CABINET FOR HEALTH AND FAMILY SERVICES

Department for Medicaid Services

Division of Policy and Operations

(Amendment)

 

††††† 907 KAR 3:066. Nonemergency medical transportation waiver services and payments.

 

††††† RELATES TO: KRS[96 A.010,] 96A.095,[96A.170,] 205.520, 281.010[281.014(5)], 281.605(9), 281.635(5)[(9)], 281.872, 281.875, 42 C.F.R. 431.53, 440.170[440.710], 42 U.S.C. 1396n(b)

††††† STATUTORY AUTHORITY: KRS 194A.050(1), 205.520(3), 42 C.F.R. 431.53, 42 U.S.C. 1396a[194A.025, 194.030(2), 195.020, 281.014, 281.872, 281.875, 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 to qualify for federal Medicaid funds[for the provision of medical assistance to Kentuckyís indigent citizenry]. 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[Health Care Financing Administration] 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[. The capitated rate shall not be] a statewide rate; and

††††† 2.[but shall be] 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[a] 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[Health Care Financing Administration, U.S. Department for Health and Human 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[, exclusive of pharmaceutical services];

††††† (b) The service is determined to be of medical necessity; and

††††† (c) Free transportation, which is appropriate for the recipientís 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 Programís 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.[; or]

††††† (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[on or after April 12, 2000].

 

STEPHEN P. MILLER, Commissioner

VICKIE YATES BROWN GLISSON, Secretary

††††† APPROVED BY AGENCY: June 7, 2017

††††† FILED WITH LRC: June 14, 2017 at 2 p.m.

††††† PUBLIC HEARING AND PUBLIC COMMENT PERIOD: A public hearing on this administrative regulation shall, if requested, be held on July 21, 2017 at 9:00 a.m. in Suites A & B, Health Services Building, First Floor, 275 East Main Street, Frankfort, Kentucky 40621. Individuals interested in attending this hearing shall notify this agency in writing by July 14, 2017, five (5) workdays prior to the hearing, of their intent to attend. If no notification of intent to attend the hearing is received by that date, the hearing may be canceled. The hearing is open to the public. Any person who attends will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to attend the public hearing, you may submit written comments on the proposed administrative regulation. You may submit written comments regarding this proposed administrative regulation until July 31, 2017. Send written notification of intent to attend the public hearing or written comments on the proposed administrative regulation to:

††††† CONTACT PERSON: Tricia Orme, Administrative Specialist, Office of Legal Services, 275 East Main Street 5 W-B, Frankfort, Kentucky 40621, phone (502) 564-7905, fax (502) 564-7573, emailTricia.orme@ky.gov.

 

REGULATORY IMPACT ANALYSIS And Tiering Statement

 

Contact Persons: Donna Little, (502) 564-4321, ext. 2015, donna.little@ky.gov., or Tricia Orme

††††† (1) Provide a brief summary of:

††††† (a) What this administrative regulation does: 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.

††††† (b) The necessity of this administrative regulation: 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.

††††† (c) How this administrative regulation conforms to the content of the authorizing statutes: This administrative regulation conforms to the content of the authorizing statutes by establishing 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.

††††† (d) How this administrative regulation currently assists or will assist in the effective administration of the statutes: This administrative regulation assists in the effective administration of the authorizing statutes by establishing 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.

††††† (2) If this is an amendment to an existing administrative regulation, provide a brief summary of:

††††† (a) How the amendment will change this existing administrative regulation: The amendment removes the exclusion for pharmaceutical services from the description of a Medicaid-covered service, which means that a Medicaid-eligible recipient may receive nonemergency medical transportation services if the recipient is traveling to or from a Medicaid-covered service (even if to a pharmacy); the service is determined to be of medical necessity; and free transportation, which is appropriate for the recipientís medical needs, is not available or use of an appropriate and operational household vehicle is not available. The amendment also corrects citations and makes other drafting and formatting changes to comply with KRS Chapter 13A.

††††† (b) The necessity of the amendment to this administrative regulation: 42 C.F.R. 431.53 requires transportation for beneficiaries to and from providers, without an exclusion for pharmacies. The Centers for Medicare and Medicaid Services has conditionally approved the Department for Medicaid Servicesí human service transportation delivery program waiver, contingent upon the removal of the previously-established exclusion for pharmacy services. This amendment is therefore necessary to prevent a loss of federal funds and meet the deadline for promulgation of the regulatory change established by CMS to bring Kentuckyís administrative regulation into compliance with 42 C.F.R. 431.53.

