Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:047 - Community mental health center primary care services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.622,
				205.8451(9),
				210.370-210.485,
				319A.010(3),
				(4),
				327.010(2),
				334A.020(3),
				369.101
				- 369.120,
				42 C.F.R.
				400.203,
				431.17,
				438.2, 493, 45 C.F.R.
				164,
				42 U.S.C.
				12101 et seq., 1396r-8(a)
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.
				KRS
				205.6313(4) requires the
				cabinet to promulgate administrative regulations to implement Medicaid
				reimbursement for primary care practitioners at community mental health
				centers. This administrative regulation establishes the Medicaid Program's
				coverage provisions and requirements regarding primary care services provided
				in a community mental health center to Medicaid recipients.
Section 1. Definitions.
(1) "CLIA" means the Clinical Laboratory
			 Improvement Amendments, 42 C.F.R. Part 493 .
(2) "Community mental health center" or
			 "CMHC" means a facility that meets the community mental health center
			 requirements established in
			 902
			 KAR 20:091.
(3) "Department" means the Department for
			 Medicaid Services or its designee.
(4) "Enrollee" means a recipient who is
			 enrolled with a managed care organization.
(5) "Federal financial participation" is
			 defined by
			 42 C.F.R.
			 400.203.
(6) "Managed care organization" means an
			 entity for which the Department for Medicaid Services has contracted to serve
			 as a managed care organization as defined by
			 42
			 C.F.R. 438.2.
(7) "Medically necessary" means that a
			 covered benefit is determined to be needed in accordance with
			 907
			 KAR 3:130.
(8) "Occupational therapist" is defined by
			 KRS
			 319A.010(3).
(9) "Occupational therapy assistant" is
			 defined by
			 KRS
			 319A.010(4).
(10) "Physical therapist" is defined by
			 KRS
			 327.010(2).
(11) "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.
(12) "Physician administered drug" or "PAD"
			 means any rebateable covered outpatient drug that is:
(a) Provided or administered to a Medicaid
			 recipient;
(b) Billed by a provider
			 other than a pharmacy provider through the medical benefit, including providers
			 who are physician offices or another outpatient clinical setting; and
(c) An injectable or non-injectable drug
			 furnished incident to provider services that are billed separately to
			 Medicaid.
(13)
			 "Rebateable" means a drug for which the drug manufacturer has entered into and
			 has in effect a rebate agreement in accordance with
			 42 U.S.C.
			 1396r-8(a).
(14) "Recipient" is defined by
			 KRS
			 205.8451(9).
(15) "Speech-language pathologist" is defined
			 by
			 KRS
			 334A.020(3).
(16) "Speech-language pathology clinical
			 fellow" means an individual who is recognized by the American
			 Speech-Language-Hearing Association as a speech-language pathology clinical
			 fellow.