907 KAR 3:020. Coverage and payments for targeted
case management and rehabilitative services provided through an agreement with
the state Title V agency.
RELATES TO: KRS 205.520
STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1),
205.520(3), 42 C.F.R. 431.615, 440.130, 447 Subpart B, 42 U.S.C. 1396a-d,
1396s, 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) empowers 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
provides for coverage and payments for targeted case management and rehabilitative
services 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.
(2) "Rehabilitative services" means medical
or remedial services recommended by a physician or other licensed practitioner
of the healing arts, within the scope of his practice under state law, for
maximum reduction of physical or mental disability and restoration of a
recipient to his best possible functional level.
(3) "Targeted case management services"
means a set of activities which assist an individual in accessing needed
medical, social, educational, and other support services.
(4) "Title V agency" means the Department
for Public Health.
Section 2. Interagency Agreement. Services provided
pursuant to this administrative regulation shall be in accordance with an
interagency agreement between the department and the Title V agency.
Section 3. Coverage. Services provided shall be the
(1) Targeted case management services provided to
(a) Medicaid-eligible children under the age of
twenty-one (21) who meet the Department for Social Services' conditions and
circumstances to be defined as a child in the custody of, or under the
supervision of or at risk of being in the custody of the state; and
(b) Medicaid-eligible adults (persons twenty-one
(21) years of age or older) who meet the Department for Social Services'
conditions and circumstances to be defined as an adult in need of protective
(2) Rehabilitative services provided to
Medicaid-eligible children under the age of twenty-one (21) who meet the
Department for Social Services' conditions and circumstances as a child in the
custody of, or under the supervision of or at risk of being in the custody of
Section 4. Provider Qualifications and Conditions
for Participation. The following provider qualifications and conditions for
participation shall be applicable for services provided pursuant to this
(1) The Title V agency may provide services
directly or through agreement with the Department for Social Services as the
state agency responsible for the provision of child and adult protective
services, which includes the following:
(a) Children in the custody of the state; or
(b) Under the supervision of the state; or
(c) At risk of being in the custody of the state;
(d) Adults who may receive protective services from
the state as a component of the Title V Maternal and Child Health Program.
(2) Services which are provided by the Department
for Social Services and its subcontractors shall meet appropriate requirements
for the service, including as appropriate a plan of care, supervision, and
(3) Providers and subcontractors shall maintain
records to document services provided for not less than five (5) years or until
any audit dispute or issue is resolved if beyond five (5) years.
Section 5. Access to Records, Providers, and
Recipients. (1) The treatment and financial records of providers and
subcontractors shall be made available to the department upon request to verify
services provided and the cost of the services.
(2) Inspection may be on site or through the
submittal of written or electronic materials as determined to be appropriate by
(3) The department shall have the right to
interview all current or previous provider or subcontractor staff with regard
to services provided pursuant to this administrative regulation and all recipients
of targeted case management or rehabilitative services with regard to services
received pursuant to this administrative regulation.
(4) Access to provider or subcontractor records
relating to services provided shall be required for:
(a) Representatives of the United States Department
of Health and Human Services;
(b) The state Attorney General's Office; and
(c) The state Auditor's Office.
(5) Providers or subcontractors shall be required
to provide to the department and representatives of those agencies or offices
referenced in this section of this administrative regulation, on request, any
information maintained by the provider to document the service provided and any
information regarding payments claimed by the provider for furnishing services.
Section 6. Reimbursement. The following
reimbursement provisions shall be applicable:
(1) Payments shall be based on cost.
(2) An interim rate based on projected cost shall
be used as necessary with a settlement to cost at the end of the state fiscal
(3) A billable unit of service shall include all
services of that type (targeted case management or rehabilitative services)
provided during the month.
Section 7. Incorporation by Reference of the
Provider Manual. (1) "The Policies and Procedures Manual for Title V
Services provided by the Department for Social Services", dated July 1996,
shall be incorporated by reference in this administrative regulation.
(2) The manual shall be on file in the Office of
the Commissioner, Department for Medicaid Services, 275 East Main Street, Third
Floor East, Frankfort, Kentucky 40621.
(3) The manual shall be available for review during
the normal business week, Monday through Friday, 8 a.m. through 4:30 p.m.
(eastern time), excluding state holidays.
(4) Each participating provider shall be provided
one (1) copy of the manual and appropriate manual updates following their
incorporation by reference. Additional copies may be obtained from the
Department for Medicaid Services upon payment of an appropriate fee which
approximates cost in accordance with KRS 61.872.
Section 8. Implementation Date. The provisions of
this administrative regulation shall be applicable with regard to services
provided on or after July 1, 1996. (23 Ky.R. 2656; eff. 2-19-97.)