††††† 907 KAR 1:082. Rural health clinic services.

 

††††† RELATES TO: KRS 205.520, 314.011, 319.050, 335.100, 42 C.F.R. 400.203, 42 C.F.R. 405.2401(b), 405.2412-405.2417, 405.2450, 405.2452, 405.2468, 440.20, 42 C.F.R. 491.1-491.11, 42 U.S.C. 1395x(aa) and (hh)

††††† STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.520(3)

††††† NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and Family Services, Department for Medicaid Services has responsibility to administer the Medicaid Program. KRS Chapter 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 provisions relating to coverage of rural health clinic services for which payment shall be made by the Medicaid Program on behalf of both categorically needy and medically needy.

 

††††† Section 1. Definitions. (1) "Advanced registered nurse practitioner" is defined by KRS Chapter 314.011(7).

††††† (2) "Clinical psychologist" means a doctorate level psychologist who is licensed in accordance with KRS 319.050.

††††† (3) "Department" means the Department for Medicaid Services or its designee.

††††† (4) "Homebound recipient" is defined by 42 C.F.R. 440.20(b)(4)(iv).

††††† (5) "Intermittent nursing care" is defined by 42 C.F.R. 405.2401(b).

††††† (6) "Licensed clinical social worker" means an individual who meets the licensed clinical social worker requirements established in KRS 335.100.

††††† (7) "Medically necessary" means that a covered benefit or service is necessary in accordance with the provisions of 907 KAR 3:130, Section 2.

††††† (8) "Nurse-midwife" is defined by 42 C.F.R. 405.2401(b).

††††† (9) "Other ambulatory services" is defined by 42 C.F.R. 440.20(c).

††††† (10) "Part-time nursing care" is defined by 42 C.F.R. 405.2401(b).

††††† (11) "Physician" is defined by KRS 205.510(11) and 42 C.F.R. 405.2401(b).

††††† (12) "Physician assistant" is defined by KRS 311.840(3) and 42 C.F.R. 405.2401(b).

††††† (13) "Rural health clinic" or "RHC" is defined by 42 C.F.R. 405.2401(b).

††††† (14) "State plan" is defined by 42 C.F.R. 400.203.

††††† (15) "Visiting nurse services" is defined by 42 C.F.R. 405.2401(b).

 

††††† Section 2. Covered Services. The department shall cover the following medically necessary rural health clinic services furnished by an RHC that has been certified in accordance with 42 C.F.R. 491.1 through 491.11:

††††† (1) Services pursuant to 42 U.S.C. 1395x(aa);

††††† (2) Services provided by a physician if the physician:

††††† (a) Complies with the physician responsibility requirements established by 42 C.F.R. 491.8(b); and

††††† (b)1. Performs the services in an RHC; or

††††† 2. Is compensated under an agreement with an RHC for providing services furnished to a Medicaid eligible RHC patient in a location other than the RHC;

††††† (3) Services provided by a physician assistant, advanced registered nurse practitioner, or nurse midwife who is employed by or receives compensation from the RHC if the services:

††††† (a) Are furnished by a member of the RHC's staff who complies with the responsibility requirements established by 42 C.F.R. 491.8(c);

††††† (b) Are furnished under the medical supervision of a physician;

††††† (c) Are furnished in accordance with a medical order for the care and treatment of a patient as prepared by a physician;

††††† (d) Are within the providerís legally-authorized scope of practice; and

††††† (e) Would be covered if furnished by a physician;

††††† (4) Services or supplies furnished as an incident to services provided by a physician, physician assistant, advanced registered nurse practitioner, or nurse midwife if the service or supply meets the criteria established in 42 C.F.R. 405.2413 or 42 C.F.R. 405.2415;

††††† (5) Part-time or intermittent visiting nurse care and related supplies, except for drugs or biologicals, if:

††††† (a) The RHC is located in an area where a determination has been made that there is a shortage of home health agencies pursuant to 42 C.F.R. 405.2417;

††††† (b) The services are provided by a registered nurse, licensed practical nurse, or a licensed vocational nurse who is employed by or compensated for the services by the RHC; and

††††† (c) The services are furnished to a homebound recipient under a written plan of treatment that is:

††††† 1. Established and reviewed at least every sixty (60) days by a supervising physician of the RHC; or

††††† 2. Established by a physician, physician assistant, advanced registered nurse practitioner, or nurse midwife and reviewed and approved at least every sixty (60) days by a supervising physician of the RHC;

††††† (6) Behavioral health services provided by a clinical psychologist, licensed clinical social worker, or advanced registered nurse practitioner if the services are:

††††† (a) Provided by an individual who is employed by or furnishes services under contract to the RHC; and

††††† (b) Within the providerís legally-authorized scope of practice;

††††† (7) Services or supplies incident to a clinical psychologist's or licensed clinical social worker's behavioral health services if the service or supply meets the criteria established in 42 C.F.R. 405.2452; and

††††† (8) Other ambulatory services as established in the state plan.

 

††††† Section 3. Provision of Services. An RHC shall comply with the service provision requirements established by 42 C.F.R. 491.9.

 

††††† Section 4. Immunizations. An RHC shall provide, upon request from a recipient, the following covered immunizations:

††††† (1) Diphtheria and tetanus toxoids and pertussis vaccine (DPT);

††††† (2) Measles, mumps, and rubella virus vaccine live (MMR);

††††† (3) Poliovirus vaccine, live, oral (any type(s)) (OPV); or

††††† (4) Hemophilus B conjugate vaccine (HBCV). (Recodified from 904 KAR 1:082, 5-2-86; Am. 15 Ky.R. 1329; eff. 12-13-88; 34 Ky.R. 1831; 2116; eff. 4-4-08.)