CABINET FOR HEALTH AND FAMILY SERVICES

Department for Medicaid Services

Division of Policy and Operations

(As Amended at ARRS, May 13, 2014)

 

      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[administrative regulations in] 907 KAR Chapter 8.

 

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

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

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

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

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

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

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

      (9) "Occupational therapist" is defined by KRS 319A.010(3).

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

      (11) "Physical therapist" is defined by KRS 327.010(2).

      (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.

      (13) "Physician" is defined by KRS 311.550(12).

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

      [(13) “Physical therapist” is defined by KRS 327.010(2).

      (14) “Physical therapy 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) "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.

      (16) "Provider" is defined by KRS 205.8451(7).

      (17) "Recipient" is defined by KRS 205.8451(9).

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

 

LAWRENCE KISSNER, Commissioner

AUDREY TAYSE HAYNES, Secretary

      APPROVED BY AGENCY: December 19, 2013

      FILED WITH LRC: December 26, 2013 at 4 p.m.

      CONTACT PERSON: Tricia Orme, 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.