reglab/statecodes huggingface dataset:
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:065 - Reimbursement 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 reimbursement
				provisions and requirements regarding Medicaid Program targeted case management
				services for individuals with a severe mental illness and children with a
				severe emotional disability 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 15:060; and
(c) In accordance with the requirements
			 established in
			 907
			 KAR 15:060; and
(3) Covered in accordance with
			 907
			 KAR 15:060.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:070 - Coverage provisions and requirements regarding services provided by residential crisis stabilization units

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				21 U.S.C.
				823(g)(2),
				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 behavioral health
				services provided by residential crisis stabilization units.
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 residential crisis stabilization unit
			 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 15:075 - Reimbursement provisions and requirements for behavioral health services provided by residential crisis stabilization units

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 behavioral health
				services provided by residential crisis stabilization units 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)
			 Medically necessary;
(2) Provided:
(a) To a recipient;
(b) By a residential crisis stabilization
			 unit that meets the provider participation requirements established in
			 907
			 KAR 15:070; and
(c) In accordance with the requirements
			 established in
			 907
			 KAR 15:070; and
(3) Covered in accordance with
			 907
			 KAR 15:070.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:080 - Coverage provisions and requirements regarding chemical dependency treatment center services

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,
				21 U.S.C.
				823(g)(2),
				29 U.S.C.
				701,
				42
				U.S.C. 290ee-3,
				1320d-2-1320
				d-8, 1396a(a)(10)(B), 1396a(a)(23), 12101,
				42 C.F.R. Part 2,
				431.17,
				435.1010,
				45 C.F.R. 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 outpatient and inpatient
				chemical dependency treatment center services.
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 chemical dependency treatment center
			 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 15:085 - Reimbursement provisions and requirements regarding outpatient chemical dependency treatment center services

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 outpatient chemical
				dependency treatment center services 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 15:080; and
(2) Be covered in accordance with
			 907
			 KAR 15:080.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 17 - Managed Care › Section 907 KAR 17:015 - Managed care organization requirements and policies relating to providers

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				194A.025(3),
				205.593,
				304.14-135,
				304.17A-700-304.17A-730,
				42 C.F.R.
				431.52, Part 438,
				447.45,
				447.46,
				42 U.S.C.
				1396a(a)(37),
				1396n,
				1396u-2(b)(2)(A)(i)
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 Medicaid
				funds.
				42 U.S.C.
				1396n(b) and 42 C.F.R. Part
				438 establish requirements relating to managed care. This administrative
				regulation establishes the managed care organization requirements and policies
				relating to providers.
Section 1.
			 Provider Network.
(1) An MCO shall:
(a) Enroll providers of sufficient types,
			 numbers, and specialties in its network to satisfy the access and capacity
			 requirements established in Section 2 of this administrative regulation;
			 and
(b) Exclude, terminate, or
			 suspend from the MCO's network a provider or subcontractor who engages in an
			 activity that results in suspension, termination, or exclusion from a Medicare
			 or Medicaid program.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 17 - Managed Care › Section 907 KAR 17:020 - Managed care organization service and service coverage requirements and policies

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				194A.025(3), Chapters 202A,
				645,
				42 U.S.C.
				1396n(c),
				42
				C.F.R. 422.113(c),
				431.51(a)(4),
				431.52,
				Part 438, 447.500-447.522,
				42 U.S.C.
				1396b(m)(2)(A) (xiii),
				1396d(r), 1396u-2(b)(2)(A)(i), (ii)
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 Medicaid
				funds.
				42 U.S.C.
				1396n(b) and 42 C.F.R. Part
				438 establish requirements relating to managed care. This administrative
				regulation establishes the Medicaid managed care organization service and
				service coverage requirements and policies.
Section
			 1. Covered Services.
(1) Except
			 as established in subsection (2) of this section, an MCO shall be responsible
			 for the provision of a covered health service:
(a) That is established in Title 907 of the
			 Kentucky Administrative Regulations;
(b) That shall be in the amount, duration,
			 and scope that the services are covered for recipients pursuant to the
			 department's administrative regulations located in Title 907 of the Kentucky
			 Administrative Regulations; and
(c)
			 Beginning on the date of enrollment of a recipient into the MCO.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 17 - Managed Care › Section 907 KAR 17:035 - External independent third-party review

