Kentucky Cabinet for Health and Family Services (Banner Imagery) - Go to home page

Department for Medicaid Services

What's New

Attention Department for Medicaid Services  providers/partners

The Department for Medicaid Services is aware of issues with the new benefind system, which processes all benefit programs administered by the Department for Community Based Services. It has resulted in discontinuation letters being sent in error or the system incorrectly showing an individual as ineligible. The Cabinet for Health and Family Services is taking action to ensure that no individual loses benefits as a result. If a person was eligible for Medicaid benefits in March, the person will automatically be eligible for benefits in April.

The Cabinet and DCBS are working with its technology partner, Deloitte, on system issues to stop the incorrect notices and properly reflect eligibility. Medicaid requests that providers continue to provide necessary services and prescriptions to members during this time.

To all providers participating in the Kentucky Medicaid EHR Incentive Program

The Kentucky Medicaid EHR Incentive Program will accept program year 2015 meaningful use attestations beginning at 8 a.m. Eastern time Thursday, April 7. The system will not be available beginning at 4 p.m. Eastern time April 6.

Please keep in mind all attestations must be submitted for program year 2015 by 11:59 p.m. Eastern time May 31, 2016.

Please contact us if you have questions.  

Attention Providers

(Mar. 17, 2016) - Provider type 76 - Multi-Therapy Agency, is anticipated to be effective in June, 2016. Providers may begin submitting applications to enroll in Medicaid as this provider type on May 15, 2016 but applications will be held and will not be processed until state regulations are final. The information provided for this provider type is subject to change pending adoption of state regulations.

For more information about the new therapy process, please read the

If you have questions about the therapy process, contact the Department of Medicaid Services at 502-564-7540. If you have any questions regarding enrollment after May 15, 2016, please contact Provider Enrollment at 1-877-838-5085.

ABI-LTC Waiver Renewal

(Feb. 23, 2016) The Cabinet for Health and Family Services, Department for Medicaid Services hereby provides a 30-day public notice and comment period for its intent to submit to the Centers for Medicare and Medicaid Services a renewal for the Acquired Brain Injury-Long Term Care (ABI-LTC) waiver. The current ABI-LTC waiver expires June 30, 2016 and a renewed waiver must be submitted and approved by July 1, 2016.

The renewal of the ABI-LTC waiver includes changes to comply with federal requirements set forth by Final Rule-CMS 2249-F–1915(i) State Plan Home and Community-Based Services, Five-Year Period for Waivers, Provider Payment Reassignment, Setting Requirements for Community First Choice, and CMS 2296-F 1915(c) Home and Community-Based Services Waivers (Final Rule). In addition, the renewal reflects several programmatic changes, including transition of payment for physical, occupational and speech therapy services to the Medicaid state plan, revisions in participant-directed services processes, assessment/reassessment and waiting list processes.

View the ABI-LTC Waiver Renewal

To receive a hard copy of the ABI-LTC waiver renewal application, please email or call (502) 564-4321

Public Comment
To submit written comments regarding this public notice please do so by emailing them or by mailing them to the following address by April 24, 2016:

Department for Medicaid Services
ABI-LTC Waiver Renewal
Commissioners Office
275 E. Main Street, 6W-A
Frankfort, Kentucky  40621

Attention Members - Coventry Cares of KY has changed their name.

CoventryCares of Kentucky is now Aetna Better Health of Kentucky. The official change took place Feb. 1, 2016.

You do not have to take any action. The new name in no way affects your care. Nothing about your services or benefits will change. You will begin to see Aetna Better Health of Kentucky information in the mail. You will have a new ID card mailed to you. Please visit Aetna Better Health of Kentucky's new website.

If you have questions about this change, please call Member Services at 1-(855) 300-5528, (TTY 711 and TDD 1-800-627-4702), Monday - Friday, 7 a.m. to 7 p.m. Eastern time.

Upcoming HCBS Final Rule - Stakeholder Engagement Meeting

The Cabinet for Health and Family Services is hosting a meeting for providers to provide input on the Home and Community-Based Services Final Rules implementation. CHFS encourages participation from stakeholders as it continues to develop the processes for ongoing compliance with the HCBS Final Rules. The meeting will focus on key indicators of provider compliance with the HCBS Final Rules and how information to document compliance can best be collected.

