CABINET FOR HEALTH AND FAMILY SERVICES

Department for Medicaid Services

Division of Policy and Operations

(As Amended at ARRS, May 13, 2014)

 

      907 KAR 15:015. Reimbursement provisions and requirements for behavioral health services provided by independent providers.

 

      RELATES TO: KRS 205.520, 42 U.S.C. 1396a(a)(10)(B), 42 U.S.C. 1396a(a)(23)

      STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.520(3)

      NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and Family Services, Department for Medicaid Services, has a 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 to qualify for federal Medicaid funds. This administrative regulation establishes the reimbursement provisions and requirements regarding Medicaid Program behavioral health services provided by certain licensed behavioral health professionals who are independently enrolled in the Medicaid Program as Medicaid providers, or behavioral health service practitioners working for or under supervision of the independent behavioral health service providers, to Medicaid recipients who are not enrolled with a managed care organization.

 

      Section 1. General Requirements. For the department to reimburse for a service covered under this administrative regulation, the service shall be:

      (1) Medically necessary;

      (2) Provided:

      (a) To a recipient; and

      (b) By a:

      1. Provider who meets the provider participation requirements established in 907 KAR 15:010; or

      2. Practitioner working under the supervision of a provider who meets the provider participation requirements established in 907 KAR 15:010;

      (3) A service covered in accordance with 907 KAR 15:010; and

      (4) Billed to the department by the billing provider who provided the service or under whose supervision the service was provided by an authorized practitioner in accordance with 907 KAR 15:010.

 

      Section 2. Reimbursement. (1) One (1) unit of service shall be fifteen (15) minutes in length or the unit amount identified in the corresponding current procedural terminology code.

      (2) The rate per unit for a screening shall be:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner;[or]

      4. Licensed marriage and family therapist; or

      5. Licensed professional art therapist; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a licensed marriage and family therapist if the licensed marriage and family therapist is the billing provider for the service;

      2. Licensed professional counselor associate working under the supervision of a licensed professional clinical counselor if the licensed professional clinical counselor is the billing provider for the service;

      3. Licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service;

      4. Certified social worker working under the supervision of a licensed clinical social worker if the licensed clinical social worker is the billing provider for the service;[or]

      5. Physician assistant working for a physician if the physician is the billing provider for the service; or

      6. Licensed professional art therapist associate working under the supervision of a licensed professional art therapist if the licensed professional art therapist is the billing provider for the service.

      (3) The rate per unit for an assessment shall be:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner;[or]

      4. Licensed marriage and family therapist;

      5. Licensed professional art therapist; or

      6. Licensed behavior analyst; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a licensed marriage and family therapist if the licensed marriage and family therapist is the billing provider for the service;

      2. Licensed professional counselor associate working under the supervision of a licensed professional clinical counselor if the licensed professional clinical counselor is the billing provider for the service;

      3. Licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service;

      4. Certified social worker working under the supervision of a licensed clinical social worker if the licensed clinical social worker is the billing provider for the service;[or]

      5. Physician assistant working for a physician if the physician is the billing provider for the service;

      6. Licensed professional art therapist associate working under the supervision of a licensed professional art therapist if the licensed professional art therapist is the billing provider for the service; or

      7. Licensed assistant behavior analyst working under the supervision of a licensed behavior analyst if the licensed behavior analyst is the billing provider for the service.

      (4) The rate per unit for psychological testing shall be:

      (a) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a licensed psychologist;

      (b) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a licensed psychological practitioner; or

      (c) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service.

      (5) The rate per unit for screening, brief intervention, and referral to treatment shall be as established on the Non-Medicare Services Fee Schedule[:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner; or

      4. Licensed marriage and family therapist; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a licensed marriage and family therapist if the licensed marriage and family therapist is the billing provider for the service;

      2. Licensed professional counselor associate working under the supervision of a licensed professional clinical counselor if the licensed professional clinical counselor is the billing provider for the service;

      3. Licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service;

      4. Certified social worker working under the supervision of a licensed clinical social worker if the licensed clinical social worker is the billing provider for the service; or

      5. Physician assistant working for a physician if the physician is the billing provider for the service].

      (6) The rate per unit for crisis intervention shall be:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner;[or]

      4. Licensed marriage and family therapist; or

      5. Licensed professional art therapist; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a licensed marriage and family therapist if the licensed marriage and family therapist is the billing provider for the service;

      2. Licensed professional counselor associate working under the supervision of a licensed professional clinical counselor if the licensed professional clinical counselor is the billing provider for the service;

      3. Licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service;

      4. Certified social worker working under the supervision of a licensed clinical social worker if the licensed clinical social worker is the billing provider for the service; [or]

      5. Physician assistant working for a physician if the physician is the billing provider for the service; or

      6. Licensed professional art therapist associate working under the supervision of a licensed professional art therapist if the licensed professional art therapist is the billing provider for the service[;

      6. Peer support specialist working under the supervision of a mental health professional;

      7. Family peer support specialist working under the supervision of a mental health professional; or

      8. Youth peer support specialist working under the supervision of a mental health professional].

      (7) The rate per unit for service planning shall be as established on the Non-Medicare Services Fee Schedule[:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner; or

