Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:225 - Specialty intermediate care (IC) clinic service and coverage policies and requirements

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520(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 Medicaid program
				service and coverage policies and requirements regarding specialty intermediate
				care clinic services.
Section 1.
			 Definitions.
(1) "1915(c) home and community
			 based services waiver program" means a Kentucky Medicaid program established
			 pursuant to and in accordance with
			 42 U.S.C.
			 1396n(c).
(2) "Audiologist" is defined by
			 KRS
			 334A.020(5).
(3) "Behavior Analyst Certification Board"
			 means the nonprofit corporation:
(a)
			 Established in 1998; and
(b) Known
			 as the Behavior Analyst Certification Board, Inc.
(4) "Board certified behavior analyst" means
			 an individual who is currently certified by the Behavior Analyst Certification
			 Board as a certified behavior analyst.
(5) "Clinical laboratory" means a medical
			 laboratory pursuant to
			 KRS
			 333.020(3).
(6) "Department" means the Department for
			 Medicaid Services or its designee.
(7) "Developmental disability" means a severe
			 chronic disability which:
(a) Is attributable
			 to a mental or physical impairment or combination of mental and physical
			 impairments manifested before the person attains the age of twenty-two
			 (22);
(b) Is likely to continue
			 indefinitely;
(c) Results in
			 substantial limitations in three (3) or more areas of major life activity
			 including:
1. Self-care;
2. Receptive and expressive
			 language;
3. Learning;
4. Self direction;
5. Mobility; and
6. Capacity for independent living and
			 economic sufficiency; and
(d) Requires individually planned and
			 coordinated services of a lifelong or extended duration.
(8) "Enrollee" means an individual who is
			 enrolled with a managed care organization for the purposes of receiving
			 Medicaid program or KCHIP program covered services.
(9) "Epileptologist" means a physician who
			 specializes in treating patients who have epilepsy.
(10) "Federal financial participation" is
			 defined in
			 42 C.F.R.
			 400.203.
(11) "Functional assessment" means an
			 assessment performed using evidenced-based tools, direct observation, and
			 empirical measurement to obtain and identify functional relations between
			 behavioral and environmental factors.
(12) "Intellectual disability" means an
			 individual has:
(a) Sub-average intellectual
			 functioning;
(b) An intelligence
			 quotient of seventy (70) or below;
(c) Concurrent deficits or impairments in
			 present adaptive functioning in at least two (2) of the following areas:
1. Communication;
2. Self-care;
3. Home living;
4. Social or interpersonal skills;
5. Use of community resources;
6. Self-direction;
7. Functional academic skills;
8. Work;
9. Leisure; or
10. Health and safety; and
(d) Had an onset prior to eighteen
			 (18) years of age.
(13)
			 "Licensed psychological associate" means an individual who is currently
			 licensed in accordance with
			 KRS
			 319.064.
(14) "Licensed psychological practitioner"
			 means an individual who is currently licensed in accordance with
			 KRS
			 319.053.
(15) "Licensed psychologist" means an
			 individual who is currently licensed in accordance with
			 KRS
			 319.050.
(16) "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.
(17) "Medically necessary" means determined
			 by the department to be needed in accordance with
			 907
			 KAR 3:130.
(18) "Mental illness" is defined by
			 KRS
			 210.005(2).
(19) "Neurologist" means a physician who
			 specializes in neurology.
(20)
			 "Occupational therapist" is defined by
			 KRS
			 319A.010(3).
(21) "Occupational therapist assistant" is
			 defined by
			 KRS
			 319A.010(4).
(22) "Ophthalmic dispenser" means an
			 individual licensed to perform ophthalmic dispensing in accordance with
			 KRS
			 326.030.
(23) "Ophthalmic dispensing" is defined by
			 KRS
			 326.010(2).
(24) "Physical therapist" is defined by
			 KRS
			 327.010(2).
(25) "Physical therapist assistant" means a
			 skilled health care worker who:
(a) Is
			 certified by the Kentucky Board of Physical Therapy; and
(b) Performs physical therapy and related
			 duties as assigned by the supervising physical therapist.
(26) "Physical therapy" is defined by
			 KRS
			 327.010(1).
(27) "Physician" is defined by
			 KRS
			 311.550(12).
(28) "Physician services" means the practice
			 of medicine or osteopathy provided by a physician.
(29) "Positive behavior support specialist"
			 means an individual who:
(a) Provides:
1. Evidence-based individual interventions
			 that assist a recipient with acquiring or maintaining skills for community
			 living; and
2. Behavioral
			 intervention to reduce maladaptive behaviors;
(b) Has a master's degree in a behavioral
			 science and one (1) year of experience in behavioral programming; and
(c) Has at least one (1) year of direct
			 services with individuals with an intellectual or developmental
			 disability.
(30)
			 "Practice of medicine or osteopathy" is defined by
			 KRS
			 311.550(11).
(31) "Practice of psychology" is defined by
			 KRS
			 319.010(6).
(32) "Psychiatrist" is defined by
			 KRS
			 504.060(8).
(33) "Psychological services" means the
			 practice of psychology.
(34)
			 "Psychotropic medication" means a medication that is prescribed to treat the
			 symptoms of a psychiatric disorder.
(35) "Recipient" is defined by
			 KRS
			 205.8451(9).
(36) "Rural health clinic" is defined by
			 42 C.F.R.
			 405.2401(b).
(37) "Specialty intermediate care clinic" or
			 "specialty IC clinic" means a clinic licensed pursuant to
			 902 KAR
			 20:410.
(38) "Speech-language pathologist" is defined
			 by
			 KRS
			 334A.020(3).