:
1.
											907 KAR 1:671; and
2.
											907 KAR 1:672;
(b) The Medicaid Program is the
			 payer for the service; and
(c) The
			 recipient is not liable for payment to the provider for the service.
(8) "Medically necessary" or
			 "medical necessity" means that a covered benefit is determined to be needed in
			 accordance with
			 907 KAR 3:130.
(9) "Ophthalmic dispenser" means an
			 individual who is qualified to engage in the practice of ophthalmic dispensing
			 in accordance with KRS 326.030 or
			 326.040.
(10) "Optometrist" means an individual who is
			 licensed as an optometrist in accordance with KRS Chapter 320.
(11) "Provider" is defined by
			 KRS
			 205.8451(7).
(12) "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 1:673 - Claims processing

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.8451
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) 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 Medicaid provider claims processing
				requirements.
Section 1. Definitions.
(1) "Cabinet" means the Cabinet for Health
			 and Family Services.
(2) "Claim"
			 means a request for payment that relates to each individual billing submitted
			 by a provider to the department which details services rendered to a recipient
			 on a specific date. The claim may be either a line item of service or all
			 services for one (1) recipient on a bill.
(3) "Department" means the Department for
			 Medicaid Services or its designee.
(4) "Home infusion therapy" means the
			 parental administration of a premanufactured or sterile compounded product for
			 intravenous, intramuscular, subcutaneous or intraspinal infusion to a patient
			 in a nonacute alternative site setting.
(5) "POS" means on-line real time point of
			 sale claims electronically transmitted to the department.
(6) "ProDUR" means prospective drug use
			 review in accordance with
			 201 KAR
			 2:210.
(7)
			 "Provider" means as defined in 907 KAR 1:002, Section 1.
(8) "Provider type fifty-four (54)" means an
			 enrolled pharmacy provider who dispenses drugs to outpatient, long-term care
			 residents, and personal care home residents who are Medicaid recipients. A
			 number shall be assigned by the department to these providers and the first two
			 (2) digits shall be fifty-four (54).
(9) "Recipient" means as defined by
			 KRS
			 205.8451(9).
(10) "Services" means as defined in
			 907
			 KAR 1:671, Section 1.
(11) "Unacceptable practice" means as defined
			 in
			 907
			 KAR 1:671, Section 1.
(12) "Withholding" means as defined in
			 907
			 KAR 1:671, Section 1.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:680 - Vaccines for Children Program

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 U.S.C.
				1396s
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 for the provision of medical
				assistance to Kentucky's indigent citizenry. This administrative regulation
				establishes the provisions relating to vaccines provided through the Vaccines
				for Children Program.
Section 1.
			 Definitions.
(1) "Immunization" means an
			 inoculation against a vaccine preventable disease.
(2) "Program registered provider" means a
			 health care provider that is:
(a) Licensed or
			 otherwise authorized for administration of pediatric vaccines; and
(b) Enrolled in the Vaccines for Children
			 Program.
(3) "Recipient"
			 means a person age eighteen (18) or under who has been determined eligible to
			 receive benefits under the Medicaid program or Kentucky Children's Health
			 Insurance Program (KCHIP) in accordance with Title 907 KAR.
(4) "Vaccines for Children Program" means the
			 program for distribution of pediatric vaccines administered by the Department
			 for Public Health and described in
			 42 U.S.C.
			 1396s.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:720 - Coverage and payments for the Kentucky Early Intervention Program services provided through an agreement with the state Title V agency

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				200.654,
				200.656,
				200.664,
				200.668,
				200.676,
				205.520,
				42
				C.F.R. 431.615,
				42 U.S.C.
				1471-1485
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.
				KRS
				200.660(7) requires the
				cabinet to promulgate administrative regulations to implement the Kentucky
				Early Intervention Program. This administrative regulation establishes
				requirements for coverage and payment for early intervention services provided
				through an agreement with the state Title V agency, the Commission for Children
				with Special Health Care Needs.
Section
			 1. Definitions.
(1) "Department"
			 means the Department for Medicaid Services or its designee.
(2) "Early intervention services" is defined
			 in
			 KRS
			 200.654(7).
(3) "Title V agency" means the Commission for
			 Children with Special Health Care Needs.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:780 - Converted dual-licensed hospital-based nursing facility beds

