907 KAR 1:520. Payments for targeted case management services for adults with chronic mental illness.
RELATES TO: KRS 205.520(3), 42 U.S.C. 1396a, 1396b, 1396c, 1396d, 1396n
STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), (3), 205.520(3), 42 U.S.C. 1396a-d, n, EO 2004-726
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 provisions relating to payments for targeted case management services for adults with chronic mental illness.
Section 1. Provision of Service. Payment for services shall be limited to those case management services provided in accordance with 907 KAR 1:515.
Section 2. Reimbursement. (1) The Department for Medicaid Services shall pay for a unit of targeted case management up to the allowable reasonable cost per unit, not to exceed 130 percent of the median reasonable cost per unit of all providers.
(2) Reasonable costs shall be determined from the 2002 audited cost report.
(3) A unit of service shall:
(a) Be one (1) month; and
(b) Consist of a minimum of four (4) service contacts including:
1. Two (2) face-to-face contacts with the recipient; and
2. Two (2) additional contacts which may be by telephone or face-to-face with, or on behalf of, the recipient.
Section 3. Nonduplication of Services. The Department for Medicaid Services shall not pay for a targeted case management service provided as part of another Medicaid Program to the extent that payment has already been made by the Department for Medicaid Services.
Section 4. Appeal Rights. A provider may appeal a Department for Medicaid Services decision as to the application of this administrative regulation in accordance with 907 KAR 1:671. (18 Ky.R. 603; eff. 10-6-1991; Am. 30 Ky.R. 466; 1267; eff. 11-25-2003.)