reglab/statecodes huggingface dataset:
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:020 - Coverage and payments for targeted case management and rehabilitative services provided through an agreement with the state Title V agency

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520
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) empowers 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 provides for coverage and payments for targeted case management and
				rehabilitative services provided through an agreement with the state Title V
				agency, the Department for Public Health.
Section
			 1. Definitions.
(1) "Department"
			 means the Department for Medicaid Services.
(2) "Rehabilitative services" means medical
			 or remedial services recommended by a physician or other licensed practitioner
			 of the healing arts, within the scope of his practice under state law, for
			 maximum reduction of physical or mental disability and restoration of a
			 recipient to his best possible functional level.
(3) "Targeted case management services" means
			 a set of activities which assist an individual in accessing needed medical,
			 social, educational, and other support services.
(4) "Title V agency" means the Department for
			 Public Health.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:035 - Criteria for certification for out-of-state residential services for Medicaid-eligible children under twenty-one (21)

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				199.680,
				205.634
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.
				KRS
				199.680(3) and
				205.634(4)
				require the department to promulgate an administrative regulation establishing
				the requirements for a determination of the availability of providers of
				residential care within Kentucky.
				KRS
				199.680(1) and
				205.634(2)
				prohibit the reimbursement of an out-of-state provider of residential care for
				children whose care is paid by state general funds or state administered
				federal funds unless a determination has been made that a provider in Kentucky
				is not capable or willing to provide comparable services to the child. This
				administrative regulation establishes uniform conditions and requirements for
				certification for out-of-state residential services for Medicaid-eligible
				children under age twenty-one (21), and for determining the availability of
				providers of residential care within the Commonwealth.
Section 1. Definitions.
(1) "Comparable cost per child" means total
			 payments made by the department per child to an out-of-state facility are
			 comparable to total payments made by the department per child to an in-state
			 facility for comparable residential care.
(2) "Comparable services" mean services
			 provided by an in-state residential provider equal to or surpassing services
			 provided by an out-of-state residential provider.
(3) "Department" means the Department for
			 Medicaid Services or its designated agent.
(4) "Participating provider" means a provider
			 who receives reimbursement from the Department for Medicaid Services for
			 services provided to a Medicaid-eligible child under age twenty-one
			 (21).
(5) "Residential care" means
			 behavioral health services provided twenty-four (24) hours a day by a
			 participating provider in a structured setting with an organized program of
			 care.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:060 - Ambulance provider assessment program

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				45.229,
				142.301,
				142.318,
				142.343,
				142.359,
				194A.030(2),
				205.5601, 205.5602, 205.5603, 42 C.F.R. 413,
				42 U.S.C.
				1396a
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 funds.
				KRS 205.5602(2) requires the department to promulgate an administrative
				regulation to implement the Ambulance Provider Assessment Program, as
				established pursuant to KRS 205.5601 and 205.5603. This administrative
				regulation establishes the requirements for implementing the Ambulance Provider
				Assessment Program for ground ambulance providers.
Section 1. Definitions.
(1) "Assessment" is defined by KRS
			 205.5602(1)(b).
(2) "Department" is
			 defined by KRS 205.5602(1)(e).
(3)
			 "Federal financial participation" is defined by
			 42 C.F.R.
			 400.203.
(4) "Ground ambulance provider" is defined by
			 KRS 205.5602(1)(a).
(5) "Medicaid"
			 is defined by
			 KRS
			 142.301(14).
(6) "MMIS" means the Medicaid Management
			 Information System or its successor program.
(7) "Program year" means the calendar year
			 during which supplemental payments and tax assessments are made.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:066 - Nonemergency medical transportation waiver services and payments

