907 KAR 1:190. Payments for alternative birth center services.

      RELATES TO: KRS 205.520

      STATUTORY AUTHORITY: KRS 194.030(2), 194A.050(1), 205.520(3), 42 C.F.R. 447.325, 42 U.S.C. 1396a, b, d, 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 has responsibility to administer the program of Medical Assistance. 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 sets forth the method for determining amounts payable by the cabinet for alternative birth center services.

      Section 1. General Requirements. The cabinet shall reimburse participating licensed alternative birth centers for covered services rendered eligible Medicaid recipients when the services are provided in accordance with the provisions of 902 KAR 20:150, Alternative birth centers.

      Section 2. Payments. (1) Prenatal visits, standby services and postnatal visits billed by a birthing center shall be paid at the lower of the billed charge or seventy-five (75) percent of the upper limit for physicians for the same services provided on an outpatient basis when services are provided by the medical professional (i.e., physician or nurse-midwife who is an appropriately licensed and certified advanced registered nurse practitioner). Laboratory services shall be paid at the lower of the billed charges or the upper limit for physicians.

      (2) The delivery fee payable to the center shall be the facility's usual and customary rate not to exceed $365 per delivery. This fee is inclusive of all costs associated with the delivery, including the professional fee for the delivery, necessary supplies and materials, and the post delivery examination.

      (3) Program payment shall be considered payment in full for all services, supplies, and devices provided during the visit billed, and no additional amounts may be requested from the recipient, the Medicaid program, or any other source. This shall not, however, preclude the collection of appropriate amounts from liable third party sources which shall serve to reduce the liability of the cabinet. (Recodified from 904 KAR 1:190, 5-2-86; 18 Ky.R. 1643; 2346; eff. 2-7-92.)