      4. Licensed marriage and family therapist; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a licensed marriage and family therapist if the licensed marriage and family therapist is the billing provider for the service;

      2. Licensed professional counselor associate working under the supervision of a licensed professional clinical counselor if the licensed professional clinical counselor is the billing provider for the service;

      3. Licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service;

      4. Certified social worker working under the supervision of a licensed clinical social worker if the licensed clinical social worker is the billing provider for the service; or

      5. Physician assistant working for a physician if the physician is the billing provider for the service].

      (8) The rate per unit for individual outpatient therapy shall be:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner;[or]

      4. Licensed marriage and family therapist;

      5. Licensed professional art therapist; or

      6. Licensed behavior analyst; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a licensed marriage and family therapist if the licensed marriage and family therapist is the billing provider for the service;

      2. Licensed professional counselor associate working under the supervision of a licensed professional clinical counselor if the licensed professional clinical counselor is the billing provider for the service;

      3. Licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service;

      4. Certified social worker working under the supervision of a licensed clinical social worker if the licensed clinical social worker is the billing provider for the service;[or]

      5. Physician assistant working for a physician if the physician is the billing provider for the service;

      6. Licensed professional art therapist associate working under the supervision of a licensed professional art therapist if the licensed professional art therapist is the billing provider for the service; or

      7. Licensed assistant behavior analyst working under the supervision of a licensed behavior analyst if the licensed behavior analyst is the billing provider for the service.

      (9) The rate per unit for family outpatient therapy shall be:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner;[or]

      4. Licensed marriage and family therapist; or

      5. Licensed professional art therapist; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a licensed marriage and family therapist if the licensed marriage and family therapist is the billing provider for the service;

      2. Licensed professional counselor associate working under the supervision of a licensed professional clinical counselor if the licensed professional clinical counselor is the billing provider for the service;

      3. Licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service;

      4. Certified social worker working under the supervision of a licensed clinical social worker if the licensed clinical social worker is the billing provider for the service;[or]

      5. Physician assistant working for a physician if the physician is the billing provider for the service; or

      6. Licensed professional art therapist associate working under the supervision of a licensed professional art therapist if the licensed professional art therapist is the billing provider for the service.

      (10) The rate per unit for group outpatient therapy shall be:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner;[or]

      4. Licensed marriage and family therapist;

      5. Licensed professional art therapist; or

      6. Licensed behavior analyst; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a licensed marriage and family therapist if the licensed marriage and family therapist is the billing provider for the service;

      2. Licensed professional counselor associate working under the supervision of a licensed professional clinical counselor if the licensed professional clinical counselor is the billing provider for the service;

      3. Licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service;

      4. Certified social worker working under the supervision of a licensed clinical social worker if the licensed clinical social worker is the billing provider for the service;[or]

      5. Physician assistant working for a physician if the physician is the billing provider for the service;

      6. Licensed professional art therapist associate working under the supervision of a licensed professional art therapist if the licensed professional art therapist is the billing provider for the service; or

      7. Licensed assistant behavior analyst working under the supervision of a licensed behavior analyst if the licensed behavior analyst is the billing provider for the service.

      (11) The rate per unit for collateral outpatient therapy shall be:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner;[or]

      4. Licensed marriage and family therapist;

      5. Licensed professional art therapist; or

      6. Licensed behavior analyst; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a licensed marriage and family therapist if the licensed marriage and family therapist is the billing provider for the service;

      2. Licensed professional counselor associate working under the supervision of a licensed professional clinical counselor if the licensed professional clinical counselor is the billing provider for the service;

      3. Licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service;

      4. Certified social worker working under the supervision of a licensed clinical social worker if the licensed clinical social worker is the billing provider for the service;[or]

      5. Physician assistant working for a physician if the physician is the billing provider for the service;

      6. Licensed professional art therapist associate working under the supervision of a licensed professional art therapist if the licensed professional art therapist is the billing provider for the service; or

      7. Licensed assistant behavior analyst working under the supervision of a licensed behavior analyst if the licensed behavior analyst is the billing provider for the service.

      (12) The rate per unit for[medication assisted treatment for a substance use disorder shall be:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist; or

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by an advanced practice registered nurse.

      (13) The rate per unit for] day treatment shall be as established on the Non-Medicare Services Fee Schedule[:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner; or

      4. Licensed marriage and family therapist; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a licensed marriage and family therapist if the licensed marriage and family therapist is the billing provider for the service;

      2. Licensed professional counselor associate working under the supervision of a licensed professional clinical counselor if the licensed professional clinical counselor is the billing provider for the service;

      3. Licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service;

      4. Certified social worker working under the supervision of a licensed clinical social worker if the licensed clinical social worker is the billing provider for the service; or

      5. Physician assistant working for a physician if the physician is the billing provider for the service][;

      6. Peer support specialist working under the supervision of a mental health professional;

      7. Family peer support specialist working under the supervision of a mental health professional; or

      8. Youth peer support specialist working under the supervision of a mental health professional].

      (13)[(14)] The rate per unit for comprehensive community support services shall be as established on the Non-Medicare Services Fee Schedule[:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner; or