The meeting will be held on Wednesday, Feb. 10, 1:30 - 3:30 p.m. and Thursday, Feb. 11, 10 a.m. - noon to best accommodate stakeholders' schedules, and stakeholders have the option to attend in-person or electronically via the webinar.

Please see the attachments below for further information.

CMS Final Rule Webinar

(Dec. 18, 2015) - Update - The Centers for Medicare and Medicaid Services (CMS) has adopted new final federal regulations which address home- and community-based setting requirements for Medicaid waivers. View a webinar on this topic conducted on June 5, 2014 by CHFS staff. Or, you may review the handout or the Q and A document about the CMS final regulations.

The final rule provides for a five-year transition process to allow Kentucky to implement this rule to support continuity of services for Medicaid participants and minimize disruptions in services during implementation. The submitted Statewide Transition Plan offers the steps DMS will take to effectively plan for and execute the transition with public engagement.

Public Comment - Please email written comments regarding the public notices or submit via postal mail by Dec. 10, 2015 to:

Department for Medicaid Services
HCB Final Rule Statewide Transition Plan
Commissioners Office
275 E. Main St., 6W-A
Frankfort, KY 40621

Attention Members: Form 1095-B Information

(Dec. 4, 2015) - Any member of your household enrolled in Medicaid or KCHIP through kynect will receive his or her own Form 1095-B. If you file a tax return, you will be asked if you had health coverage. Form 1095-B is proof of the coverage you had with Medicaid. You should save Form 1095-B with your tax information. If you don't file a tax return, just keep Form 1095-B for your records. You can view a sample of the letter and form.

Get Help
1095-B Quick Reference provides answers to your questions about health coverage and your taxes.

You also can find answers to your questions from your tax preparer, your accountant or the IRS. To reach the IRS help service, go online or call the IRS toll free at (800) 829-1040.

Kentuckians have access to nearly 200 free tax preparation sites across the state where trained and IRS-certified volunteers will help you with your taxes. For more information on Volunteer Income Tax Assistance, go online or call Community Action Kentucky at (800) 456-3452.

Information regarding the upcoming Physical/Speech/Occupational Therapy Webinar

(Nov. 17, 2015) - Please join the Cabinet for Health and Family Services for a webinar discussing upcoming changes to physical, speech and occupational therapy services on Nov. 24, 2015 from 10 a.m. to 11:30 a.m.

For more information, please refer to the Ancillary Services Webinar Information Announcement

Adjusted Primary Care Payment Update

Sept. 17, 2015 - In accordance with the Patient Protection and Affordable Care Act (ACA), certain physicians were eligible to receive adjusted Medicaid payments for primary care services. The federal government fully financed the difference between the state Medicaid payment rate and the applicable Medicare rate for Calendar Years 2013 and 2014 to pay the providers an enhanced rate. At the end of that period, the enhanced federal funding for this program ended. A 6-month claim run-out period was allowed for providers to submit claims for dates of service in CY 2013-14 not yet submitted/processed; as well as any claim adjustments/corrections per the CMS final rule.

The final cycle for the adjusted primary care payment rate, which includes the claim run-out period as well as the reconciliation, will process Oct. 1, 2015.

For more information about the Adjusted Primary Care payments, please refer to the KY Medicaid Affordable Care Act Information page.

If you have questions, please contact the Division of Policy and Operations at 502-564-6890.

Attention Providers

Providers serving waiver members may request prior authorizations under their EPSDT PT-45 provider number for physical, occupational and speech therapies.,

(July 9, 2015) - Effective immediately and until further notice, providers serving waiver members with a prior authorization approved under a new physical, occupational or speech therapy provider type number may ask to replace it with a prior authorization under their EPSDT PT-45 number. Providers serving waiver members also may continue to submit new prior authorizations under their EPSDT PT-45 number until further notice.

For more information on the process, read the EPSDT Prior authorizations for PT OT ST provider notice (July 9, 2015)

Please contact HP at 800-807-1232 for assistance and if you have questions about submitting prior authorizations under the EPSDT PT-45 number to replace prior authorizations approved under the new provider type.

For questions about the EPSDT therapy services procedure codes and rates or other questions about EPSDT special services, contact Catherann Terry at 502-564-9444, ext. 2120.

