Current through Register Vol. 50, No. 9, March 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.
Section 2. Enhanced or Expanded Medicaid
Benefits. Medicaid services and requirements that may be enhanced or expanded
include:
(1) Any appropriate health service
related to or rationally related to the declared emergency;
(2) Telehealth services, which may include:
(a) Those services that are otherwise
designated as face-to-face only throughout KAR Title 907;
(b) The use of equipment, such as a
telephone, that would not customarily be allowable for a telehealth service
pursuant to KAR Title 907; or
(c)
Expanded use of asynchronous telehealth or store-and-forward telehealth,
including:
1. Remote patient monitoring, as
appropriate; or
2. Any other
telehealth service for which an evidence base exists to justify the safety and
efficacy of the service if provided as asynchronous telehealth;
(3) The introduction or
expansion of any appropriate telecommunication or electronically mediated
health service as allowable pursuant to federal law; or
(4) "Telehealth" or "telehealth service" or
"telehealth consultation" as it is defined throughout KAR Title 907, which
shall be equivalent to an in-person service or a service requiring physical
presence.
Section 3.
Eligibility. Pursuant to Section 1 of this administrative regulation, the
department may:
(1) Temporarily expand
eligibility to include individuals with higher income than currently allowed
pursuant to
907
KAR 20:100;
(2) Temporarily suspend the requirement that
a beneficiary eligible pursuant to
42 U.S.C.
1396a(a)(10)(A)(ii)(V) be
institutionalized for at least thirty (30) days;
(3) Implement a simplified electronic or
paper application for use by designated providers; or
(4) Extend the availability of presumptive
eligibility to additional groups than allowed pursuant to
907 KAR
20:050.
Section 4. Temporary Enhancement of Rate or
Rate Methodology. The department may temporarily enhance rates or rate
methodology relating to a declared national or state emergency.
Section 5. Provider Enrollment.
(1) In response to a declared national or
state emergency, the department may:
(a)
Simplify any existing provider enrollment process to meet an existing or
anticipated demand for health services; or
(b) Reenroll retired or previously enrolled
providers.
(2) Any
enrollment or reenrollment process utilized pursuant to subsection (1) of this
section shall exercise discretion when enrolling or not enrolling providers
with a history of disenrollment for good cause or other negative criminal or
registry record.
Section
6. Women, Infants, and Children (WIC) Program Services.
(1) The department or any other agency of the
Cabinet for Health and Family Services shall facilitate the provision of all
appropriate WIC services via telehealth or as a telecommunications or other
electronically mediated health service to the full extent allowable by federal
or state law.
(2) For the purposes
of all WIC services administered by the Cabinet for Health and Family Services,
any requirement that a service be "face-to-face", "in-person", or "physically
present" shall include a synchronous telehealth or telecommunication or other
electronically mediated health service.
Section 7. Federal Financial Participation. A
policy established in this administrative regulation may be null and void if
the Centers for Medicare and Medicaid Services:
(1) Denies federal financial participation
for the policy; or
(2) Disapproves
the policy.
Section 8.
If any policy stated in another administrative regulation within KAR Title 907
contradicts a policy stated in this administrative regulation, the policy
stated in this administrative regulation shall supersede the policy stated
elsewhere within KAR Title 907.
STATUTORY AUTHORITY:
KRS
194A.030(2),
194A.050(1),
205.520(3),
205.559(2),
(7),
205.560