Kentucky Administrative Regulations
Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES
Chapter 1 - Medicaid Services
Section 907 KAR 1:032 - Dual licensed pediatric facility services
Current through Register Vol. 50, No. 9, March 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 has responsibility to administer the program of Medical Assistance. KRS 205.520 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 sets forth the provisions relating to nursing services provided in a dual licensed pediatric facility for which payment shall be made by the Medicaid Program in behalf of both the categorically needy and medically needy.
Section 1. Definition. A dual licensed pediatric facility is any facility providing both high intensity and low intensity nursing facility services to children under age twenty-one (21) only in the same beds.
Section 2. Participation Requirements. Each facility desiring to participate as a dual licensed pediatric facility shall meet the following requirements:
Section 3. Provision of Service. Payment for services shall be limited to those services provided to eligible individuals meeting the criteria for provision of nursing facility services as determined in accordance with 907 KAR 1:022.
Section 4. Utilization Review. The facility shall have in place a program of utilization review which meets the requirements specified in 42 C.F.R. Part 456. Determination of nursing care patient status made by the utilization review committee (and which are available to the cabinet) shall be given due consideration by the cabinet in its determinations of patient status.
STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 42 C.F.R. 442, 456, 42 U.S.C. 1396a, b, c, d, EO 2004-726