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				96A.095,
				205.520,
				281.010,
				281.605(9),
				281.635(5),
				281.872,
				281.875,
				42 C.F.R.
				431.53,
				440.170,
				42 U.S.C.
				1396n(b)
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 coverage and
				payment requirements for nonemergency medical transportation services,
				excluding ambulance stretcher services, provided pursuant to
				42 U.S.C.
				1396n(b) and approved by the
				Centers for Medicare and Medicaid Services to waive Medicaid requirements
				related to nonemergency medical transportation of Medicaid requirements.
Section 1. Definitions.
(1) "Capitated rate" means one (1) amount
			 paid each month:
(a) For each Medicaid
			 recipient covered under authority of the waiver; and
(b) That is:
1. Not a statewide rate; and
2. Set individually for each human service
			 transportation delivery region as established in
			 603 KAR
			 7:080.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:100 - Reimbursement for acquired brain injury waiver services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				42 C.F.R.
				441.300- 310,
				42 U.S.C.
				1396a, b, d, n
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health
				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 payment provisions relating to home - and community
				-based waiver services provided to an individual with an acquired brain injury
				as an alternative to nursing facility services for the purpose of
				rehabilitation and retraining for reentry into the community with existing
				resources.
Section 1. Definitions.
(1) "ABI" means an acquired brain
			 injury.
(2) "ABI provider" means an
			 entity that meets the provider criteria established in
			 907 KAR
			 3:090, Section 2.
(3) "ABI recipient" means an individual who
			 meets the ABI recipient criteria established in
			 907 KAR
			 3:090, Section 3.
(4) "Acquired brain injury waiver service" or
			 "ABI waiver service" means a home and community based waiver service provided
			 to a Medicaid eligible individual who has acquired a brain injury.
(5) "Consumer" is defined by
			 KRS
			 205.5605(2).
(6) "Consumer directed option" or "CDO" means
			 an option established by
			 KRS
			 205.5606 within the home and community based
			 services waiver that allows recipients to:
(a) Assist with the design of their
			 programs;
(b) Choose their
			 providers of services; and
(c)
			 Direct the delivery of services to meet their needs.
(7) "Department" means the Department for
			 Medicaid Services or its designated agent.
(8) "Medically necessary" or "medical
			 necessity" means that a covered benefit is determined to be needed in
			 accordance with
			 907
			 KAR 3:130.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:125 - Chiropractic services and reimbursement

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				312.015,
				312.017,
				42 C.F.R.
				440.230, 441 Subpart B
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 for the provision of medical
				assistance to Kentucky's indigent citizenry. This administrative regulation
				establishes the provisions relating to chiropractic services for which payment
				shall be made by the Medicaid Program on behalf of both the categorically needy
				and the medically needy.
Section 1.
			 Definitions.
(1) "Chiropractic service" means
			 the diagnosis and the therapeutic adjustment or manipulation of the
			 subluxations of the articulations of the human spine and its adjacent tissues
			 performed by, and within the scope of licensure of, a licensed chiropractor in
			 accordance with
			 KRS
			 312.015 and
			 312.017.
(2) "Chiropractor" is defined in
			 KRS
			 312.015(3).
(3) "Current procedural terminology code" or
			 "CPT code" means the code used for reporting procedures and services performed
			 by medical practitioners and published annually by the American Medical
			 Association in Current Procedural Terminology.
(4) "Department" means the Department for
			 Medicaid Services or its designee.
(5) "Medically necessary" or "medical
			 necessity" means that a covered benefit is determined to be needed in
			 accordance with
			 907
			 KAR 3:130.
(6) "Usual and customary charge" means the
			 uniform amount that a medical provider charges to a private-pay patient or
			 third-party payor in the majority of cases for a specific medical procedure or
			 service.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:130 - Medical necessity and clinically appropriate determination basis

