Kentucky Administrative Regulations
Title 911 - CABINET FOR HEALTH AND FAMILY SERVICES - OFFICE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS
Chapter 1 - Children with Special Health Care Needs Services
Section 911 KAR 1:020 - Billing and fees
Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO: KRS 194A.030(5), 200.470(2)
NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.030(5) authorizes the Office for Children with Special Health Care Needs to promulgate administrative regulations to implement and administer its responsibilities. This administrative regulation establishes minimum monthly payments for cost of treatment and care, commensurate with ability to pay, procedures for the preparation and transmittal of patient statement of accounts, receipt of payments, clinic participation fees, services provided by contracted providers, authorizations of payment, procedures for failure to provide payments, provisions for discharge, criteria for reapplication, as well as a process for reconsideration of an adverse decision.
Section 1. Definitions.
Section 2. Minimum Monthly Payment.
Pay Category |
Minimum Monthly Payment |
0% |
$20.00 |
20% |
$40.00 |
40% |
$80.00 |
60% |
$120.00 |
80% |
$160.00 |
100% |
$200.00 |
Section 3. Patient Statement of Account. Designated staff shall prepare a statement of account, which shall:
Section 4. Receipt of Payments. A family shall make payments to OCSHCN:
Section 5. OCSHCN Clinic Participation Fees.
Pay Category |
Participation Fee |
0% |
$5.00 |
20% |
$5.00 |
40% |
$10.00 |
60% |
$10.00 |
80% |
$15.00 |
100% |
$15.00 |
Section 6. OCSHCN Referral for Services Provided by Contracted Providers.
Section 7. Authorization of Payment for External Services.
Pay Category |
Amount Owed |
0% |
$0.00 |
20% |
20% of amount paid by OCSHCN |
40% |
40% of amount paid by OCSHCN |
60% |
60% of amount paid by OCSHCN |
80% |
80% of amount paid by OCSHCN |
100% |
100% of amount paid by OCSHCN |
Pay Category |
Amount Owed |
0% |
$0.00 |
20% |
20% of amount paid by OCSHCN |
40% |
40% of amount paid by OCSHCN |
60% |
60% of amount paid by OCSHCN |
80% |
80% of amount paid by OCSHCN |
100% |
100% of amount paid by OCSHCN |
Pay Category |
Amount Owed |
0% |
$0.00, unless patient is covered by Medicaid and hearing instruments have been provided within the past thirty-six (36) months, in which case the Medicaid contract rate shall apply |
20% |
20% of amount paid by OCSHCN |
40% |
40% of amount paid by OCSHCN |
60% |
60% of amount paid by OCSHCN |
80% |
80% of amount paid by OCSHCN |
100% |
100% of amount paid by OCSHCN |
Pay Category |
Amount Owed |
0% |
$0.00 |
20% |
20% of amount paid by OCSHCN |
40% |
40% of amount paid by OCSHCN |
60% |
60% of amount paid by OCSHCN |
80% |
80% of amount paid by OCSHCN |
100% |
100% of amount paid by OCSHCN |
Pay Category |
Amount Owed |
20% |
100% of amount paid by OCSHCN, not to exceed $20.00 per month |
40% |
100% of amount paid by OCSHCN, not to exceed $40.00 per month |
60% |
100% of amount paid by OCSHCN, not to exceed $60.00 per month |
80% |
100% of amount paid by OCSHCN, not to exceed $80.00 per month |
100% |
100% of amount paid by OCSHCN, not to exceed $100.00 per month |
Pay Category |
Payment Due on Balance Owed |
0% |
$20.00 per month, or account balance if balance is less than $20.00 |
20% |
$40.00 per month, or account balance if balance is less than $40.00 |
40% |
$80.00 per month, or account balance if balance is less than $80.00 |
60% |
$120.00 per month, or account balance if balance is less than $120.00 |
80% |
$160.00 per month, or account balance if balance is less than $160.00 |
100% |
$200.00 per month, or account balance if balance is less than $200.00 |
Section 8. Failure to Provide Payments.
Section 9. Reapplication. OCSHCN shall allow no more than three (3) reapplications if the discharge reasons include failure to:
Section 10. Request for Reconsideration.
Section 11. Incorporation by Reference.
STATUTORY AUTHORITY: KRS 194A.030(5)