Kentucky Administrative Regulations
Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES
Chapter 13 - Private Duty Nursing
Section 907 KAR 13:005 - Definitions for 907 KAR Chapter 13

Universal Citation: 907 KY Admin Regs Service 13:005

Current through Register Vol. 50, No. 6, December 1, 2023

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 any 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 13.

Section 1. Definitions.

(1) "Department" means the Department for Medicaid Services or its designee.

(2) "Electronic signature" is defined by KRS 369.102(8).

(3) "Enrollee" means a recipient who is enrolled with a managed care organization.

(4) "Home health agency" or "HHA" means a Medicare and Medicaid-certified agency licensed in accordance with 902 KAR 20:081.

(5) "Immediate family member" is defined by KRS 205.8451(3).

(6) "Licensed practical nurse" is defined by KRS 314.011(9).

(7) "Managed care organization" or "MCO" 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.

(8) "Medically necessary" means that a covered benefit is determined to be needed in accordance with 907 KAR 3:130.

(9) "Prior authorized" means authorized by:
(a) The department, if the service is for a recipient who is not an enrollee; or

(b) A managed care organization, if the service is for an enrollee.

(10) "Private duty nursing agency" means an agency licensed in accordance with 902 KAR 20:370.

(11) "Provider" is defined by KRS 205.8451(7).

(12) "Recipient" is defined by KRS 205.8451(9).

(13) "Registered nurse" is defined by KRS 314.011(5).

40 Ky.R. 2056; 2776; eff. 7-7-2014; Crt eff. 12-6-2019.

STATUTORY AUTHORITY: KRS 194A.010(1), 194A.030(2), 194A.050(1), 205.520(3), 42 U.S.C. 1396a

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