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 C.F.R.
				440.230, 441 Subpart B,
				42
				U.S.C. 1396d(r)
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 for the provision of medical
				assistance to Kentucky's indigent citizenry. This administrative regulation
				establishes the basis for the determination of the medical necessity and
				clinical appropriateness of benefits and services for which payment shall be
				made by the Medicaid Program on behalf of both the categorically and the
				medically needy.
Section 1.
			 Definitions.
(1) "Clinically appropriate"
			 means appropriate pursuant to the nationally-recognized clinical criteria known
			 as Interqual developed by McKesson Health Solutions:
(a) For which the department has contracted;
			 and
(b) Which is available for
			 purchase from McKesson Health Solutions by:
1.
			 Visiting
www.mckesson.com
.
2. Calling 1-800-522-6780; or
3. Submitting a written request to McKesson
			 Health Solutions, 275 Grove Street Suite 1 -210, Newton, MA
			 02466-2273.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:140 - Coverage and payments for the Health Access Nurturing Development Services (HANDS) Program

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				194A.030(2),
				205.520,
				211.690,
				42 U.S.C.
				1396a -d, 1396n(g)
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 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 or state regulation for the
				provision of medical assistance to Kentucky's indigent citizenry. This
				administrative regulation establishes requirements for coverage and payment for
				Health Access Nurturing Development Services (HANDS) provided through an
				agreement with the state Title V agency, the Department for Public
				Health.
Section 1. Definitions.
(1) "Department" means the Department for
			 Medicaid Services or its designated agent.
(2) "Title V agency" means the Department for
			 Public Health.
(3) "HANDS" means
			 health access nurturing development services provided in accordance with
			 902
			 KAR 4:120.
(4) "Recipient" is defined in KRS
			 205.8541.
(5) "Partnership" means
			 an entity that meets the criteria established in
			 907
			 KAR 1:705, and under contract with the department in
			 accordance with KRS Chapter 45A, agrees to provide, or arrange for the
			 provision of health services to members, on the basis of prepaid capitation
			 payments.
(6) "KenPAC" means the
			 Kentucky Patient Access and Care System which operates as primary care case
			 management system in accordance with
			 907 KAR
			 1:320 E.
(7) "Managed care organization" means the
			 risk-bearing managed care organization that provides physical or behavioral
			 health services through provider networks on a prepaid basis as either a health
			 maintenance organization or a provider sponsored integrated health care
			 delivery network.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:190 - Reimbursement for treatment related to clinical trials

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.5605,
				205.5606,
				205.5607,
				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. 42 U.S.C.
				1396d(gg) establishes
				federal requirements for reimbursement relating to a qualifying clinical trial.
				In keeping with that federal requirement, this administrative regulation
				establishes the department's coverage and reimbursement for routine patient
				costs relating to a qualifying clinical trial.
Section 1. Definitions.
(1) "Department" means the Department for
			 Medicaid Services or its designee.
(2) "Qualifying clinical trial" has the same
			 meaning as in 42 U.S.C.
			 1396d(gg)(2).
(3) "Routine patient costs" has the same
			 meaning as in 42 U.S.C.
			 1396d(gg)(1).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:215 - Tobacco cessation coverage and reimbursement