      4. Licensed marriage and family therapist; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a licensed marriage and family therapist if the licensed marriage and family therapist is the billing provider for the service;

      2. Licensed professional counselor associate working under the supervision of a licensed professional clinical counselor if the licensed professional clinical counselor is the billing provider for the service;

      3. Licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service;

      4. Certified social worker working under the supervision of a licensed clinical social worker if the licensed clinical social worker is the billing provider for the service; or

      5. Physician assistant working for a physician if the physician is the billing provider for the service][;

      6. Peer support specialist working under the supervision of a mental health professional;

      7. Family peer support specialist working under the supervision of a mental health professional; or

      8. Youth peer support specialist working under the supervision of a mental health professional].

      (14)[(15)] The rate per unit for peer support services shall be as established on the Non-Medicare Services Fee Schedule[fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      (a) Peer support specialist working under the supervision of a qualified mental health professional; or

      (b)][Family peer support specialist working under the supervision of a mental health professional; or

      (c)][Youth peer support specialist working under the supervision of a qualified mental health professional].

      (15)[(16)] The rate per unit for parent or family peer support services shall be as established on the Non-Medicare Services Fee Schedule[fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a][:

      (a) Peer support specialist working under the supervision of a mental health professional;

      (b)][family peer support specialist working under the supervision of a qualified mental health professional][; or

      (c) Youth peer support specialist working under the supervision of a mental health professional].

      (16)[(17)] The rate per unit for an intensive outpatient program shall be as established on the Non-Medicare Services Fee Schedule[:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner; or

      4. Licensed marriage and family therapist; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a licensed marriage and family therapist if the licensed marriage and family therapist is the billing provider for the service;

      2. Licensed professional counselor associate working under the supervision of a licensed professional clinical counselor if the licensed professional clinical counselor is the billing provider for the service;

      3. Licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service;

      4. Certified social worker working under the supervision of a licensed clinical social worker if the licensed clinical social worker is the billing provider for the service; or

      5. Physician assistant working under the supervision of a physician if the physician is the billing provider for the service].

      (17)[(18)] The rate per unit for a therapeutic rehabilitation program shall be as established on the Non-Medicare Services Fee Schedule[:

      (a) Seventy-five (75) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Physician; or

      2. Psychiatrist;

      (b) 63.75 percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by:

      1. An advanced practice registered nurse; or

      2. A licensed psychologist;

      (c) Sixty (60) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Licensed professional clinical counselor;

      2. Licensed clinical social worker;

      3. Licensed psychological practitioner; or

      2. Licensed marriage and family therapist; or

      (d) Fifty-two and five-tenths (52.5) percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the service if provided by a:

      1. Marriage and family therapy associate working under the supervision of a licensed marriage and family therapist if the licensed marriage and family therapist is the billing provider for the service;

      2. Licensed professional counselor associate working under the supervision of a licensed professional clinical counselor if the licensed professional clinical counselor is the billing provider for the service;

      3. Licensed psychological associate working under the supervision of a licensed psychologist if the licensed psychologist is the billing provider for the service;

      4. Certified social worker working under the supervision of a licensed clinical social worker if the licensed clinical social worker is the billing provider for the service; or

      5. Physician assistant working under the supervision of a physician if the physician is the billing provider for the service].

      (18)[(19)](a) The department shall use the current version of the Kentucky-specific Medicare Physician Fee Schedule for reimbursement purposes.

      (b) For example, if the Kentucky-specific Medicare Physician Fee Schedule currently published and used by the Centers for Medicare and Medicaid Services for the Medicare Program is:

      1. An interim version, the department shall use the interim version until the final version has been published; or

      2. Final version, the department shall use the final version.

      (19)[(20)] The department shall not reimburse for a service billed by or on behalf of an entity or individual that is not a billing provider.

 

      Section 3. No Duplication of Service. (1) The department shall not reimburse for a service provided to a recipient by more than one (1) provider of any program in which the service is covered during the same time period.

      (2) For example, if a recipient is receiving a behavioral health service from an independent behavioral health provider, the department shall not reimburse for the same service provided to the same recipient during the same time period by a community mental health center.

 

      Section 4. Not Applicable to Managed Care Organizations. A managed care organization shall not be required to reimburse in accordance with this administrative regulation for a service covered pursuant to:

      (1) 907 KAR 15:010; and

      (2) This administrative regulation.

 

      Section 5. Federal Approval and Federal Financial Participation. The department’s reimbursement for services pursuant to this administrative regulation shall be contingent upon:

      (1) Receipt of federal financial participation for the reimbursement; and

      (2) Centers for Medicare and Medicaid Services’ approval for the reimbursement.

 

      Section 6. Incorporation by Reference. (1) “Non-Medicare Services Fee Schedule”, May 2014, is incorporated by reference.

      (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at:

      (a) The Department for Medicaid Services, 275 East Main Street, Frankfort, Kentucky, Monday through Friday, 8:00 a.m. to 4:30 p.m.; or

      (b) Online at the department’s Web site at http://www.chfs.ky.gov/dms/incorporated.htm

 

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.