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				194A.025(3),
				205.646,
				304.17A-607(1)(b),
				42 C.F.R. Part 438
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 Medicaid
				funds.
				KRS
				205.646 requires the department to promulgate
				administrative regulations to implement the external independent third-party
				review required by that statute. This administrative regulation establishes
				provisions regarding a Medicaid provider's right to an external independent
				third-party review of a managed care organization's adverse final decision of a
				provider's appeal of a denial of a claim for reimbursement or a service.
Section 1. Managed Care Organization Notice
			 to Provider.
(1) If an MCO issues an adverse
			 final decision to a provider of a denial, in whole or in part, of a health care
			 service, or claim for reimbursement as referenced in
			 KRS
			 205.646(2) for a date of
			 service or request for service on or after December 1, 2016, the MCO shall
			 notify the provider in writing of the provider's right to an external
			 independent third-party review pursuant to
			 KRS
			 205.646.
(2) The MCO's notice shall:
(a) Comply with the requirements established
			 in
			 KRS
			 205.646(3) regarding an
			 external independent third-party review; and
(b) State the reason for the adverse
			 decision.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 18 - Veterans Affairs Nursing Facilities › Section 907 KAR 18:001 - Definitions for 907 KAR Chapter 18

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				42 U.S.C.
				1396a(a)(13)(A),
				42 U.S.C.
				1396a(a)(30)(A), 42 C.F.R.
				Part 413,
				42
				C.F.R. 447.204
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 18.
Section 1.
			 Definitions.
(1) "Allowable cost" means that
			 portion of a facility's cost which may be allowed by the department for
			 reimbursement purposes.
(2)
			 "Ancillary service" means an ancillary service as established in
			 907
			 KAR 1:023.
(3) "Capital costs" means capital costs as
			 established in
			 42 C.F.R.
			 413.130 through 157.
(4) "Cost report" means a copy of the cost
			 report that a VA NF submits to the Medicare program.
(5) "Department" means the Department for
			 Medicaid Services or its designee.
(6) "Federal financial participation" is
			 defined by
			 42 C.F.R.
			 400.203.
(7) "Global Insight Index" means an
			 indication of changes in health care costs from year to year developed by
			 Global Insights Index.
(8) "Pro
			 forma cost data" means estimated cost data for a specific future period of
			 time.
(9) "Prospective payment
			 rate" means a payment rate for services based on allowable costs and other
			 factors.
(10) "Recipient" is
			 defined by
			 KRS
			 205.8451(9).
(11) "Regular part-time employee" means an
			 employee who works part-time:
(a) On a
			 continual basis; and
(b) Not on a
			 short-term or temporary basis.
(12) "State fiscal year" means the twelve
			 (12) month period beginning on July 1 of one year and ending on June 30 of the
			 following year.
(13) "Upper payment
			 limit" means an amount of reimbursement that:
(a) Equates to a Veterans Affairs nursing
			 facility's Medicaid-allowable cost; and
(b) Does not exceed the limit established in
			 42 C.F.R.
			 447.272.
(14) "VA NF" means a nursing facility that
			 meets the requirements of
			 907
			 KAR 18:005, Section 1.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 18 - Veterans Affairs Nursing Facilities › Section 907 KAR 18:005 - Reimbursement provisions and requirements regarding Veterans Affairs nursing facility services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				42 U.S.C.
				1396a(a)(13)(A),
				42 U.S.C.
				1396a(a)(30)(A), 42 C.F.R.
				Part 413,
				42
				C.F.R. 447.204
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 Department for
				Medicaid Services' reimbursement provisions and requirements regarding Veterans
				Affairs nursing facility services in Kentucky.
Section 1. Provider Participation. To be
			 eligible to be reimbursed for services and drugs under this administrative
			 regulation, a VA NF shall be currently:
(1)
			 Enrolled in the Kentucky Medicaid Program in accordance with
			 907
			 KAR 1:672;
(2) Participating in the Kentucky Medicaid
			 Program in accordance with 907 1:671;
(3) Licensed by the Cabinet for Health and
			 Family Services, Office of Inspector General as a nursing facility;
			 and
(4) Certified as a state
			 veterans home by the United States Department of Veterans Affairs.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:010 - Medicaid procedures for determining initial and continuing eligibility other than procedures related to a modified adjusted gross income eligibility standard or related to former foster care individuals

