††††† 907 KAR 3:066. Nonemergency medical transportation waiver services and payments.

 

††††† RELATES TO: KRS 96A.010, 96A.095, 96A.170, 205.520, 281.014(5), 281.605(9), 281.635(9), 42 C.F.R. 431.53, 440.710, 42 U.S.C. 1396n(b)

††††† STATUTORY AUTHORITY: KRS 194A.025, 194.030(2), 195.020, 281.014, 281.872, 281.875, 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) 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 Kentuckyís indigent citizenry. This administrative regulation establishes the coverage and payment requirements for nonemergency medical transportation services, excluding ambulance stretcher services, provided pursuant to 42 U.S.C. 1396n(b) and approved by the Health Care Financing Administration to waive Medicaid requirements related to nonemergency medical transportation of Medicaid requirements.

 

††††† Section 1. Definitions. (1) "Capitated rate" means one (1) amount paid each month for each Medicaid recipient covered under authority of the waiver. The capitated rate shall not be a statewide rate but shall be set individually for each Human Service Transportation delivery region as established in 603 KAR 7:080.

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

††††† (3) "Human service transportation" means provision of mass transportation and taxi services to transport an individual who is eligible to receive Medicaid services.

††††† (4) "Nonemergency medical transportation" means medical transportation not of an emergency nature, excluding ambulance stretcher services, provided to a Medicaid recipient by the Transportation Cabinet pursuant to an agreement between the Transportation Cabinet and the department.

††††† (5) "Waiver authority" means the provisions contained in 42 U.S.C. 1396n(b).

 

††††† Section 2. Interagency Agreement. Pursuant to waiver authority granted by the Health Care Financing Administration, U.S. Department for Health and Human Services, the Department for Medicaid Services may enter into an agreement with the Transportation Cabinet for the provision of nonemergency medical transportation to a Medicaid recipient.

 

††††† Section 3. Coverage. (1) The coverage provisions established in 603 KAR 7:080 shall comply with this administrative regulation.

††††† (2) A Medicaid-eligible recipient may receive nonemergency medical transportation services if the recipient meets the following conditions:

††††† (a) The recipient is traveling to or from a Medicaid-covered service, exclusive of pharmaceutical services;

††††† (b) The service is determined to be of medical necessity; and

††††† (c) Free transportation which is appropriate for the recipientís medical needs is not available or use of an appropriate and operational household vehicle is not available.

 

††††† Section 4. Reimbursement. (1) The Transportation Cabinet shall be reimbursed at a monthly capitated rate set by the department for each Medicaid recipient receiving services pursuant to this administrative regulation.

††††† (2) The capitated rate shall not exceed the Medicaid Programís usual aggregate cost on a projected statewide basis of providing nonemergency medical transportation services to the covered group of recipients.

 

††††† Section 5. Appeal Rights. (1) An appeal of a negative action regarding a Medicaid recipient shall be in accordance with 907 KAR 1:563;

††††† (2) An appeal of a negative action regarding Medicaid eligibility of an individual shall be in accordance with 907 KAR 1:560; or

††††† (3) An appeal of a negative action regarding a Medicaid provider shall be in accordance with 907 KAR 1:671.

 

††††† Section 6. Implementation. The provisions of this administrative regulation shall be applicable for nonemergency transportation waiver services provided in accordance with KRS Chapter 45A and Section 2 of this administrative regulation on or after April 12, 2000. (27 Ky.R. 648; Am. 994; eff. 10-16-2000.)