Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:595 - Model Waiver II service coverage and reimbursement policies and requirements

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				314.011,
				42 C.F.R.
				440.70,
				440.185,
				42 U.S.C.
				1396,
				42 U.S.C.
				1396n(c)
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, to qualify for federal Medicaid funds.
				This administrative regulation establishes the service coverage and
				reimbursement policies and requirements relating to Model Waiver II services
				provided to a Medicaid-eligible recipient. These services are provided pursuant
				to a 1915(c) home and community based waiver granted by the U. S. Department
				for Health and Human Services in accordance with
				42 U.S.C.
				1396n(c).
Section 1. Definitions.
(1) "1915(c) home and community based waiver
			 program" means a Kentucky Medicaid program established pursuant to and in
			 accordance with 42 U.S.C.
			 1396n(c).
(2) "Department" means the Department for
			 Medicaid Services or its designee.
(3) "Federal financial participation" is
			 defined in 42 C.F.R.
			 400.203.
(4) "Home health agency" means an agency that
			 is:
(a) Licensed in accordance with
			 902 KAR 20:081;
(b) Medicare certified; and
(c) Medicaid certified.
(5) "Licensed practical nurse" is defined by
			 KRS
			 314.011(9).
(6) "Model Waiver II services" means 1915(c)
			 home and community based waiver program in-home ventilator services provided to
			 a Medicaid-eligible recipient who:
(a) Is
			 dependent on a ventilator; and
(b)
			 Would otherwise require a nursing facility level of care in a hospital based
			 nursing facility that will accept a recipient who is dependent on a
			 ventilator.
(7) "MWMA"
			 means the Kentucky Medicaid Waiver Management Application internet portal
			 located at
http://chfs.ky.gov/dms/mwma.htm
.
(8) "Participant" means a recipient who
			 qualifies for and is receiving Model Waiver II services in accordance with
			 Section 2 of this administrative regulation.
(9) "Person-centered service plan" means a
			 written individualized plan of services.
(10) "Private duty nursing agency" means a
			 facility licensed to provide private duty nursing services:
(a) By the Cabinet for Health and Family
			 Services, Office of Inspector General; and
(b) Pursuant to
			 902 KAR 20:370.
(11) "Recipient" is defined by
			 KRS
			 205.8451(9).
(12) "Registered nurse" is defined by
			 KRS
			 314.011(5).
(13) "Registered respiratory therapist" is
			 defined by KRS
			 314A.010(3)(a).
(14) "Ventilator" means a respiration
			 stimulating mechanism.
(15)
			 "Ventilator dependent" means the condition or state of an individual who:
(a) Requires the aid of a ventilator for
			 respiratory function; and
(b) Meets
			 the high intensity nursing facility patient status criteria established in
			 907 KAR 1:022.