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 C.F.R.
				435.530,
				435.531,
				435.540,
				435.541,
				435.906,
				435.914,
				435.916,
				435.926,
				42 U.S.C.
				416,
				423,
				1382,
				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 federal Medicaid
				funds. This administrative regulation establishes provisions relating to
				determining initial and continuing eligibility for assistance under the
				Medicaid Program except for individuals for whom a modified adjusted gross
				income is the Medicaid eligibility income standard or former foster care
				individuals who aged out of foster care while receiving Medicaid
				coverage.
Section 1. Eligibility
			 Determination Process.
(1)
(a) Except as provided in subsection (3) or
			 (5) of this section, eligibility shall be determined prospectively.
(b) To receive or continue to receive
			 assistance, a household shall meet technical and financial eligibility
			 criteria, for the appropriate month of coverage, pursuant to:
1. This section;
2. Section 3 of this administrative
			 regulation; and
3. As established
			 in:
a.
												907 KAR 20:005;
b.
												907 KAR 20:020; and
c.
												907 KAR
			 20:025.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:015 - Medicaid right to apply and reapply for individuals whose Medicaid eligibility is not based on a modified adjusted gross income eligibility standard or who are not former foster care individuals

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) 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.
				KRS
				116.048 designates the cabinet to have
				responsibility for the administration of public assistance programs as a voter
				registration agency in accordance with
				42
				U.S.C. 1973gg-10. This administrative
				regulation establishes the provisions relating to the procedure by which an
				application for Medicaid coverage is filed, except for individuals for whom a
				modified adjusted gross income is the Medicaid eligibility income standard or
				for former foster care individuals between the ages of nineteen (19) and
				twenty-six (26) years who aged out of foster care while receiving Medicaid
				coverage, and establishes the provisions and procedures necessary to provide an
				eligible Medicaid recipient the opportunity to register, or to decline from
				registering, to vote.
Section 1. Right
			 to Apply or Reapply.
(1) Each individual
			 wishing to do so shall have the opportunity to apply or reapply for Medicaid
			 through the Department for Community Based Services.
(2)
(a) An
			 individual applying on the basis of age, blindness, or disability shall not be
			 eligible as a medically needy individual, under
			 907
			 KAR 20:005, if the individual's income and resources
			 are within SSI limits.
(b) Denial
			 of assistance by the Social Security Administration for SSI for technical
			 reasons shall also be considered a denial for Medicaid benefits.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:020 - Income standards for Medicaid other than Modified Adjusted Gross Income (MAGI) standards or for former foster care individuals

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 C.F.R. Part 130, Section
				4735 of Pub.L. 105-33,
				42 U.S.C.
				1382a,
				1383c(b),
				1396-1396v,
				1396p(d)(4),
				1397jj(b)
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services has responsibility to
				administer the Medicaid program in accordance with
				42 U.S.C.
				1396 through
				1396v.
				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 provisions of
				medical assistance to Kentucky's indigent citizenry. This administrative
				regulation establishes the income standards by which Medicaid eligibility is
				determined, except for individuals for whom a modified adjusted gross income is
				the Medicaid eligibility income standard or former foster care individuals who
				aged out of foster care while receiving Medicaid coverage.
Section 1. Income Limitations.
(1)
(a)
			 Income shall be determined by comparing adjusted income as required by Section
			 2 of this administrative regulation, of the applicant, applicant and spouse, or
			 applicant, spouse, and minor dependent children with the following scale of
			 income protected for basic maintenance:
Size of Family
Annual
Monthly
1
$2,820
$235
2
3,492
291
3
4,056
338
4
5,028
419
5
5,904
492
6
6,672
556
7
7,452
621
(b) For
			 each additional family member, $720 annually or sixty (60) dollars monthly
			 shall be added to the scale.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:025 - Resource standards for Medicaid other than Modified Adjusted Gross Income (MAGI) standards or for former foster care individuals