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520(3),
				205.560(1)(j),
				42 U.S.C.
				1396r-8(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 for the provision of medical
				assistance to Kentucky's indigent citizenry.
				KRS
				205.560(1)(j) authorizes the
				department to cover smoking cessation treatment interventions or programs. This
				administrative regulation establishes the department's coverage and
				reimbursement of tobacco cessation services.
Section 1. Definitions.
(1) "Advanced practice registered nurse" or
			 "APRN" is defined by
			 KRS
			 314.011(7).
(2) "Department" means the Department for
			 Medicaid Services or its designee.
(3) "FDA" means the United States Food and
			 Drug Administration.
(4) "Federal
			 financial participation" is defined by
			 42 C.F.R.
			 400.203.
(5) "Legend drug" means a drug:
(a) Defined by the United States Food and
			 Drug Administration as a legend drug; and
(b) Required to bear the statement: "Caution:
			 Federal law prohibits dispensing without prescription."
(6) "Medically necessary" means that a
			 covered benefit is determined by the department to be needed in accordance with
			 907
			 KAR 3:130.
(7) "Physician" is defined by
			 KRS
			 311.550(12).
(8) "Physician assistant" is defined by
			 KRS
			 311.840(3).
(9) "Recipient" is defined by
			 KRS
			 205.8451(9).
(10) "Supervising physician" is defined by
			 KRS
			 311.840(4).
(11) "Tobacco cessation medication" means:
(a) Nicotine replacement therapy:
1. Gum;
2. Lozenge;
3. Patch;
4. Inhaler; or
5. Spray; or
(b) A legend drug approved by the United
			 States Food and Drug Administration for tobacco cessation.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:230 - Reimbursement policies and requirements for specialty intermediate care (IC) clinic services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520(3),
				205.560(1),
				42 C.F.R. Part 413,
				42
				C.F.R. 447.204,
				42
				C.F.R. 447.321
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 reimbursement
				policies and requirements for covered specialty intermediate care clinic
				services provided to a Medicaid recipient who is not enrolled with a managed
				care organization and optional policies for covered specialty IC clinic
				services provided to a Medicaid recipient who is enrolled with a managed care
				organization.
Section 1. Definitions.
(1) "Bad debt" means accounts receivable
			 which will likely remain uncollected.
(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) "Government Auditing Standards" means the
			 standards:
(a) For audits of government
			 organizations, programs, activities, functions, and of government assistance
			 received by contractors, nonprofit organizations, and other nongovernment
			 organizations;
(b) Often referred
			 to as generally accepted government auditing standards or GAGAS; and
(c) Accessible at the Web site of
http://www.gao.gov/govaud/ybk01.htm
.
(5) "Medically necessary" means
			 determined by the department to be needed in accordance with
			 907
			 KAR 3:130.
(6) "Recipient" is defined by
			 KRS
			 205.8451(9).
(7) "Specialty intermediate care clinic" or
			 "specialty IC clinic" means a clinic located on the grounds of a state-owned
			 facility licensed pursuant to
			 902
			 KAR 20:086 as an intermediate care facility for
			 individuals with an intellectual disability.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:250 - Programs of All-Inclusive Care for the Elderly (PACE)

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.5605,
				205.5606,
				205.5607,
				42 C.F.R. Part 460, 42 C.F.R.
				489.100 -
				489.104, 42
				U.S.C. 1396a, 1396b, 1396d, 1396n
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. 42 C.F.R. Part 460 establishes the federal requirements for
				PACE to provide comprehensive, capitated health services that enhance the lives
				of frail, older adults, and enable those adults to live in the community as
				long as medically and socially feasible. This administrative regulation
				establishes the department's coverage and reimbursement for Programs of
				All-Inclusive Care for the Elderly (PACE).
Section
			 1. Definitions.
(1) "Emergency
			 medical condition" is defined by
			 42 C.F.R.
			 460.100(c).
(2) "PACE" means Programs of All-Inclusive
			 Care for the Elderly.
(3) "PACE
			 program agreement" means an agreement that:
(a) Is between a PACE organization, the
			 Centers for Medicare and Medicaid Services (CMS), and the department for the
			 operation of a PACE program; and
(b) Meets the requirements of Section 7 of
			 this administrative regulation.
(4) "Participant" means an individual who is
			 enrolled in a PACE program.
(5)
			 "Post stabilization care" is defined by
			 42 C.F.R.
			 460.100(e)(3)(i).
(6) "Restraint" means a physical or chemical
			 restraint as defined by
			 42
			 C.F.R. 460.114(a)(1) and
			 (2).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:300 - Enhanced and suspended Medicaid services and requirements if there is a declared national or state emergency

