RELATES TO:
KRS
96A.095,
205.520,
281.010,
281.605(9),
281.635(5),
281.872,
281.875,
42 C.F.R.
431.53,
440.170,
42 U.S.C.
1396n(b)
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 any requirement that may
be imposed, or opportunity presented, by federal law to qualify for federal
Medicaid funds. This administrative regulation establishes the coverage and
payment requirements for nonemergency medical transportation services,
excluding ambulance stretcher services, provided pursuant to
42 U.S.C.
1396n(b) and approved by the
Centers for Medicare and Medicaid Services to waive Medicaid requirements
related to nonemergency medical transportation of Medicaid requirements.
Section 1. Definitions.
(1) "Capitated rate" means one (1) amount
paid each month:
(a) For each Medicaid
recipient covered under authority of the waiver; and
(b) That is:
1. Not a statewide rate; and
2. Set individually for each human service
transportation delivery region as established in
603 KAR
7:080.
(2) "Department" means the Department for
Medicaid Services or its designee.
(3) "Human service transportation" means
provision of mass transportation and taxi services to transport an individual
who is eligible to receive Medicaid transportation services.
(4) "Nonemergency medical transportation"
means medical transportation not of an emergency nature, excluding ambulance
stretcher services, provided to an eligible Medicaid recipient by the
Transportation Cabinet pursuant to an agreement between the Transportation
Cabinet and the department.
(5)
"Waiver authority" means the provisions contained in
42 U.S.C.
1396n(b).
Section 2. Interagency Agreement. Pursuant to
waiver authority granted by the Centers for Medicare and Medicaid Services, the
Department for Medicaid Services may enter into an agreement with the
Transportation Cabinet for the provision of nonemergency medical transportation
to a Medicaid recipient.
Section 3.
Coverage.
(1) The coverage provisions
established in
603 KAR
7:080 shall comply with this administrative
regulation.
(2) A Medicaid-eligible
recipient may receive nonemergency medical transportation services if the
recipient meets the following conditions:
(a)
The recipient is traveling to or from a Medicaid-covered service;
(b) The service is determined to be of
medical necessity; and
(c) Free
transportation, which is appropriate for the recipient's medical needs, is not
available or use of an appropriate and operational household vehicle is not
available.
Section
4. Reimbursement.
(1) The
Transportation Cabinet shall be reimbursed at a monthly capitated rate set by
the department for each Medicaid recipient receiving services pursuant to this
administrative regulation.
(2) The
capitated rate shall not exceed the Medicaid Program's usual aggregate cost on
a projected statewide basis of providing nonemergency medical transportation
services to the covered group of recipients.
Section 5. Appeal Rights.
(1) An appeal of a negative action regarding
a Medicaid recipient shall be in accordance with
907
KAR 1:563.
(2) An appeal of a negative action regarding
Medicaid eligibility of an individual shall be in accordance with
907
KAR 1:560.
(3) An appeal of a negative action regarding
a Medicaid provider shall be in accordance with
907
KAR 1:671.
Section 6. Implementation. The provisions of
this administrative regulation shall be applicable for nonemergency
transportation waiver services provided in accordance with KRS Chapter 45A and
Section 2 of this administrative regulation.