Model II Waiver Renewal

(May 28, 2015) The Cabinet for Health and Family Services Department for Medicaid Services hereby provides a 30-day public notice and comment period for its intent to submit to the Centers for Medicare and Medicaid Services a renewal for the Model II Waiver. The current waiver expires Sept. 30, 2015, and a renewed waiver must be submitted and approved by Oct. 1, 2015.

View the Model II Waiver renewal.

If you would like to receive a hard copy of the Model Waiver II renewal application, please call 502-564-4321 or request by email.

Public Comment
If you wish to submit written comments regarding this public notice please email them or send them by postal mail by June 29, 2015 to:

Department for Medicaid Services
MIIW Renewal
Commissioners Office
275 E. Main St., 6W-A
Frankfort, KY 40621

Supports for Community Living Waiver Renewal

(April 29, 2015) The Cabinet for Health and Family Services Department for Medicaid Services hereby provides a 30-day public notice of and comment period for its intent to submit to the Centers for Medicare and Medicaid Services a renewal for the Supports for Community Living (SCL) waiver. The current SCL waiver expires Aug. 31, 2015, and a renewed waiver must be submitted and approved by Sept. 1, 2015.

The renewal of the SCL waiver includes changes to comply with federal requirements set forth by Final Rule-CMS 2249-F-1915(i) State Plan Home and Community-Based Services, five-year period for waivers, Provider Payment Reassignment, Setting Requirements for Community First Choice and CMS 2296-F 1915(c) Home and Community-Based Services Waivers (final rule).

If you would like to receive a hard copy of the SCL waiver renewal application, please call 502-564-4321 or request by email.

Public Comment
If you wish to submit written comments regarding this public notice please email them or send them by postal mail by May 28, 2015, to:

Department for Medicaid Services
HCB Waiver Amendment
Commissioners Office
275 E. Main St., 6W-A
Frankfort, KY 40621

Attention Behavioral health Services Organization (BSHO) Providers

For questions regarding providing BHSO services, please refer to the DBHDID BHSO page and review the recent 2015 BSHO Webinar. For questions not addressed in the webinar, please email us.

The BHSO Medicaid Billing Manual is under development and will be posted in the near future.

Home and Community Based Waiver Renewal

(Apr. 8, 2015) - The Cabinet for Health and Family Services Department for Medicaid Services hereby provides a 30-day public notice of and comment period for its intent to submit to the Centers for Medicare and Medicaid Services a renewal for the Home and Community Based (HCB) waiver. The current HCB waiver expires June 30, 2015 and a renewed waiver must be submitted and approved by July 1, 2015

The renewal of the HCB waiver includes changes to comply with federal requirements set forth by Final Rule-CMS 2249-F-1915(i) State Plan Home and Community-Based Services, five-year period for waivers, provider payment reassignment, setting requirements for community first choice and CMS 2296-F-1915(c) Home and Community-Based Services Waivers (final rule). The renewal also includes changes to enhance waiver services.

To receive a hard copy of the HCB waiver renewal application, please email or call (502) 564-4321

Please submit written comments regarding this public notice by email or by postal mail by May 10, 2015, to:

Department for Medicaid Services
HCB Waiver Amendment
Commissioners Office
275 E. Main St., 6W-A
Frankfort, KY 40621

Return to the top

Medicaid Managed Care Information

KY Department for Medicaid Services Managed Care Open Enrollment Information- 2016

The Department for Medicaid Services will be conducting an Open Enrollment period for recipients in a Managed Care plan starting Oct. 19, 2015, and ending Dec. 11, 2015.

For more information about covered benefits, services and the associated cost included in the letter, see:

To make a change, call us, toll-free at 855-446-1245 , Monday through Friday from 8 a.m. to 5 p.m. pm Eastern time.

All plan changes made during Open Enrollment will take effect January 1, 2016.

Attention Members - Information on how to change your Managed Care Organization (MCO)

Federal regulations allow members to change their managed care organizations outside the 90-day timeline to change. The process is called disenrollment for cause.

Learn more about

Prompt Payment Update

Oct. 11, 2013 - Department of Insurance (DOI) Medicaid Prompt Payment Contact Information
Department of Insurance
Address:
Medicaid Prompt Payment Compliance Branch
P.O. Box 517
Frankfort, KY 40601-0517
Phone: 502-564-6106
Toll Free: 800-595-6053, Option 5
EMail

To learn more about the Medicaid MCO Complaint process and how to file a complaint, please call or visit the webpage for the Medicaid Prompt Payment Compliance Branch.

