Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:054 - Coverage provisions and requirements regarding federally-qualified health center services, federally-qualified health center look-alike services, and primary care center services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				310.005,
				314.011,
				335.100,
				42 C.F.R.
				400.203,
				405.2401,
				2412-2416, 2446, 2448, 2450, 2452, 441 Subpart E and F, 447.53,
				42
				U.S.C. 1395x(aa),
				42
				U.S.C. 1396d
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 Program
				coverage provisions and requirements relating to primary care center,
				federally-qualified health center services, and federally-qualified health
				center look-alike.
Section 1.
			 Definitions.
(1) "Advanced practice registered
			 nurse" is defined by
			 KRS
			 314.011(7).
(2) "Certified social worker" means an
			 individual who meets the requirements established in
			 KRS
			 335.080.
(3) "Clinical pharmacist" means a licensed
			 pharmacist whose scope of service includes taking medication histories,
			 monitoring drug use, contributing to drug therapy, drug selection, patient
			 counseling, administering drug programs, or surveillance for adverse reactions
			 and drug interactions.
(4)
			 "Community support associate" means an individual who:
(a) Meets the community support associate
			 requirements established in
			 908
			 KAR 2:250; and
(b) Has been certified by the Department for
			 Behavioral Health, Intellectual and Developmental Disabilities as a community
			 support associate.
(5)
			 "Department" means the Department for Medicaid Services or its
			 designee.
(6) "Emergency condition"
			 means a condition or situation requiring an emergency service pursuant to
			 42 C.F.R.
			 447.53.
(7) "Enrollee" means a recipient who is
			 enrolled with a managed care organization.
(8) "Face-to-face" means occurring:
(a) In person; or
(b) Via a real-time, electronic communication
			 that involves two (2) way interactive video and audio communication.
(9) "Federal financial
			 participation" is defined in
			 42 C.F.R.
			 400.203.
(10) "Federally-qualified health center" or
			 "FQHC" is defined by
			 42
			 U.S.C.
			 1396d(l)(2)(B).
(11) "Federally-qualified health center
			 look-alike" or "FQHC look-alike" means an entity that is currently approved by
			 the United States Department of Health and Human Services, Health Resources and
			 Services Administration, and the Centers for Medicare and Medicaid Services to
			 be a federally-qualified health center look-alike.
(12) "Licensed assistant behavior analyst" is
			 defined by
			 KRS
			 319C.010(7).
(13) "Licensed behavior analyst" is defined
			 by
			 KRS
			 319C.010(6).
(14) "Licensed clinical social worker" means
			 an individual who meets the licensed clinical social worker requirements
			 established in
			 KRS
			 335.100.
(15) "Licensed marriage and family therapist"
			 is defined by
			 KRS
			 335.300(2).
(16) "Licensed professional art therapist" is
			 defined by
			 KRS
			 309.130(2).
(17) "Licensed professional art therapist
			 associate" is defined by
			 KRS
			 309.130(3).
(18) "Licensed professional clinical
			 counselor" is defined by
			 KRS
			 335.500(3).
(19) "Licensed professional counselor
			 associate" is defined by
			 KRS
			 335.500(3).
(20) "Licensed psychological associate"
			 means:
(a) An individual who:
1. Currently possesses a licensed
			 psychological associate license in accordance with
			 KRS
			 319.010(6); and
2. Meets the licensed psychological associate
			 requirements established in 201 KAR Chapter 26; or
(b) A certified
			 psychologist.
(21)
			 "Licensed psychological practitioner" means;
(a) An individual who meets the requirements
			 established in
			 KRS
			 319.053; or
(b) A certified psychologist with autonomous
			 functioning.
(22)
			 "Licensed psychologist" means an individual who:
(a) Currently possesses a licensed
			 psychologist license in accordance with
			 KRS
			 319.010(6); and
(b) Meets the licensed psychologist
			 requirements established in 201 KAR Chapter 26.
(23) "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.
(24) "Marriage and family therapy associate"
			 is defined by
			 KRS
			 335.300(3).
(25) "Medically necessary" means that a
			 covered benefit or service is necessary in accordance with
			 907
			 KAR 3:130.
(26) "Nurse-midwife" is defined by
			 42 C.F.R.
			 405.2401(b).
(27) "Nutritionist" is defined by
			 KRS
			 310.005(4).
(28) "Physician" is defined by
			 KRS
			 205.510(11) and
			 42 C.F.R.
			 405.2401(b).
(29) "Physician assistant" is defined by
			 KRS
			 311.840(3) and
			 42 C.F.R.
			 405.2401(b).
(30) "Primary care center" or "PCC" means an
			 entity meeting the primary care center requirements established in
			 902
			 KAR 20:058.
(31) "Recipient" is defined by
			 KRS
			 205.8451(9).
(32) "State plan" is defined by
			 42 C.F.R.
			 400.203.