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO: KRS Chapter 39A, 194A.060, 205.510(15), 205.559,
				205.560
NECESSITY, FUNCTION, AND CONFORMITY: In accordance with
				KRS
				194A.030(2), 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 requirements for
				enhancing or suspending certain Medicaid services and requirements if there is
				a declared national or state emergency.
Section
			 1. General Provisions Relating to a Declared Emergency.
(1) In accordance with all applicable federal
			 law, the department shall respond to a declared national or state emergency
			 that is related to or rationally related to healthcare or public health by
			 temporarily enhancing, expanding, or suspending Medicaid services and
			 requirements as necessary to respond to the declared emergency.
(2) The department shall provide information
			 about specific expanded services via the use of the department's Web site,
			 electronic provider letters, or other reliable methods of communication with
			 members, providers, and stakeholders.
(3) The department may target any activity
			 undertaken pursuant to this administrative regulation to a subpopulation based
			 on criteria that include:
(a)
			 Geography;
(b) Age;
(c) Condition; or
(d) Disease.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:310 - Community Health Worker services and reimbursement

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				309.460-309.464,
				369.101-369.120
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				194A.030(2) requires the
				Cabinet for Health and Family Services, Department for Medicaid Services 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
				205.648 requires DMS to seek a state plan
				amendment and implement covered services on behalf of community health workers.
				This administrative regulation establishes community health worker services and
				reimbursement.
Section 1. Definitions.
(1) "Certified community health worker" is
			 defined by KRS
			 309.460(2).
(2) "Department" means the Department for
			 Medicaid Services or its designee.
(3) "Medical intervention":
(a) Means a treatment, procedure, or other
			 action taken to prevent or treat disease, or improve health in other ways;
			 and
(b) Includes, but does not
			 require the direct application of medical care.
(4) "Ordering provider" means a provider that
			 is employed by or contracted with a sponsoring provider and who is:
(a) A physician;
(b) A physician assistant;
(c) An advanced practice registered nurse,
			 including a certified nurse midwife;
(d) A dentist;
(e) An optometrist; or
(f) Any other clinician type included by the
			 department.
(5)
			 "Sponsoring provider":
(a) Means a provider
			 listed or permitted to employ a certified community health worker pursuant to
			 KRS
			 205.648(2); and
(b)
1.
			 Includes a behavioral health multi-specialty group; or
2. Any other provider or facility that has
			 been approved pursuant to
			 KRS
			 205.648(2)(b)
			 10.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 4 - Kentucky Children's Health Insurance Program › Section 907 KAR 4:020 - Kentucky Children's Health Insurance Program Medicaid Expansion Title XXI of the Social Security Act

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.510-205.647,
				205.6481-205.6497,
				304.5-040,
				304.17A-005(8),
				(14),
				42 C.F.R.
				432,
				433,
				435,
				436,
				440.230,
				457,
				42 U.S.C.
				1396,
				1396a,
				1397aa -jj, 9902
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				194A.030(2) requires the
				Cabinet for Health and Family Services, Department for Medicaid Services, to
				administer Title XIX of the Federal Social Security Act,
				42 U.S.C.
				1396 through
				1396v.
				KRS
				194A.050(1) requires the
				secretary of the cabinet to promulgate administrative regulations necessary to
				protect, develop, and maintain the health, personal dignity, integrity, and
				sufficiency of the individual citizens of the commonwealth; to operate the
				programs and fulfill the responsibilities vested in the cabinet; and to
				implement programs mandated by federal law or to qualify for the receipt of
				federal funds. KRS
				205.6485 requires the cabinet to establish
				the Kentucky Children's Health Insurance Program (KCHIP) to provide health care
				coverage and other coordinated health care services to children of the
				commonwealth who are uninsured and otherwise not eligible for health insurance
				coverage. This administrative regulation establishes the KCHIP eligibility
				criteria, covered services, application requirements, grievance and appeal
				rights for recipients, and the requirements for providers who wish to
				participate with the commonwealth to provide health care coverage to KCHIP
				members through an expansion of the Title XIX Medicaid Program.
Section 1. Definitions.
(1) "Cabinet" means the Kentucky Cabinet for
			 Health and Family Services or its designee.
(2) "Child" means an individual under the age
			 of nineteen (19) years.
(3)
			 "Creditable coverage" is defined by
			 KRS
			 304.17A-005(8)(a) 1 through
			 3 and 5 through 10.
(4)
			 "Department" means the Department for Medicaid Services or its
			 designee.
(5) "Excepted benefits"
			 is defined by KRS
			 304.17A-005(14).
(6) "Health insurance" is defined by
			 KRS
			 304.5-040.
(7) "KCHIP" means the Kentucky Children's
			 Health Insurance Program administered in accordance with
			 42 U.S.C.
			 1397aa through jj.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 4 - Kentucky Children's Health Insurance Program › Section 907 KAR 4:030 - Kentucky Children's Health Insurance Program Phase III Title XXI of the Social Security Act