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.619,
				304.14-640,
				304.14-642,
				42 C.F.R. Part 435, 38 U.S.C. 5503, 42 U.S.C. 1396a, 1396b, 1396d, 1397jj(b),
				1397p
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 resource
				standards for determining eligibility for Medicaid benefits.
Section 1. Resource Limitations.
(1) For an individual whose Medicaid
			 eligibility is determined using a resource standard, the upper limit for
			 resources for a family size of:
(a) One (1)
			 shall be $2,000;
(b) Two (2) shall
			 be $4,000; or
(c) Three (3) or more
			 shall be $4,000 plus fifty (50) dollars added for each additional member over
			 the initial two (2) members.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:030 - Trust and transferred resource requirements for Medicaid other than Modified Adjusted Gross Income (MAGI) standards or for former foster care individuals

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.619,
				205.6322,
				304.14-640,
				304.14-642,
				42
				U.S.C. 1396p(b) -f
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 provisions of
				medical assistance to Kentucky's indigent citizenry.
				KRS
				205.6322 requires the cabinet to promulgate
				administrative regulations to prohibit the sheltering of assets in medical
				assistance long-term care cases. This administrative regulation establishes
				trust and transferred resource requirements for Medicaid eligibility
				determinations for individuals for whom resources are considered for Medicaid
				eligibility purposes.
Section 1.
			 Transferred Resources.
(1) Transfer of
			 resources on or before August 10, 1993.
(a)
			 If an institutionalized individual applies for Medicaid, a period of
			 ineligibility shall be computed if during the thirty (30) month period
			 immediately preceding the application, but on or before August 10, 1993, the
			 individual or the spouse disposed of property for less than fair market
			 value.
(b) The period of
			 ineligibility shall begin with the month of the transfer and shall be equal to
			 the lesser of:
1. Thirty (30) months;
			 or
2. The number of months derived
			 by dividing the total uncompensated value of the resources transferred by the
			 transferred resource factor at the time of the application.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:035 - Spousal impoverishment and nursing facility requirements for Medicaid

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				194A.505,
				205.520,
				205.619,
				304.14-640,
				304.14-642,
				38
				U.S.C. 5503
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 a requirement that may be
				imposed, or opportunity presented, by federal law to qualify for federal
				Medicaid funds. This administrative regulation establishes spousal
				impoverishment and nursing facility requirements for Medicaid eligibility
				determinations for individuals for whom resources are considered for Medicaid
				eligibility purposes.
Section 1.
			 Resource Assessment.
(1) Pursuant to
			 42 U.S.C.
			 1396r-5(c)(1)(B),
			 an assessment of the joint resources of an institutionalized spouse and the
			 community spouse shall be made:
(a) Upon
			 request of either spouse at the beginning of a continuous period of
			 institutionalization of the institutionalized spouse; and
(b) Upon receipt of relevant documentation of
			 resources.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:045 - Special income requirements for hospice and 1915(c) home and community based services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520, 42 C.F.R. Part 435,
				38 U.S.C.
				5503,
				42 U.S.C.
				1396a, n
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 a requirement that may be
				imposed or opportunity presented by federal law to qualify for federal Medicaid
				funds. This administrative regulation establishes special income requirements
				for 1915(c) home and community based waiver and hospice services, except for
				individuals for whom a modified adjusted gross income is the Medicaid
				eligibility income standard or former foster care individuals between the ages
				of nineteen (19) and under twenty-six (26) who aged out of foster care while
				receiving Medicaid coverage.
Section
			 1. Special Provisions for Recipients Participating in a 1915(c)
			 Home and Community Based Services Waiver Program.
(1) Medicaid eligibility for a recipient
			 receiving 1915(c) home and community based services shall be determined if
			 necessary to establish eligibility for Medicaid benefits for a case with income
			 in excess of the basic maintenance standard taking into consideration the
			 special provisions established in:
(a) This
			 section; and
(b)
										907 KAR
			 20:035.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:050 - Presumptive eligibility

