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 has
responsibility to administer the program of Medical Assistance.
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 sets forth the provisions relating to nursing facility services
furnished by a licensed hospital for which payment shall be made by the
Medicaid Program in behalf of both the categorically needy and the medically
needy.
Section 1. Definition. "Hospital
furnished nursing facility services" means nursing facility services provided
in a licensed hospital bed by a facility which has entered into an agreement
with the secretary, Department of Health and Human Services, pursuant to
Section 1883 of the Social Security Act, or nursing facility services provided
in a hospital bed which is licensed (in accordance with KRS Chapter 216B) for
provision of acute care and is appropriately certified for provision of nursing
facility services if the beds qualify for participation in the Medicaid Program
in accordance with usual Medicaid requirements for participation.
Section 2. Participation Requirements. The
hospital must be licensed and certified to participate in the Medicaid Program,
and any beds to be used for hospital furnished nursing facility services must
be appropriately certified. The requirements for Medicare participation shall
be the same as those Medicare participation requirements specified in
907
KAR 1:022.
Section
3. Provision of Service. Payment for services shall be limited to
those services provided to eligible individuals meeting the criteria for
provision of nursing facility services as determined in accordance with
907
KAR 1:022.
Section
4. Utilization Review. The facility shall have in place a program
of utilization review which meets the requirements specified in 42 CFR
456,
subparts C, E, and F, for hospitals, skilled nursing facilities, and
intermediate care facilities. The facility shall be responsible for cooperating
with the cabinet or its designated agents in the establishment of patient
status and performance of utilization review and control.