April 17, 2013 - Read the General Provider Letter #A-93 - Medicaid MCO Prompt Payment Complaints to be Reviewed by the Department of Insurance (DOI)

April 5, 2013 - Read the Letter from Gov. Steve Beshear explaining his veto of House Bill 5.

View older announcements.

Return to the top

Provider Updates

Attention Providers Clarification for Dentists.

Dentists who currently do not bill ICD-9 codes do not have to convert to ICD-10. However, Oral Surgeons currently billing ICD-9 codes will be required to comply with ICD-10. For more information about Kentucky Medicaid's implementation of ICD-10, including how to test for readiness, please visit the DMS ICD-10 website.

Attention Providers

View the CMS National Provider Call - Countdown to ICD 10 dated Aug. 27, 2015

Notice to all providers regarding Electronic Funds Transfer

(Feb. 18, 2015) - The electronic funds transfer (EFT) update function via KY Health Net will be disabled on March 6, 2015. To update your EFT, please contact provider enrollment at 877-838-5085 for further instructions. We apologize for any inconvenience

Attention Providers: Policy Clarification Updates

Attention providers who bill paper, professional crossover claims.

The Medicare Coding Sheet has been revised. You may obtain the newest revision at Kentucky Medicaid Management Information System along with the updated billing instructions. For questions, please contact Provider Inquiry at 800-807-1232.

5010 Announcement

Attention all providers: As of Jan. 1, 2012, all electronic claims submissions must be in the X12 5010 format. Please refer to your billing instructions for additional information required on the CMS1500 and UB04 paper claim forms due to 5010 implementation.

Attention KY Health Net Users: All claims paid prior to Dec. 29, 2011, will not have the Copy Claim or the Adjust Claim function through KY Health Net. Any adjustments to claims paid prior to Dec. 29, 2011, will require paper adjustment submission to the following Address HP Enterprise Services P.O. Box 2108 Frankfort, KY 40602-2108 Attn: Financial Services.

Physician Pricing Update

  • Pricing Update - The procedure code J7300 new pricing will be $645.84 with an effective date of 7-1-11. This change has been made on the physicians fee schedule located on the fee and rate schedule page.
  • ESSURE In-Office Placement - Effective Date of Service (DOS) Jan. 1, 2011, Physicians performing in-office placement of Essure will be reimbursed for A4264 at a rate of $1400 for Place of Service (POS) 11 (office). Physicians can continue to bill 58565 for the placement of the product and payment will remain at $338.62. These two codes must be billed on the same DOS and supporting documentation retained in the patient's chart for placement of product. Prior Authorization will continue to be required. If 58565 is billed with Place of Service (POS) 22, the payment for the profession fee will be $338.62.
  • Physician Provider Update as of June 2011 - Refer to the Physician NDC Code Update for changes in billing.

Return to the top

Program Updates

Kentucky Medicaid eligibility is expanding Jan. 1, 2014

More information

New Application for Medicare Savings Programs

Feb. 5, 2010 - Do you have Medicare? Kentucky Medicaid provides partial financial assistance with Medicare premiums, deductibles and coinsurance through the Medicare Savings Program for qualified Medicare beneficiaries, specified low-income Medicare beneficiaries and qualifying individuals who are not entitled to the full Medicaid benefit package.

Apply Now - fill out an application for the Kentucky Medicare Savings Program.

Attention Providers and Parents

Kentucky children may be eligible for free or low-cost health insurance through the Kentucky Children's Health Insurance Program (KCHIP).

KCHIP Application Process Training Presentation provides information about filling out the new application.

To view more programs and services, refer to the Program and Services page.

Return to the top

Policy Updates

DMS does not provide guidance on billing

The Department for Medicaid Services does not provide guidance on how companies should bill for services, but will direct you to applicable regulations.

If you receive direction from staff about how to bill, the department will not be bound by such instruction, unless it was given by a director or commissioner.

Older updates

To review more updates and/or clarifications, refer to the Policy Clarifications page.

Return to the top

 

Last Updated 3/30/2016