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520(3),
				205.5375,
				205.592,
				45 C.F.R.
				164,
				42 U.S.C.
				1396a(a)(47), r-1,
				42 U.S.C.
				9902
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
				secretary to promulgate administrative regulations necessary to qualify for
				federal funds by compliance with any requirement that may be imposed or
				opportunity that may be presented by federal law.
				KRS
				205.5375(7) requires the
				department to promulgate administrative regulations in accordance with KRS
				Chapter 13A that are necessary to administer this statute, including a thorough
				presumptive eligibility application form to be used by qualified hospitals when
				making presumptive eligibility determinations using information provided and
				attested to by an individual. This administrative regulation establishes
				requirements for the determination of presumptive eligibility and the provision
				of services to individuals deemed presumptively eligible for Medicaid-covered
				services.
Section 1. Providers
			 Eligible to Grant Presumptive Eligibility.
(1)
			 A determination of presumptive eligibility regarding:
(a) A pregnant woman shall be made by a
			 qualified provider who is:
1. A family or
			 general practitioner;
2. A
			 pediatrician;
3. An
			 internist;
4. An obstetrician or
			 gynecologist;
5. A physician
			 assistant;
6. A certified nurse
			 midwife;
7. An advanced practice
			 registered nurse;
8. A
			 federally-qualified health care center;
9. A primary care center;
10. A rural health clinic; or
11. A local health department; or
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:055 - Breast and cervical cancer eligibility for Medicaid

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				42 U.S.C.
				1396a(aa)
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 requirements for the determination of Medicaid
				eligibility for low-income, uninsured women under the age of sixty-five (65)
				who have been identified by the Kentucky Women's Cancer Screening Program and
				are in need of treatment for breast or cervical cancer, including a
				precancerous condition and early stage cancer.
Section 1. Definitions.
(1) "Cabinet" means the Cabinet for Health
			 and Family Services.
(2) "CDC"
			 means the federal Centers for Disease Control and Prevention.
(3) "Creditable coverage" is defined in
			 KRS
			 304.17A-005(7).
(4) "Department" means the Department for
			 Medicaid Services or its designated agent.
(5) "Kentucky Women's Cancer Screening
			 Program" means the program administered by the Department for Public Health
			 which provides breast and cervical cancer screening and diagnostic services to
			 low-income, uninsured or underinsured women using both state funds and monies
			 from the Centers for Disease Control and Prevention's National Breast and
			 Cervical Cancer Early Detection Program, including Title XV funds.
(6) "Qualified alien" means an alien who, at
			 the time the alien applies for or receives Medi-caid, meets the requirements
			 established in
			 907
			 KAR 20:005, Section 2(2)(a)2 or 3.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:060 - Medicaid adverse action and conditions for recipients

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) 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 the conditions under
				which an application is denied or medical assistance is decreased or
				discontinued and establishes the advance notice requirements.
Section 1. Reasons for Adverse Action.
(1) For an individual:
(a) Whose eligibility standard is not a
			 modified adjusted gross income or who is not a former foster care individual,
			 an application for Medicaid eligibility shall be denied if:
1. The individual's income exceeds the
			 standards as established in
			 907
			 KAR 20:020;
2. The individual's resources exceed the
			 standards established in
			 907
			 KAR 20:025;
3. The applicant does not meet technical
			 eligibility criteria or fails to comply with a technical requirement as
			 established in
			 907
			 KAR 20:005;
4. Despite receipt of written notice
			 detailing the additional information needed for a determination, the applicant
			 fails to provide sufficient information or clarify conflicting information
			 necessary for a determination of eligibility;
5. The applicant fails to keep the
			 appointment for an interview without good cause;
6. The applicant requests, in writing,
			 voluntary withdrawal of the application without good cause;
7. Staff are unable to locate the applicant;
			 or
8. The applicant is no longer
			 domiciled in Kentucky;
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:075 - Eligibility provisions and requirements regarding former foster care individuals, and individuals who were in out-of-state equivalents to foster care

