Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:015 - Supplemental payments for certain primary care and vaccines

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 Medicaid program supplemental payments for certain
				primary care services and vaccines in accordance with Title V, Subtitle F,
				Section 5501 of the Affordable Care Act (42 U.S.C.
				1395l and
				42
				U.S.C. 1395w-4(c)(2)(B)) ,
				42 C.F.R.
				447.405,
				42 C.F.R.
				447.410, and
				42 C.F.R.
				447.415.
Section
			 1. Definitions.
(1) "Advanced
			 practice registered nurse" is defined by
			 KRS
			 314.011(7).
(2) "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.
(3) "Department" means
			 the Department for Medicaid Services or its designee.
(4) "Eligible evaluation and management
			 service" means a service:
(a) Which qualifies
			 for supplemental reimbursement in accordance with Section 3(1)(a), (b), and
			 (c)1. of this administrative regulation; and
(b) For which there is a corresponding paid
			 claim.
(5) "Eligible
			 provider" means a provider who qualifies for supplemental reimbursement in
			 accordance with Section 2 of this administrative regulation.
(6) "Eligible vaccine" means a vaccine:
(a) Which qualifies for supplemental
			 reimbursement in accordance with Section 3(1)(a), (b) and (c)2. of this
			 administrative regulation; and
(b)
			 For which there is a corresponding paid claim.
(7) "Federal financial participation" is
			 defined by
			 42 C.F.R.
			 400.203.
(8) "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.
(9) "Medically necessary" or "medical
			 necessity" means that a covered benefit is determined to be needed in
			 accordance with
			 907
			 KAR 3:130.
(10) "Medicaid program" means Kentucky's
			 program of services and benefits covered by the Department for Medicaid
			 Services or managed care organizations.
(11) "Personal supervision" means being
			 professionally responsible for the services rendered by an advanced practice
			 registered nurse or a physician assistant.
(12) "Physician" is defined by
			 KRS
			 311.550(12).
(13) "Physician assistant" is defined by
			 KRS
			 311.840(3).
(14) "Provider" is defined by
			 KRS
			 205.8451(7).
(15) "Recipient" is defined in
			 KRS
			 205.8451(9).