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				216B.020(4), (5)
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 the responsibility for administering the
				Kentucky Medicaid Program in an efficient, cost-effective manner, consonant
				with the funds that are available, and consistent with the objectives of the
				Program. One (1) of these objectives is for recipients to have reasonable
				access to health care and services under the Medicaid Program, taking into
				account such factors as geographic location, travel time, choice of providers,
				and utilization rates. This administrative regulation establishes the process
				and criteria relating to Medicaid participation for dual-licensed acute care
				hospital beds that were converted to nursing facility beds pursuant to
				KRS
				216B.020(4), and supplements
				applicable provisions for provider enrollment in Section 2 of
				907
				KAR 1:672 and the administrative hearing process in
				907
				KAR 1:671.
Section
			 1. Definitions.
(1)
			 "Administrative process" means meeting, review, investigation, hearing, appeal,
			 deliberation or exchange of documents or information between the provider and
			 the department.
(2) "Applicant"
			 means a person or entity who submits an application to become a Medicaid
			 provider.
(3) "Applicant's
			 geographic area" means the county in which the applicant's converted
			 dual-licensed hospital-based nursing facility beds are located and contiguous
			 Kentucky counties.
(4)
			 "Application" means a request for Medicaid certification for beds that were
			 converted to hospital-based nursing facility beds pursuant to
			 KRS
			 216B.020(4).
(5) "Certificate of need" is defined in
			 KRS
			 216B.015(8).
(6) "Converted" means a bed that was
			 previously a dual-licensed acute care hospital bed that, pursuant to
			 KRS
			 216B.020(4) and (5), changed
			 a dual-licensed acute care bed to a hospital-based nursing facility bed and is
			 not presently participating in the Medicaid Program.
(7) "Provider" is defined in
			 KRS
			 205.8451(7).
(8) "State Health Plan" is defined in
			 KRS
			 216B.015(19).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:790 - Medicaid service category expenditure information

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO: KRS Chapter 45A, 304.17A, 304.38,
				42 C.F.R.
				440.230, 41 Subpart B,
				42
				U.S.C. 1396d(r),
				1396u-2
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 Medicaid service category expenditure
				information for which a managed care organization and the Region 3 Partnership
				shall report expenditures to the department.
Section
			 1. Definitions.
(1) "BBA" means
			 the Balanced Budget Act of 1997 as amended and codified under
			 42 U.S.C.
			 1396u-2.
(2) "Department" means the Department for
			 Medicaid Services or its designated agent.
(3) "MCO" means the risk-bearing managed care
			 organization that provides physical or behavioral health services through
			 provider networks on a prepaid capitated basis as either an HMO or a
			 PSN.
(4) "Partnership" means a
			 legal entity that satisfies the requirements of
			 907
			 KAR 1:705, Section 5, and while under contract with
			 the department, in accordance with KRS Chapter 45A, agrees to provide or
			 arrange for the provision of health services to Medicaid eligible members on a
			 prepaid capitation payment basis.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:017 - Enhanced reimbursement for preventive and wellness services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.560
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 policies and
				requirements regarding the Department for Medicaid Services' enhanced
				reimbursement for certain preventive services and wellness services provided to
				Medicaid recipients who are not enrolled with a managed care
				organization.
Section 1. Definitions.
(1) "Advanced practice registered nurse" or
			 "APRN" is defined by
			 KRS
			 314.011(7).
(2) "Currently enrolled with the Medicaid
			 Program" means:
(a) Currently enrolled with
			 the Medicaid Program pursuant to
			 907
			 KAR 1:672; and
(b) Currently participating with the Medicaid
			 Program pursuant to
			 907
			 KAR 1:671.
(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) "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.
(6) "Medically necessary" or "medical
			 necessity" means that a covered benefit is determined to be needed in
			 accordance with
			 907
			 KAR 3:130.
(7) "Physician" is defined by
			 KRS
			 311.550(12).
(8) "Physician assistant" is defined by
			 KRS
			 311.840(3).
(9) "Provider group" means a group of at
			 least:
(a) Two (2) individually licensed
			 physicians who:
1. Are currently enrolled with
			 the Medicaid Program individually and as a group; and
2. Share the same Medicaid group provider
			 number;
(b) Two (2)
			 individually licensed APRNs who:
1. Are
			 currently enrolled with the Medicaid Program individually and as a group;
			 and
2. Share the same Medicaid
			 group provider number; or
(c) At least one (1) APRN and at least one
			 (1) physician who:
1. Are currently enrolled
			 with the Medicaid Program individually and as a group; and
2. Share the same Medicaid group provider
			 number.
(10)
			 "Recipient" is defined in
			 KRS
			 205.8451(9).