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 C.F.R.
				435.150
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
				eligibility provisions and requirements for an individual between the age of
				nineteen (19) and under twenty-six (26) years, who formerly was in foster care,
				or an out-of-state equivalent to foster care, and was receiving Medicaid
				benefits at the time that the individual aged out of foster care, or the
				out-of-state equivalent.
Section 1.
			 Former Foster Care Eligibility Criteria. An individual between the age of
			 nineteen (19) and under twenty-six (26) years, who formerly was in foster care,
			 or an out-of-state equivalent to foster care, and was receiving Medicaid
			 benefits at the time the individual's age exceeded the foster care, or
			 out-of-state equivalent, age limit shall be eligible for Medicaid benefits if
			 the individual meets the requirements of this administrative
			 regulation.
Section 2. Income
			 Standard. There shall be no income standard for individuals between the age of
			 nineteen (19) and under twenty-six (26) years and who formerly were in foster
			 care, or an out-of-state equivalent to foster care, but aged out of foster care
			 or the out-of-state equivalent.
Section
			 3. Resource Standard. There shall be no resource standard for
			 individuals between the age of nineteen (19) and under twenty-six (26) years
			 and who formerly were in foster care, or an out-of-state equivalent to foster
			 care, but aged out of foster care or the out-of-state equivalent.
Section 4. Attestation of Having Aged Out of
			 Foster Care.
(1) An individual between the age
			 of nineteen (19) and under twenty-six (26) years, who formerly was in foster
			 care, or an out-of-state equivalent to foster care, and was receiving Medicaid
			 benefits at the time the individual's age exceeded the foster care, or
			 out-of-state equivalent to foster care, age limit shall attest, during the
			 application process, that the individual was receiving Medicaid benefits at the
			 time that the individual reached the age which exceeded the foster care, or
			 out-of-state equivalent to foster care, age limit.
(2) An individual who does not attest as
			 established in subsection (1) of this section shall not be eligible for
			 Medicaid benefits under this administrative regulation.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:100 - Modified Adjusted Gross Income (MAGI) Medicaid eligibility standards

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 U.S.C.
				1396a(e)(14), (l)(1),
				1396b(x),
				9902(2),
				42 C.F.R.
				435.403,
				435.406,
				435.603,
				435.926,
				440.255
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 provisions and
				requirements for individuals whose Medicaid eligibility is determined using the
				modified adjusted gross income as the income standard. The affected individuals
				include children under the age of nineteen (19) years, pregnant women to 365
				days postpartum, caretaker relatives, and adults under age sixty-five (65) who
				do not have a dependent child under the age of nineteen (19) years and are not
				otherwise eligible for Medicaid benefits.
Section
			 1. Applicability.
(1)
(a) The provisions and requirements of this
			 administrative regulation shall apply to individuals whose Medicaid eligibility
			 is determined using the modified adjusted gross income as the income
			 standard.
(b) An individual whose
			 Medicaid eligibility is determined using the modified adjusted gross income as
			 an income standard shall be an individual who is:
1. A child under the age of nineteen (19)
			 years, excluding a child in foster care;
2. A caretaker relative with income up to 133
			 percent of the federal poverty level established annually by the United States
			 Department of Health and Human Services pursuant to
			 42 U.S.C.
			 9902(2);
3. A pregnant woman, with income up to 195
			 percent of the federal poverty level established annually by the United States
			 Department of Health and Human Services pursuant to
			 42 U.S.C.
			 9902(2), including the
			 postpartum period to 365 days after delivery;
4. An adult under age sixty-five (65) with
			 income up to 133 percent of the federal poverty level established annually by
			 the United States Department of Health and Human Services pursuant to
			 42 U.S.C.
			 9902(2), who:
a. Does not have a dependent child under the
			 age of nineteen (19) years; and
b.
			 Is not otherwise eligible for Medicaid benefits; or
5. A targeted low income child with income up
			 to 150 percent of the federal poverty level established annually by the United
			 States Department of Health and Human Services pursuant to
			 42 U.S.C.
			 9902(2).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 23 - Outpatient Pharmacy Program › Section 907 KAR 23:010 - Outpatient Pharmacy Program

