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 8:045 - Reimbursement of occupational therapy, physical therapy, and speech-language pathology provided by various entities

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 occupational therapy services,
				physical therapy services, and speech-language pathology services provided to
				Medicaid recipients who are not enrolled with a managed care organization and
				by adult day health care programs, rehabilitation agencies, special health
				clinics, mobile health services, multi-therapy agencies, and comprehensive
				outpatient rehabilitation facilities.
Section
			 1. Provider Participation. To be eligible to provide and be
			 reimbursed for services covered under this administrative regulation, a
			 provider shall meet the requirements established in
			 907 KAR 8:040.
Section 2. Reimbursement.
(1) To be reimbursable under this
			 administrative regulation, a service shall meet the coverage requirements
			 established in
			 907 KAR 8:040.
(2) The department shall reimburse:
(a) 63.75 percent of the rate listed on the
			 current Kentucky-specific Medicare Physician Fee Schedule for a service
			 provided by:
1. An occupational
			 therapist;
2. A physical therapist;
			 or
3. A speech-language
			 pathologist; or
(b) 37.5
			 percent of the rate listed on the current Kentucky-specific Medicare Physician
			 Fee Schedule for a service provided by:
1. An
			 occupational therapy assistant;
2.
			 A physical therapist assistant; or
3. A speech-language pathology clinical
			 fellow.
(3)
(a) The current Kentucky-specific Medicare
			 Physician Fee Schedule shall be the Kentucky-specific Medicare Physician Fee
			 Schedule used by the Centers for Medicare and Medicaid Services on the date
			 that the service is provided.
(b)
			 For example, if an occupational therapy service is provided on a date when the
			 Centers for Medicare and Medicaid Services':
1. Interim Kentucky-specific Medicare
			 Physician Fee Schedule for a given year is in effect, the reimbursement for the
			 service shall be the amount established on the interim Kentucky-specific
			 Medicare Physician Fee Schedule for the year; or
2. Final Kentucky-specific Medicare Physician
			 Fee Schedule for a given year is in effect, the reimbursement for the service
			 shall be the amount established on the final Kentucky-specific Medicare
			 Physician Fee Schedule for the year.
(4) The unit amount for a given service shall
			 be as established in the corresponding:
(a)
			 Current procedural terminology code for the service; or
(b) Healthcare common procedure coding system
			 code for the service or item.