††††† (c) How the amendment conforms to the content of the authorizing statutes: This administrative regulation conforms to the content of the authorizing statutes by removing the exclusion for pharmaceutical services from the description of nonemergency medical transportation services. 42 C.F.R. 431.53 requires transportation for beneficiaries to and from providers, without an exclusion for pharmacies.

††††† (d) How the amendment will assist in the effective administration of the statutes: This administrative regulation assists in the effective administration of the authorizing statutes by removing an exclusion that was not authorized by 42 C.F.R. 431.53 for nonemergency medical transportation services.

††††† (3) List the type and number of individuals, businesses, organizations, or state and local government affected by this administrative regulation: This amendment will affect all individuals who qualify for nonemergency medical transportation services as well as all providers of those transportation services. The number of individuals and providers affected cannot be determined.

††††† (4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:

††††† (a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment: The nonemergency medical transportation service providers will be required to transport each Medicaid-eligible recipient who meets the specified requirements to or from a Medicaid-covered service, including to a pharmacy.

††††† (b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3): Removing the exclusion for pharmaceutical services will increase the nonemergency medical transportation annual costs by about $9 million.

††††† (c) As a result of compliance, what benefits will accrue to the entities identified in question (3): The main benefit to the providers and the Department for Medicaid Services will be compliance with 42 C.F.R. 431.53. The main benefit to Medicaid-eligible recipients will be the ability to receive nonemergency medical transportation to and from a pharmacy service.

††††† (5) Provide an estimate of how much it will cost to implement this administrative regulation:

††††† (a) Initially: Removing the exclusion for pharmaceutical services will cost about $9 million in increased nonemergency medical transportation costs annually.

††††† (b) On a continuing basis: Removing the exclusion for pharmaceutical services will cost about $9 million in increased nonemergency medical transportation costs annually.

††††† (6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation: Sources of funding to be used for the implementation and enforcement of this administrative regulation are federal funds authorized under Title XIX and Title XXI of the Social Security Act, and state matching funds of general and agency appropriations.

††††† (7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new, or by the change if it is an amendment: Neither an increase in fees nor funding is necessary to implement this administrative regulation.

††††† (8) State whether or not this administrative regulation establishes any fees or directly or indirectly increases any fees: This administrative regulation does not establish or increase any fees.

††††† (9) Tiering: Is tiering applied? Tiering was not appropriate in this administrative regulation because the administration regulation applies equally to all individuals and entities regulated by it.

 

FISCAL NOTE ON STATE OR LOCAL GOVERNMENT

 

††††† 1. What units, parts, or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation? The Department for Medicaid Services

††††† 2. Identify each state or federal regulation that requires or authorizes the action taken by the administrative regulation. KRS 194A.050(1), 205.520(3), 42 C.F.R. 431.53, 42 U.S.C. 1396a

††††† 3. Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.

††††† (a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year? The amendment is not expected to generate revenue for state or local government.

††††† (b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years? The amendment is not expected to generate revenue for state or local government.

††††† (c) How much will it cost to administer this program for the first year? Removing the exclusion for pharmaceutical services will cost about $9 million in increased nonemergency medical transportation costs annually.

††††† (d) How much will it cost to administer this program for subsequent years? Removing the exclusion for pharmaceutical services will cost about $9 million in increased nonemergency medical transportation costs annually.

††††† Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.

††††† Revenues (+/-):

††††† Expenditures (+/-):

††††† Other Explanation:

 

FEDERAL MANDATE ANALYSIS COMPARISON

 

††††† 1. Federal statute or regulation constituting the federal mandate. 42 C.F.R. 431.53, 42 U.S.C. 1396a

††††† 2. State compliance standards. 42 C.F.R. 431.53 requires transportation for beneficiaries to and from providers, without an exclusion for pharmacies. The Centers for Medicare and Medicaid Services has conditionally approved the Department for Medicaid Servicesí human service transportation delivery program waiver, contingent upon the removal of the previously-established exclusion for pharmacy services. This amendment is therefore necessary to prevent a loss of federal funds and meet the deadline for promulgation of the regulatory change established by CMS to bring Kentuckyís administrative regulation into compliance with 42 C.F.R. 431.53.

††††† 3. Minimum or uniform standards contained in the federal mandate. 42 C.F.R. 431.53 requires transportation for beneficiaries to and from providers, without an exclusion for pharmacies.

††††† 4. Will this administrative regulation impose stricter requirements, or additional or different responsibilities or requirements, than those required by the federal mandate? The administrative regulation does not impose stricter or different responsibilities than the federal requirements. The amendment aligns this administrative regulation with the federal regulation, 42 C.F.R. 431.53.

††††† 5. Justification for the imposition of the stricter standard, or additional or different responsibilities or requirements. The administrative regulation does not impose stricter or different responsibilities than the federal requirements.