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO: KRS Chapter 13B, 205.510, 205.560, 205.561,
				205.5631-205.5639, 205.564, 205.6316, 205.8451, 205.8453, 217.015, 217.822,
				42 C.F.R. 430.10,
				431.54,
				440.120,
				447.512-447.518,
				42 U.S.C.
				1396a,
				1396b,
				1396c,
				1396d,
				1396r-8
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.
				KRS
				205.560 provides that the scope of medical
				care for which Medicaid shall pay is determined by administrative regulations
				promulgated by the cabinet. This administrative regulation establishes the
				provisions for coverage of outpatient drugs through the Medicaid outpatient
				pharmacy program for fee-for-service recipients and managed care
				enrollees.
Section 1. Covered Drugs. A
			 covered drug shall be:
(1) Medically
			 necessary;
(2) Approved by the
			 FDA;
(3) Prescribed for an
			 indication that has been approved by the FDA or for which there is
			 documentation in official compendia or peer-reviewed medical literature
			 supporting its medical use;
(4) A
			 rebateable drug; and
(5) A covered
			 outpatient drug.
Kentucky Administrative Regulations › Title 908 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR DEVELOPMENTAL HEALTH, DEVELOPMENTAL AND INTELLECTUAL DISABILITIES › Chapter 1 - Substance Abuse › Section 908 KAR 1:300 - Chemical dependency program evaluation

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO: KRS 222.460-222.475
NECESSITY, FUNCTION AND CONFORMITY: EO 2004-726, effective July
				9, 2004, reorganized the Cabinet for Health Services and placed the Department
				for Behavioral Health, Developmental and Intellectual Disabilities within the
				cabinet.
				KRS 194.050 and
				222.460
				to
				222.475
				authorizes the cabinet to promulgate administrative regulations governing the
				gathering of information on clients discharged from publicly funded chemical
				dependency treatment agencies and the format of reports of this information to
				the cabinet in order to assess treatment effectiveness.
Section 1. Definitions.
(1) "Agency" is defined in
			 KRS
			 222.005(2) and receiving
			 state or federal funds.
(2)
			 "Client" means an individual on whom a record or chart has been opened by an
			 agency or subcontractor of an agency and for whom a treatment plan has been
			 prepared for a primary substance abuse problem. Clients receiving only DUI
			 education services, DUI assessment services or Clients receiving only
			 detoxification services during the treatment episode are excluded from the
			 definition.
(3) "Client identifier"
			 means a unique code used by agencies and the department to identify clients in
			 a departmental data set.
(4)
			 "Commissioner" means the Commissioner of the Department for Behavioral Health,
			 Developmental and Intellectual Disabilities Services, or designee.
(5) "Department" means the Department for
			 Behavioral Health, Developmental and Intellectual Disabilities Services within
			 the Cabinet.
(6) "Discharge" means
			 a date which is ninety (90) days following the last date on which a client
			 received a treatment service from the agency.
(7) "Division" means the Division of
			 Behavioral Health within the Department for Behavioral Health, Developmental
			 and Intellectual Disabilities Services.
(8) "Evaluator" means the independent
			 organization determined by the department to be qualified to conduct an outcome
			 study.
(9) "Instrument" means the
			 electronically-recorded baseline survey tool adopted for use in the
			 study.
(10) "Outcome study" means a
			 department defined study of clients to assess their progress twelve (12) months
			 after discharge from substance abuse treatment.
Kentucky Administrative Regulations › Title 908 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR DEVELOPMENTAL HEALTH, DEVELOPMENTAL AND INTELLECTUAL DISABILITIES › Chapter 1 - Substance Abuse › Section 908 KAR 1:320 - Confidential record of treatment for federally-assisted alcohol and other drug abuse programs

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				222.271, 42 C.F.R. Parts 2,
				2.11,
				2.12
NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective
				July 9, 2004, reorganized the Cabinet for Health Services and Family and placed
				the Department for Behavioral Health, Developmental and Intellectual
				Disabilities within the cabinet.
				KRS
				222.271 mandates the cabinet to establish
				standards to ensure the confidentiality of alcohol and other drug abuse client
				records. This administrative regulation establishes confidentiality standards
				for federally-assisted programs.
Section
			 1. Definitions.
(1) "AOD agency"
			 means an alcohol or other drug abuse agency licensed pursuant to
			 KRS
			 222.231.
(2) "Federally-assisted" is defined at 42 CFR
			 Part 2 , confidentiality of alcohol and drug abuse patient records, (October 1,
			 1994 edition).