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.6481 - 205.6497, 211.461 - 211.466,
				281.010(25), 304.5-040, 304.17A-005(8), (14),
				42 C.F.R.
				435.403,
				440.230, Part
				457,
				42 U.S.C.
				1396,
				1397aa,
				9902(2)
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				205.6485 authorizes the cabinet, by
				administrative regulations, to establish the Kentucky Children's Health
				Insurance Program (KCHIP) to provide health care coverage and other coordinated
				health care services to participant children of the Commonwealth who are
				uninsured and otherwise not eligible for health insurance coverage. This
				administrative regulation establishes the KCHIP Phase III eligibility criteria,
				quality assurance and utilization review, covered services, the approval
				process, grievance and appeal rights, and the requirements for delivery of
				health services for providers who wish to participate with the Commonwealth to
				provide health care coverage for KCHIP Phase III members through the provision
				of a separate health insurance program under Title XXI.
Section 1. Definitions.
(1) "Cabinet" means the Kentucky Cabinet for
			 Health and Family Services or its designee.
(2) "Creditable coverage" is defined by
			 KRS
			 304.17A-005(8)(a) 1 through
			 3 and 5 through 10.
(3)
			 "Department" means the Department for Medicaid Services or its
			 designee.
(4) "Excepted benefits"
			 is defined by KRS
			 304.17A-005(14).
(5) "Health insurance" is defined by
			 KRS
			 304.5-040.
(6) "KCHIP" means the Kentucky Children's
			 Health Insurance Program in accordance with
			 42 U.S.C.
			 1397aa through
			 42 U.S.C.
			 1397jj.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 6 - Electronic Health Record Incentive Payments › Section 907 KAR 6:005 - Electronic health record incentive payments

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520(3), 42 C.F.R.
				170.102,
				495.4,
				495.6,
				495.8,
				495.100,
				400.203,
				495.304,
				405.306, 405.308,
				495.312,
				495.314,
				495.368,
				495.370,
				42 U.S.C.
				1396(a)(3)(F), (t),
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 for the provision of medical
				assistance to Kentucky's indigent citizenry.
				42 U.S.C.
				1396(a)(3)(F) authorizes
				states to establish a Medicaid electronic health record (EHR) incentive payment
				program to provide payments to Medicaid providers who acquire and implement
				electronic health records. This administrative regulation establishes Medicaid
				electronic health record incentive payment requirements and policies.
Section 1. Definitions.
(1) "Department" means the Department for
			 Medicaid Services or its designee.
(2) "EHR" means electronic health
			 record.
(3) "Eligible hospital" is
			 defined in
			 42
			 C.F.R. 495.100.
(4) "Eligible professional" is defined in
			 42
			 C.F.R. 495.100.
(5) "Federal financial participation" is
			 defined in
			 42 C.F.R.
			 400.203.
(6) "Meaningful EHR user" is defined in
			 42
			 C.F.R. 495.4.
(7) "Program year" means:
(a) A calendar year for eligible
			 professionals; or
(b) A federal
			 fiscal year for eligible hospitals.
(8) "Provider" is defined by
			 KRS
			 205.8451(7).
(9) "Qualified electronic health record" or
			 "qualified EHR" is defined in
			 45
			 C.F.R. 170.102.
(10) "Qualifying critical access hospital" or
			 "qualifying CAH" is defined in
			 42
			 C.F.R. 495.100.
(11) "Qualifying eligible professional" is
			 defined by
			 42
			 C.F.R. 495.100.
(12) "Qualifying hospital" is defined by
			 42
			 C.F.R. 495.100.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 7 - Certified Provider Requirements › Section 907 KAR 7:015 - Reimbursement for home and community based waiver services version 2

