CABINET FOR HEALTH AND FAMILY SERVICES

Department for Medicaid Services

Division of Policy and Operations

(As Amended at ARRS, April 11, 2016)

 

      907 KAR 8:005. Definitions for 907 KAR Chapter 8.

 

      RELATES TO: KRS 194A.025(3)

      STATUTORY AUTHORITY: KRS 194A.010(1), 194A.030(2), 194A.050(1), 205.520(3), 42 U.S.C. 1396a

      NECESSITY, FUNCTION, AND CONFORMITY: 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 a requirement that may be imposed or opportunity presented by federal law to qualify for federal Medicaid funds. This administrative regulation establishes the definitions for 907 KAR Chapter 8.

 

      Section 1. Definitions. (1)["Adult" means an individual who is at least twenty-one (21) years of age.

      (2)] "Adult day health care program" or "ADHC program" means a program that is:

      (a) Licensed pursuant to 902 KAR 20:066; and

      (b) An adult day health program pursuant to KRS 216B.0441.

      (2)[(3)] "Advanced practice registered nurse" is defined by KRS 314.011(7).

      (3)[(4)][(3)]["Child" means an individual who is under twenty-one (21) years of age.

      (5)] "Comprehensive outpatient rehabilitation facility" or "CORF" means an entity that is:

      (a) Defined as a CORF in accordance with 42 U.S.C. 1395x(cc)(2); and

      (b) Licensed as a rehabilitation agency pursuant to 902 KAR 20:190.

      (4)[(6)][(4)] "Department" means the Department for Medicaid Services or its designee.

      (5)[(7)][(5)] "Electronic signature" is defined by KRS 369.102(8).

      (6)[(8)][(6)] "Enrollee" means a recipient who is enrolled with a managed care organization.

      (7)[(9)][(7)] "Managed care organization" or "MCO" means an entity for which the Department for Medicaid Services has contracted to serve as a managed care organization as defined in 42 C.F.R. 438.2.

      (8)[(10)][(8)] "Medically necessary" means that a covered benefit is determined to be needed in accordance with 907 KAR 3:130.

      (9)[(11)] "Mobile health service" means an entity that is licensed pursuant to 902 KAR 20:275.

      (10)[(12)] "Multi-therapy agency" or "MTA" means a provider group:

      (a) Comprised of any combination of the following:

      1. One (1) or more occupational therapists;

      2. One (1) or more physical therapists; or

      3. One (1) or more speech-language pathologists; and

      (b) Unless exempt from licensure in statute, licensed:

      1. In the state in which they practice; and

      2. To provide occupational therapy, physical therapy, or speech-language pathology services.

      (11)[(13)][(9)] "Occupational therapist" is defined by KRS 319A.010(3).

      (12)[(14)][(10)] "Occupational therapy assistant" is defined by KRS 319A.010(4).

      (13)[(15)][(11)] "Physical therapist" is defined by KRS 327.010(2).

      (14)[(16)][(12)] "Physical therapist assistant" means a skilled health care worker who:

      (a) Is certified by the Kentucky Board of Physical Therapy; and

      (b) Performs physical therapy and related duties as assigned by the supervising physical therapist.

      (15)[(17)][(13)] "Physician" is defined by KRS 311.550(12).

      (16)[(18)][(14)] "Physician assistant" is defined by KRS 311.840(3).

      (17)[(19)][(15)] "Prior authorized" means authorized by:

      (a) The department, if the service is for a recipient who is not an enrollee; or

      (b) A managed care organization, if the service is for an enrollee.

      (18)[(20)][(16)] "Provider" is defined by KRS 205.8451(7).

      (19)[(21)][(17)] "Recipient" is defined by KRS 205.8451(9).

      (20)[(22)] "Rehabilitation agency" means an entity that is licensed as a rehabilitation agency pursuant to 902 KAR 20:190.

      (21)[(23)] "Special health clinic" means an entity that is licensed as a special health clinic pursuant to 902 KAR 20:260.

      (22)[(24)][(18)] "Speech-language pathologist" is defined by KRS 334A.020(3).

      (23)[(25)] "Speech-language pathology clinical fellow" means an individual who is recognized by the American Speech-Language-Hearing Association as a speech-language pathology clinical fellow.

      (24)[(26)] "State plan" is defined by 42 C.F.R. 400.203.

 

LISA LEE, Commissioner

AUDREY TAYSE HAYNES, Secretary

      APPROVED BY AGENCY: November 23, 2015

      FILED WITH LRC: December 2, 2015 at 4 p.m.

      CONTACT PERSON: Tricia Orme, email tricia.orme@ky.gov, Office of Legal Services, 275 East Main Street 5 W-B, Frankfort, Kentucky 40601, phone (502) 564-7905, fax (502) 564-7573.