Current through Register Vol. 50, No. 6, December 1, 2023
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.
(2) "Advanced practice registered nurse" is
defined by KRS
314.011(7).
(3) "Comprehensive outpatient rehabilitation
facility" or "CORF" means an entity that is:
(a) Defined as a CORF in accordance with
42 U.S.C.
1395x(cc)(2); and
(b) Licensed as a rehabilitation agency
pursuant to
902 KAR
20:190.
(4) "Department" means the Department for
Medicaid Services or its designee.
(5) "Electronic signature" is defined by
KRS
369.102(8).
(6) "Enrollee" means a recipient who is
enrolled with a managed care organization.
(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) "Mobile health service" means an entity
that is licensed pursuant to
902 KAR 20:275.
(10) "Multi-therapy agency" or "MTA" means a
provider group:
(a) Comprised of any
combination of the following:
1. One (1) or
more occupational therapists;
2.
One (1) or more physical therapists; or
3. One (1) or more speech-language
pathologists; and
(b)
Unless exempt from licensure in statute, licensed:
1. In the state in which they practice;
and
2. To provide occupational
therapy, physical therapy, or speech-language pathology services.
(11) "Occupational
therapist" is defined by
KRS
319A.010(3).
(12) "Occupational therapy assistant" is
defined by KRS
319A.010(4).
(13) "Physical therapist" is defined by
KRS
327.010(2).
(14) "Physical therapist assistant" means a
skilled health care worker who:
(a) Is
certified by the Kentucky Board of Physical Therapy; and
(b) Performs physical therapy and related
duties as assigned by the supervising physical therapist.
(15) "Physician" is defined by
KRS
311.550(12).
(16) "Physician assistant" is defined by
KRS
311.840(3).
(17) "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.
(18) "Provider" is defined by
KRS
205.8451(7).
(19) "Recipient" is defined by
KRS
205.8451(9).
(20) "Rehabilitation agency" means an entity
that is licensed as a rehabilitation agency pursuant to
902 KAR 20:190.
(21) "Special health clinic" means an entity
that is licensed as a special health clinic pursuant to
902 KAR 20:260.
(22) "Speech-language pathologist" is defined
by KRS
334A.020(3).
(23) "Speech-language pathology clinical
fellow" means an individual who is recognized by the American
Speech-Language-Hearing Association as a speech-language pathology clinical
fellow.
(24) "State plan" is
defined by 42 C.F.R.
400.203.
40 Ky.R. 2038; Am.
2765; eff. 7-7-2014; 42 Ky.R. 2290, 2756; eff. 6-3-2016; Cert. eff.
5/9/2023.
STATUTORY AUTHORITY:
KRS
194A.010(1),
194A.030(2),
194A.050(1),
205.520(3),
42 U.S.C.
1396a