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO: 42 C.F.R. 441 Subparts B, G,
				42 U.S.C.
				1396a,
				1396b,
				1396d,
				1396n
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services, is required 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
				reimbursement requirements and provisions for home and community based waiver
				services version 2.
Section 1.
			 Definitions.
(1) "ADHC" means adult day
			 health care.
(2) "ADHC center"
			 means an adult day health care center that is:
(a) Licensed in accordance with
			 902 KAR 20:066; and
(b) Certified for Medicaid participation by
			 the department.
(3)
			 "Department" means the Department for Medicaid Services or its
			 designee.
(4) "Fixed upper payment
			 limit" means the maximum amount the department shall reimburse per
			 unit.
(5) "HCB" means home and
			 community based waiver.
(6)
			 "Participant" means a recipient who:
(a) Meets
			 the nursing facility level of care criteria established in
			 907 KAR 1:022; and
(b) Meets the eligibility criteria for HCB
			 services established in
			 907 KAR
			 7:010.
(7) "Recipient" is defined by
			 KRS
			 205.8451(9).
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 7 - Certified Provider Requirements › Section 907 KAR 7:020 - 1915(c) Home and community based services waiting list and waiting list placement appeal processes

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				205.5605,
				205.5606,
				205.5607,
				42 C.F.R. 431 Subpart E, 441 Subpart G,
				42 U.S.C.
				1396a,
				1396b,
				1396d,
				1396n
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
				governing 1915(c) waiver waiting lists, and governs the circumstances under
				which an appeal will be granted if emergency status is not granted for a
				waiting list for the Supports for Community Living waiver.
Section 1. Definitions.
(1) "1915(c) 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.
(3) "Emergency
			 category of need" means an order of waiting list placement, including the
			 placement described in
			 907
			 KAR 12:010, Section 12(3)(b), for the Supports for
			 Community Living (SCL) waiver.
(4)
			 "Good cause" means a circumstance that:
(a) Is
			 beyond the control of an individual and affects the individual's ability to
			 access funding or services; and
(b)
			 Includes:
1. An illness or hospitalization of
			 the individual that is expected to last sixty (60) days or less;
2. The required paperwork and documentation
			 for processing in accordance with Section 2 of this administrative regulation
			 has not been completed, but is expected to be completed in two (2) weeks or
			 less; or
3. The individual or his
			 or her guardian has made diligent contact with a potential provider to secure
			 placement or access services, but has not been accepted within the sixty (60)
			 day time period.
(5) "MWMA" means the Kentucky Medicaid Waiver
			 Management Application internet portal administered by the department, located
			 at:
https://chfs.ky.gov/agencies/dms/Pages/mwma.aspx
.
(6) "Slot" means an allocation of funding
			 available for placing an individual in a 1915(c) waiver program.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 8 - Occupational, Physical, and Speech Therapy › Section 907 KAR 8:005 - Definitions for 907 KAR Chapter 8

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				194A.025(3)
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 the definitions for 907 KAR
				Chapter 8.
Section 1. Definitions.
(1) "Adult day health care program" or "ADHC
			 program" means a program that is:
(a) Licensed
			 pursuant to
			 902 KAR 20:066; and
(b) An adult day health program pursuant to
			 KRS
			 216B.0441.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 8 - Occupational, Physical, and Speech Therapy › Section 907 KAR 8:010 - Independent occupational therapy service coverage provisions and requirements

