907 KAR 1:270.

Podiatry Program services.

 

      RELATES TO: KRS

205.520, 42 C.F.R. 440.60, 42 U.S.C. 1396a, b, d

      STATUTORY AUTHORITY:

KRS 194A.030(2), 194A.050(1), 205.520(3), 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 a 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

coverage provisions relating to podiatry services for which payment shall be

made by the Medicaid Program on behalf of both categorically needy and medically

needy beneficiaries.

 

      Section 1. Coverage.

The Medicaid program shall cover a medical or surgical service provided to an

eligible Medicaid recipient by a licensed, participating podiatrist if the

service falls within the scope of the practice of podiatry except as provided

in Section 2 of this administrative regulation.

 

      Section 2.

Exclusions From Coverage; Exceptions. Except as provided in this section, the

following areas of care shall not be covered:

      (1) Routine foot

care.

      (a) Except as

provided in paragraph (b) of this subsection and subsection (2) of this

section, a service characterized as routine foot care shall not be covered.

Routine foot care shall include:

      1. The cutting or

removal of a corn or callus;

      2. The trimming of a

nail; or

      3. Other hygienic or

preventive maintenance care in the realm of self-care including:

      a. Cleaning or

soaking a foot;

      b. The use of a skin

cream to maintain skin tone of an ambulatory or bedfast patient; or

      c. A service

performed in the absence of localized illness, injury or symptom involving the

foot.

      (b) If the patient

has a systematic disease of sufficient severity that unskilled performance of

the following procedures would be hazardous and the patient's condition results

from severe circulatory embarrassment or an area of desensitization in a leg or

foot, payment shall be made for routine foot care, including the cutting or

removing of a:

      1. Corn;

      2. Callus; or

      3. Nail.

      (2) A service

ordinarily considered routine shall be covered if the service is performed as a

necessary and integral part of an otherwise covered service, including the

diagnosis or treatment of:

      (a) A diabetic

ulcer;

      (b) A wound; or

      (c) An infection.

      (3) A diagnostic or

treatment service for a foot infection shall be covered.

 

      Section 3.

Incorporation by Reference. (1) "Podiatry Program Manual", July 1997

edition, Department of Medicaid Services, is incorporated by reference.

      (2) It may be

inspected, copied, or obtained at the Department for Medicaid Services, 275

East Main Street, Frankfort, Kentucky, 40621, Monday through Friday, 8 a.m. to

4:30 p.m. (Recodified from 904 KAR 1:270, 5-2-86; Am. 18 Ky.R. 1647; eff.

1-10-92; 23 Ky.R. 4241; 24 Ky.R. 385; eff. 7-16-97.)