907 KAR 1:045. Payments for community mental health center services.

 

      RELATES TO: KRS 205.520(3), 210.370

      STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.520(3), 42 C.F.R. 447.325, 42 U.S.C. 1396a-d

      NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and Family Services, Department for Medicaid Services has responsibility to administer the program of Medical Assistance. 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 the method for determining amounts payable by the Medicaid Program for community mental health center services.

 

      Section 1. Community Mental Health Centers. Participating in-state community mental health centers shall be reimbursed as follows:

      (1) Effective July 1, 2005 the payment rate that was in effect on June 30, 2002, for community mental health center services shall remain in effect throughout state fiscal year (SFY) 2006 and there shall be no cost settling.

      (2) Allowable costs shall not exceed customary charges which are reasonable.

      (a) Allowable costs shall not include:

      1. The costs associated with political contributions;

      2. Travel or related costs for trips outside the state (for purposes of conventions, meetings, assemblies, conferences, or any related activities);

      3. The costs of motor vehicles used by management personnel which exceed $20,000 total valuation annually (unless the excess cost is considered as compensation to the management personnel); or

      4. Legal fees for unsuccessful lawsuits against the cabinet.

      (b) Costs (excluding transportation costs) for training or educational purposes outside the state shall be allowable costs.

 

      Section 2. Implementation of Payment System. (1) Payments shall be based on units of service. One (1) unit for each service shall be defined as follows:

Service

Unit of Service

Inpatient Service

15 minutes

Individual Therapy

15 minutes

Group Therapy

15 minutes

Family Therapy

15 minutes

Collateral Therapy

15 minutes

Intensive In-Home Therapy

15 minutes

Home Visit Service

15 minutes

Emergency Service

15 minutes

Personal Care Home

15 minutes

Evaluations, Examinations, and Testing

15 minutes

Therapeutic Rehabilitation for Children

1 hour

Therapeutic Rehabilitation for Adults

1 hour

Chemotherapy Service

15 minutes

Physical Examinations

15 minutes

      (2) An initial unit of service which lasts less than fifteen (15) minutes may be billed as one (1) unit.

      (3) Except for an initial unit of a service, a service that is:

      (a) Less than one-half (1/2) of one (1) unit shall be rounded down; or

      (b) Equal to or greater than one-half (1/2) of one (1) unit shall be rounded up.

      (4) An individual provider shall not exceed four (4) units of service in one (1) hour.

      (5) Overpayments discovered as a result of audits shall be settled through recoupment or withholding.

      (6) The vendor shall complete an annual cost report on forms provided by the cabinet (and included in Community Mental Health-Intellectual Disability Reimbursement Manual) not later than ninety (90) days from the end of the vendor's accounting year and the vendor shall maintain an acceptable accounting system to account for the cost of total services provided, charges for total services rendered, to and charges for covered services rendered eligible recipients.

      (7) Each community mental health center shall make available to the cabinet at the end of each fiscal reporting period, and at intervals as the cabinet may require, all patient and fiscal records of the provider, subject to reasonable prior notice by the cabinet.

      (8) Payments due a community mental health center shall be made at reasonable intervals but not less often than monthly.

 

      Section 3. Nonallowable Costs. The cabinet shall not make reimbursement under the provisions of this administrative regulation for services not covered by 907 KAR 1:044, mental health center services, nor for that portion of a community mental health center's costs found unreasonable or nonallowable in accordance with the "Community Mental Health-Intellectual Disability Reimbursement Manual".

 

      Section 4. Reimbursement of Out-of-state Providers. Reimbursement to participating out-of-state community mental health centers shall be the lower of charges, or the facility's rate as set by the state Medicaid Program in the other state, or the upper limit for that type of service in effect for Kentucky providers.

 

      Section 5. 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.

 

      Section 6. Incorporation by Reference. (1) The "Community Mental Health-Intellectual Disability Reimbursement Manual, July 2005 edition", is incorporated by reference.

      (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, 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 1:045, 5-2-86; Am. 13 Ky.R. 387; eff. 9-4-86; 14 Ky.R. 312; eff. 9-10-87; 15 Ky.R. 1980; eff. 3-15-89; 16 Ky.R. 9-20-89; 17 Ky.R. 574; eff. 10-14-90; 18 Ky.R. 916; eff. 10-16-91; 19 Ky.R. 323; eff. 8-28-92; 20 Ky.R. 664; eff. 10-21-93; Am 1364; eff. 2-16-2004; 31 Ky.R. 461; 717; eff. 11-5-04; 32 Ky.R. 405; 685; eff. 10-14-05; TAm 7-16-2013.)