CABINET FOR HEALTH AND FAMILY SERVICES

Department for Medicaid Services

Division of Policy and Operations

(As Amended at ARRS, May 13, 2014)

 

      907 KAR 13:005. Definitions for 907 KAR Chapter 13.

 

      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 any[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 13.

 

      Section 1. Definitions. (1) "Department" means the Department for Medicaid Services or its designee.

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

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

      (4) "Home health agency" or "HHA" means a Medicare and Medicaid-certified agency licensed in accordance with 902 KAR 20:081.

      (5) "Immediate family member" is defined by KRS 205.8451(3).

      (6) "Licensed practical nurse" is defined by KRS 314.011(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) "Medically necessary" means that a covered benefit is determined to be needed in accordance with 907 KAR 3:130.

      (9) "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.

      (10) "Private duty nursing agency" means an agency licensed in accordance with 902 KAR 20:370.

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

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

      (13) "Registered nurse" is defined by KRS 314.011(5).

 

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.