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, 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 Medicaid Program
				coverage provisions and requirements regarding occupational therapy services
				provided by an independent occupational therapist or occupational therapy
				assistant working under the direct supervision of an independent occupational
				therapist.
Section 1. Provider
			 Participation.
(1)
(a) To be eligible to provide and be
			 reimbursed for an occupational therapy service as an independent provider, a
			 provider shall be:
1. Currently enrolled in
			 the Kentucky Medicaid Program in accordance with
			 907
			 KAR 1:672;
2. Except as established in paragraph (b) of
			 this subsection, currently participating in the Kentucky Medicaid Program in
			 accordance with
			 907
			 KAR 1:671; and
3. Except as provided in subsection (2) of
			 this section, an occupational therapist.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 8 - Occupational, Physical, and Speech Therapy › Section 907 KAR 8:015 - Independent occupational therapy service reimbursement provisions and requirements

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, 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 Department for
				Medicaid Services' reimbursement provisions and requirements regarding
				occupational therapy services provided by an independent occupational
				therapist, or an occupational therapy assistant working under the direct
				supervision of an independent occupational therapist, to Medicaid recipients
				who are not enrolled with a managed care organization.
Section 1. General Requirements. For the
			 department to reimburse for an occupational therapy service under this
			 administrative regulation, the:
(1)
			 Occupational therapist shall meet the provider requirements established in
			 907
			 KAR 8:010; and
(2) Service shall meet the coverage and
			 related requirements established in
			 907
			 KAR 8:010.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 8 - Occupational, Physical, and Speech Therapy › Section 907 KAR 8:020 - Independent physical therapy service coverage provisions and requirements

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, 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 Medicaid Program
				coverage provisions and requirements regarding physical therapy services
				provided by an independent physical therapist or physical therapy assistant
				working under the direct supervision of an independent physical
				therapist.
Section 1. Provider
			 Participation.
(1)
(a) To be eligible to provide and be
			 reimbursed for physical therapy as an independent provider, a provider shall
			 be:
1. Currently enrolled in the Kentucky
			 Medicaid Program in accordance with
			 907
			 KAR 1:672;
2. Except as established in paragraph (b) of
			 this subsection, currently participating in the Kentucky Medicaid Program in
			 accordance with
			 907
			 KAR 1:671; and
3. Except as provided in subsection (2) of
			 this section, a physical therapist.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 8 - Occupational, Physical, and Speech Therapy › Section 907 KAR 8:025 - Physical therapy service reimbursement provisions and requirements

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, 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 Department for
				Medicaid Services' reimbursement provisions and requirements regarding physical
				therapy services provided by an independent physical therapist, or physical
				therapist assistant working under the direct supervision of an independent
				physical therapist, to Medicaid recipients who are not enrolled with a managed
				care organization.
Section 1. General
			 Requirements. For the department to reimburse for physical therapy under this
			 administrative regulation, the:
(1) Physical
			 therapist shall meet the provider requirements established in
			 907
			 KAR 8:020; and
(2) Physical therapy shall meet the coverage
			 and related requirements established in
			 907
			 KAR 8:020.
Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 8 - Occupational, Physical, and Speech Therapy › Section 907 KAR 8:030 - Independent speech-language pathology service coverage provisions and requirements

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, 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 Medicaid Program
				coverage provisions and requirements regarding speech-language pathology
				services provided by an independent speech-language pathologist.
Section 1. Provider Participation.
(1) To be eligible to provide and be
			 reimbursed for speech-language pathology services as an independent provider, a
			 provider shall be:
(a) Currently enrolled in
			 the Kentucky Medicaid Program in accordance with
			 907
			 KAR 1:672;
(b) Except as established in subsection (2)
			 of this section, currently participating in the Kentucky Medicaid Program in
			 accordance with
			 907
			 KAR 1:671; and
(c) A speech-language pathologist.