RELATES TO:
KRS
194A.030(2),
205.520,
211.690,
42 U.S.C.
1396a -d, 1396n(g)
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 the 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 or state regulation for the
provision of medical assistance to Kentucky's indigent citizenry. This
administrative regulation establishes requirements for coverage and payment for
Health Access Nurturing Development Services (HANDS) provided through an
agreement with the state Title V agency, the Department for Public
Health.
Section 1. Definitions.
(1) "Department" means the Department for
Medicaid Services or its designated agent.
(2) "Title V agency" means the Department for
Public Health.
(3) "HANDS" means
health access nurturing development services provided in accordance with
902
KAR 4:120.
(4) "Recipient" is defined in KRS
205.8541.
(5) "Partnership" means
an entity that meets the criteria established in
907
KAR 1:705, and under contract with the department in
accordance with KRS Chapter 45A, agrees to provide, or arrange for the
provision of health services to members, on the basis of prepaid capitation
payments.
(6) "KenPAC" means the
Kentucky Patient Access and Care System which operates as primary care case
management system in accordance with
907 KAR
1:320 E.
(7) "Managed care organization" means the
risk-bearing managed care organization that provides physical or behavioral
health services through provider networks on a prepaid basis as either a health
maintenance organization or a provider sponsored integrated health care
delivery network.
Section
2. Covered Services.
(1)
Services shall be provided pursuant to an interagency agreement between the
department and the Title V agency.
(2) Except for a screening service as
established in
902
KAR 4:120, Section 4(1), HANDS services shall be
provided to a recipient who meets the eligibility requirements for HANDS as
established in
902
KAR 4:120, Section 2.
(3) Medicaid services to be provided shall be
the case management services described in
902
KAR 4:120, Section 4(2) through
(6).
Section 3. Provider
Qualifications and Conditions for Participation.
(1) Services shall be provided by the Title V
agency:
(a) Directly; or
(b) Indirectly through a subcontract that
requires a subcontractor to meet the provisions of
902
KAR 4:120, Section 3(2).
(2) If a HANDS service is provided to a
recipient who is a member of a Medicaid managed care partnership, managed care
organization or KenPAC, a provider of service shall coordinate and exchange
information with the recipient's primary care provider.
Section 4. Reimbursement.
(1) Payments shall be based on the cumulative
cost of providing the service.
(2)
An interim rate based on projected cost shall be used with a settlement to cost
after the end of the state fiscal year.
(3) A HANDS provider that meets the criteria
in
902
KAR 4:120, Section 3(2), shall have on file an
approved cost allocation plan.
(4)
Interim rates for services provided in accordance with
902
KAR 4:120, Section 4(2) through (6), shall be based on
the:
(a) Type of service;
(b) Personnel providing the
service;
(c) Amount of time
required to provide the service; and
(d) Costs related to providing the service,
including:
1. Contacting other persons in
agencies who may be familiar with the family's circumstances;
2. Telephone contacts; and
3. Indirect costs, including:
a. Utilities;
b. Building space;
c. Travel expenses; and
d. Office
administration.
(5) An annual cost report shall be submitted
to the Department for Medicaid Services within 180 days after the close of the
fiscal year.
(6) Interim payments
shall be adjusted to actual cost based upon review and acceptance of the cost
report by the department.
(7) The
provider may submit for consideration an amended cost report for a fiscal year
up to twenty-four (24) months after the close of that fiscal year.