RELATES TO:
42 U.S.C.
1396a(aa)
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) authorizes 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 establishes the requirements for the determination of Medicaid
eligibility for low-income, uninsured women under the age of sixty-five (65)
who have been identified by the Kentucky Women's Cancer Screening Program and
are in need of treatment for breast or cervical cancer, including a
precancerous condition and early stage cancer.
Section 1. Definitions.
(1) "Cabinet" means the Cabinet for Health
and Family Services.
(2) "CDC"
means the federal Centers for Disease Control and Prevention.
(3) "Creditable coverage" is defined in
KRS
304.17A-005(7).
(4) "Department" means the Department for
Medicaid Services or its designated agent.
(5) "Kentucky Women's Cancer Screening
Program" means the program administered by the Department for Public Health
which provides breast and cervical cancer screening and diagnostic services to
low-income, uninsured or underinsured women using both state funds and monies
from the Centers for Disease Control and Prevention's National Breast and
Cervical Cancer Early Detection Program, including Title XV funds.
(6) "Qualified alien" means an alien who, at
the time the alien applies for or receives Medi-caid, meets the requirements
established in
907
KAR 20:005, Section 2(2)(a)2 or 3.
Section 2. Eligibility Criteria. A
woman shall be eligible for Medicaid benefits if she:
(1) Has not attained the age of sixty-five
(65);
(2) Is a United States
citizen or qualified alien;
(3) Is
a resident of Kentucky;
(4) Is not
an individual described in any of the mandatory Medicaid categorically-needy
eligibility groups;
(5) Is not a
resident of a public institution in accordance with
907
KAR 20:005, Section 6;
(6) Has been:
(a) Screened for breast or cervical cancer
under the Kentucky Women's Cancer Screening Program; and
(b) Found to need treatment for breast or
cervical cancer, including a precancerous condition or early stage
cancer;
(7) Does not
have creditable coverage unless the treatment of breast or cervical cancer is
not:
(a) A covered service; or
(b) Covered due to:
1. Exclusion as a preexisting
condition;
2. An HMO affiliation
period; or
3. Exhaustion of a
lifetime limit on benefits; and
(8) Has provided a Social Security number in
accordance with
907
KAR 20:005, Section 11.
Section 3. Limitation. A woman who is
determined to require routine monitoring services for a precancerous breast or
cervical condition shall not be considered to need treatment.
Section 4. Eligibility Period.
(1) Medicaid eligibility may be effective
three (3) months prior to the month of application.
(2) The length of Medicaid eligibility shall
be as follows:
(a) Four (4) months for the
treatment of breast cancer;
(b)
Three (3) months for the treatment of cervical cancer; and
(c) Two (2) months for the treatment of
precancerous cervical or breast disorder.
(3)
(a) The
department may grant an extension of eligibility if further treatment is
necessary for breast or cervical cancer or a precancerous cervical or breast
disorder.
(b) To request an
extension, the treating provider shall complete a MAP-813D, Breast and Cervical
Cancer Treatment Program Request for Extension of Eligibility, and submit it to
the department.
(c) After receipt
of the completed MAP-813D, the department shall notify the recipient of the
eligibility extension period.
(4) If the age of sixty-five (65) is attained
during an eligible period, Medicaid eligibility shall be terminated at the end
of the birth month.
Section
5. Department for Public Health Responsibilities. A local health
department shall:
(1) In a joint effort with
an applicant, complete a MAP-813B, BCCTP Eligibility Screening Form, to
determine if the recipient is potentially eligible for Medicaid in another
eligibility category;
(2) Refer the
applicant to the local Department for Community Based Services office if she is
potentially eligible in another Medicaid group;
(3) If the applicant is determined to meet
the eligibility criteria established in Section 2 of this administrative
regulation:
(a) In conjunction with the
applicant, complete a MAP-813, Breast and Cervical Cancer Treatment Program
Application; and
(b) Contact the
department to obtain an authorization number; and
(4) If an authorization number is received,
provide the applicant's eligibility information to the department.
Section 6. Recipient
Responsibilities. The recipient shall be responsible for reporting to the
department within ten (10) days a change in:
(1) Breast or cervical cancer treatment
status;
(2) Creditable health
insurance coverage;
(3) Address;
or
(4) Another circumstance which
may affect eligibility.
Section
7. Appeal Rights.
(1) An appeal
regarding the Medicaid eligibility of an individual shall be conducted in
accordance with
907
KAR 1:560.
(2) If a woman is determined ineligible for
the Kentucky Women's Cancer Screening Program, the appeal procedures shall be
in accordance with
902 KAR
1:400.
Section 8. Incorporation by Reference.
(1) The following material is incorporated by
reference:
(a) "MAP-813B, BCCTP Eligibility
Screening Form, September 9, 2002 edition," Department for Medicaid
Services;
(b) "MAP-813, Breast and
Cervical Cancer Treatment Program Application, January 15, 2003 edition,"
Department for Medicaid Services; and
(c) "MAP-813D, Breast and Cervical Cancer
Treatment Program Request for Extension of Eligibility, January 15, 2003
edition," Department for Medicaid Services.
(2) This material may be inspected, copied,
or obtained, subject to applicable copyright law, at the Department for
Medicaid Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday
through Friday, 8 a.m. through 4:30 p.m.