907 KAR 1:028. Other laboratory and x-ray services.

      RELATES TO: KRS 205.520, 42 C.F.R. 440.30, 493, 42 U.S.C. 1396d

      STATUTORY AUTHORITY: 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 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 other laboratory and x-ray services for which payment shall be made by the Medicaid Program in behalf of both the categorically needy and medically needy.

      Section 1. Covered Services. (1) A laboratory service provided by a participating independent laboratory shall be limited to those procedures:

      (a) For which the laboratory is certified under Medicare and in accordance with 907 KAR 1:575; and

      (b) Prescribed by a physician, podiatrist, dentist, optometrist, or a person authorized by the physician, podiatrist, dentist, or optometrist, if the physician, podiatrist, dentist, or optometrist approved the service.

      (2) X-ray services (radiological services including x-rays, ultrasound, computer assisted tomography and magnetic resonance imaging) shall be limited to those procedures provided by a facility licensed to provide radiological services and which meets the requirements of 42 C.F.R. 440.30 with the following limitations:

      (a) The facility shall participate in the Medicare Program;

      (b) The procedure shall be ordered by a licensed physician, oral surgeon, dentist, podiatrist, optometrist or a person authorized by the physician, oral surgeon, dentist, podiatrist, or optometrist, if the physician, oral surgeon, dentist, podiatrist, or optometrist approved of the service;

      (c) The service shall be provided under the direction or supervision of a licensed physician; and

      (d) The facility shall meet the requirements of 42 C.F.R. Part 493 with regard to laboratory certification, registration or other accreditation as appropriate.

      Section 2. Incorporation by Reference. (1) "Independent Laboratory and Other Lab and X-ray Services Manual", August 1996 edition, Department of Medicaid Services, is incorporated by reference.

                (2) It may be inspected, copied, or obtained at the Department for Medicaid Services, Cabinet for Health and Family Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. (Recodified from 904 KAR 1:028, 5-2-86; Am. 12 Ky.R. 1955; eff. 7-2-86; 13 Ky.R. 1795; eff. 5-14-87; 15 Ky.R. 676; eff. 9-21-88; 19 Ky.R. 2147; eff. 4-21-93; 23 Ky.R. 3650; 4199; 24 Ky.R. 118; eff. 6-18-97.)