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,
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.
Section 2.
Interagency Agreement. Services provided pursuant to this administrative
regulation shall be in accordance with an interagency agreement between the
department and the Title V agency.
Section
3. Coverage. Services provided shall be the following:
(1) Targeted case management services
provided to the following:
(a)
Medicaid-eligible children under the age of twenty-one (21) who meet the
Department for Social Services' conditions and circumstances to be defined as a
child in the custody of, or under the supervision of or at risk of being in the
custody of the state; and
(b)
Medicaid-eligible adults (persons twenty-one (21) years of age or older) who
meet the Department for Social Services' conditions and circumstances to be
defined as an adult in need of protective services.
(2) Rehabilitative services provided to
Medicaid-eligible children under the age of twenty-one (21) who meet the
Department for Social Services' conditions and circumstances as a child in the
custody of, or under the supervision of or at risk of being in the custody of
the state.
Section 4.
Provider Qualifications and Conditions for Participation. The following
provider qualifications and conditions for participation shall be applicable
for services provided pursuant to this administrative regulation.
(1) The Title V agency may provide services
directly or through agreement with the Department for Social Services as the
state agency responsible for the provision of child and adult protective
services, which includes the following:
(a)
Children in the custody of the state; or
(b) Under the supervision of the state;
or
(c) At risk of being in the
custody of the state; and
(d)
Adults who may receive protective services from the state as a component of the
Title V Maternal and Child Health Program.
(2) Services which are provided by the
Department for Social Services and its subcontractors shall meet appropriate
requirements for the service, including as appropriate a plan of care,
supervision, and reporting.
(3)
Providers and subcontractors shall maintain records to document services
provided for not less than five (5) years or until any audit dispute or issue
is resolved if beyond five (5) years.
Section 5. Access to Records, Providers, and
Recipients.
(1) The treatment and financial
records of providers and subcontractors shall be made available to the
department upon request to verify services provided and the cost of the
services.
(2) Inspection may be on
site or through the submittal of written or electronic materials as determined
to be appropriate by the department.
(3) The department shall have the right to
interview all current or previous provider or subcontractor staff with regard
to services provided pursuant to this administrative regulation and all
recipients of targeted case management or rehabilitative services with regard
to services received pursuant to this administrative regulation.
(4) Access to provider or subcontractor
records relating to services provided shall be required for:
(a) Representatives of the United States
Department of Health and Human Services;
(b) The state Attorney General's Office;
and
(c) The state Auditor's
Office.
(5) Providers or
subcontractors shall be required to provide to the department and
representatives of those agencies or offices referenced in this section of this
administrative regulation, on request, any information maintained by the
provider to document the service provided and any information regarding
payments claimed by the provider for furnishing services.
Section 6. Reimbursement. The following
reimbursement provisions shall be applicable:
(1) Payments shall be based on
cost.
(2) An interim rate based on
projected cost shall be used as necessary with a settlement to cost at the end
of the state fiscal year.
(3) A
billable unit of service shall include all services of that type (targeted case
management or rehabilitative services) provided during the month.
Section 7. Incorporation by
Reference of the Provider Manual.
(1) "The
Policies and Procedures Manual for Title V Services provided by the Department
for Social Services", dated July 1996, shall be incorporated by reference in
this administrative regulation.
(2)
The manual shall be on file in the Office of the Commissioner, Department for
Medicaid Services, 275 East Main Street, Third Floor East, Frankfort, Kentucky
40621.
(3) The manual shall be
available for review during the normal business week, Monday through Friday, 8
a.m. through 4:30 p.m. (eastern time), excluding state holidays.
(4) Each participating provider shall be
provided one (1) copy of the manual and appropriate manual updates following
their incorporation by reference. Additional copies may be obtained from the
Department for Medicaid Services upon payment of an appropriate fee which
approximates cost in accordance with
KRS
61.872.
Section 8. Implementation Date. The
provisions of this administrative regulation shall be applicable with regard to
services provided on or after July 1, 1996.
STATUTORY AUTHORITY:
KRS
194A.030(2),
194A.050(1),
205.520(3),
42
C.F.R. 431.615,
440.130,
447 Subpart B,
42 U.S.C.
1396a -d, 1396s, EO
2004-726