Department for Medicaid Services
Important Kentucky Medicaid updates and announcements
The Cabinet for Health and Family Services (CHFS), Department for Medicaid Services (DMS), in accordance with 42 CFR 447.205, hereby provides public notice of enhanced reimbursement rates it is implementing for certain preventive and wellness services to be effective for such services provided anytime from January 1, 2015 through June 30, 2016.
The enhanced reimbursement rates will be stated on a fee schedule - the Medicaid Preventive and Wellness Enhanced Fee Schedule - located on the Fee and Rate Schedule page.
Read the Wellness Reimbursement Public Notice.
A copy of this notice is available for public review at the Department for Medicaid Services at the address listed below. Comments or inquiries may be submitted in writing within thirty (30) days to:
Department for Medicaid Services, 6W-A
275 E. Main Street
Frankfort, Kentucky 40621
Round Two State Innovation Models Initiative Model Design Awards Announced!
Today, the Centers for Medicare and Medicaid Services (CMS) announced the recipients of 21 Model Design awards under the second round of the State Innovation Models (SIM) initiative.
Over $42 million in Model Design awards will support 21 entities - including 17 states, three territories and the District of Columbia - in engaging a diverse group of stakeholders, including public and commercial payers, providers and consumers, to create or further refine a State Health Care Innovation Plan. States receiving Model Design awards will have twelve months to submit their State Health Care Innovation Plans to CMS. The Model Design awardees are: Arizona, Utah, Pennsylvania, Maryland, California, Illinois, New Jersey, Puerto Rico, and Commonwealth of the Northern Mariana Islands, American Samoa, District of Columbia, Hawaii, Kentucky, Montana, Nevada, New Hampshire, New Mexico, Oklahoma, Virginia, West Virginia and Wisconsin.
For more information, please visit the State Innovation Models Initiative main web page.
CMS Final Rule Webinar
(Dec. 18, 2014) - 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 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..
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||Medicaid Managed Care Information
Attention Members - Information on how to change your Managed Care Organization
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 how to change your managed care organization.
Read the General Provider Letter #A-97 - Medicaid Managed Care Open Enrollment (Oct. 1, 2014)
Kentucky Medicaid Open Enrollment Information for Jan. 1, 2015
The Department for Medicaid Services currently is in open enrollment. Letters have been sent to members who are eligible to change their current managed care organization (MCO).
For more information about covered benefits, services and the associated cost included in the letter, see:
Your open enrollment period is from: Oct. 27, 2014 through Dec. 12, 2014. 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.
Please note: Changes to your MCO will not take effect until Jan. 1, 2015.
Prompt Payment Update
Oct. 11, 2013 - Department of Insurance (DOI) Medicaid Prompt Payment Contact Information
Department of Insurance
Medicaid Prompt Payment Compliance Branch
P.O. Box 517
Frankfort, KY 40601-0517
Phone: (502) 564-6106
Toll Free: (800) 595 - 6053, Option 5
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.
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Electronic Annual Disclosure of Ownership Update
Jan. 22, 2014 - The Electronic Annual Disclosure of Ownership (EADO) process has been temporarily disabled for system maintenance. If you have an EADO currently in process, you may be contacted for further information if additional information is need to process your EADO.
Attention Providers: Policy Clarification Updates
Important Announcement regarding Provider Enrollment due to the Medicaid expansion
Nov. 18, 2013 - Starting Nov. 18, 2013, providers may submit an enrollment application for these New Provider Types. Although enrollment requirements are still being determined, each entity/individual must be licensed and submit their NPI documentation as well as SSN or FEIN verification. Applications will be held and processed once CMS approval is received and the regulations and enrollment requirements are finalized. DMS will provide new information as it becomes available.
The QMB limitation will be removed from these QMB Provider Types effective Jan. 1, 2014 subject to CMS approval. If you are currently enrolled in this provider type you will automatically be transitioned.
For more information, please refer to the DMS Provider Enrollment website.
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.
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.
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Kentucky Medicaid eligibility is expanding Jan. 1, 2014
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.
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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.
To review more updates and/or clarifications, refer to the Policy Clarifications page.
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