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Important Kentucky Medicaid updates and announcements

What's New

1915 C waiver Redesign Town Hall Notification

Update: Thank you for your continued support and interest in the 1915(c) waiver redesign. Listed below are two versions of the recommendations report. One is a user-friendly version and the other is a more technical version. Both contain the same information. Please share this with anyone invested in the 1915(c) waivers.

Your input is important. Please use the method of your choice to provide DMS with your feedback and thoughts. We appreciate your continued collaboration.

Please join the Kentucky Department for Medicaid Services for a Home- and Community-Based Services Waiver Program Town Hall meeting.

During the meetings, we will:

  • Share proposed updates and how they apply to the Medicaid Home- and Community-Based Services Waivers
  • Share the Navigant Consulting recommendations for our program
  • Gather your thoughts and ideas about the recommendations

For dates, times and locations, please read the 1915 C waiver redesign Town Hall Notification.

Update

Map-24 forms should only be sent to Carewise Health via fax at:

1-800-807-8843
1-800-807-7840

If the forms are not submitted via fax, they may not be reviewed or processed. This does not apply to the 1915 c waiver programs. Discharges from the waiver programs must be submitted through MWMA.

Update - Focus Group Summary and Full Report now available.

Below are the Focus Group Summary and Full Report complied by Navigant. While this report is does not include every comment made, all comments were heard, noted, and will be taken into consideration as we make a plan for waivers. Please send feedback on this report and use Focus Group Report as the subject. Your feedback in the entire process is vitally important and greatly appreciated.

Public input on experiences with Medicaid home- and community-based services sought at upcoming meetings - The Department of Medicaid Services (DMS) invites you to focus group meetings to talk about home- and community-based services provided through 1915(c) waivers. DMS would like to talk with you about how waivers are working now and how to improve them for the future. For more information about the focus group meetings, please read the KY HCBS - Focus Group Announcement

2018 Medicaid Managed Care Forums

The Cabinet for Health and Family Services, in partnership with the managed care companies, once again is sponsoring Spring forums across Kentucky in April and May 2018.

For dates, locations, times and registration information, please refer to the MCO Forum Announcement.

Review the Agenda

2017 MCO Forum Presentations are now available.

Please refer to the 2017 Medicaid MCO Provider Forum page to view the presentations.

Approved 1915c HCBS Waivers

Case Management Agencies

As you are aware, all waiver regulations now mandate use of the Medicaid Waiver Management Application (MWMA). All new waiver applications, level of care requests and plan of care requests must be submitted through MWMA. Paper or verbal processes are no longer accepted.

To support this transition, the commonwealth provided additional materials and training opportunities over the past several months.

For more information, please read the Mandatory MWMA Communication.

Public input on experiences with Medicaid home- and community-based services sought at upcoming meetings

The Department of Medicaid Services (DMS) invites you to focus group meetings to talk about home- and community-based services provided through 1915 (c) waivers. DMS would like to talk with you about how waivers are working now and how to improve them for the future.

For more information about the focus group meetings, please read the KY HCBS - Focus Group Announcement

2018 managed care open enrollment information

The Department for Medicaid Services will conduct its annual open enrollment for recipients in managed care plans starting Oct. 16, 2017 and ending Dec. 15, 2017.

For more information

To make a change to your managed care organization, please call us, toll-free at (855) 446-1245, Monday through Friday from 8 a.m. to 5 p.m. Eastern time.

All plan changes made during open enrollment will take effect Jan. 1, 2018.

Level 1 PASSR delay,

Attention Providers - Due to revisions, the July 1, 2017 implementation date for the new Level 1 PASSR form stated in the March 2017 Provider Letter has been delayed. Please continue to use the current Level I PASRR Screening form until further notice from the Department for Medicaid Services. Please also be advised the new MAP 4095 PASRR Significant Change Form will be implemented July 1, 2017 as planned.

For additional questions, please feel free to call or email either Vicki Barber at (502) 564-6890 or Benita Jackie at (502) 782-6217.

Important Notice Regarding Non-Emergency Medical Transportation

Beginning July 1, 2017, Federated Transportation Services of the Bluegrass (FTSB) will provide brokerage services for all non-emergency medical transportation for Medicaid transportation-eligible recipients living in Boone, Campbell, Carroll, Gallatin, Grant, Kenton, Pendleton and Owen counties. Those eligible for transportation services and the trips covered by the non-emergency medical transportation program are not changing.

Read the Important Member Notice Regarding Non-Emergency Transportation

KYHealth Card Update

Effective May 6, 2017, the Department for Medicaid Services will be updating the KyHealth Card as a cost saving measure for the Commonwealth. Currently fee-for-service members receive a plastic card containing a magnetic strip on the back for swipe capability. Due to the expense of the card and the minimal functionality of the strip the Department has decided to issue a printed, perforated card without swipe capability. The information printed on the card will remain the same.

Provider Notice regarding Member Cards

Effective March 31, 2017 members enrolled in an MCO will no longer receive a KyHealth Choices card. Members will receive a card from the MCO with which they are enrolled. This change is being made to reduce duplication of effort as all required Medicaid information is located on the MCO card. This change does not affect Fee For Service members.

In addition, members who have had six months or more loss in eligibility will not receive a new card.

SCL Waiver renewal officially approved by CMS

(March 29, 2017) - The Department for Medicaid Services has been notified by the Centers for Medicare and Medicaid Services that renewal of the Supports for Community Living (SCL) Medicaid Waiver will be implemented April 1, 2017. The SCL waiver renewal period is effective March 1, 2017 through Feb. 28, 2022.

Beginning April 1, 2017, providers will implement SCL regulations 907 KAR 12:010 and 907 KAR 12:020 effective June 3, 2016.

Please remember to refer to SCL Provider Letter #A-49 about documentation requirements for dates of service beginning March 15, 2017. The Department for Medicaid Services will follow those documentation requirements, exceptional support protocols and the guidance provided about billing audits and information on technical assistance included with that provider letter. Effective April 1, 2017, all exceptional support requests must be submitted through the Medicaid Waiver Management Application. No exceptional support requests will be accepted via fax to the Division of Developmental and Intellectual Disabilities in the Department for Behavioral Health, Development and Intellectual Disabilities.

With approval of the waiver renewal, notices of allocation for funding will be sent to individuals who currently meet emergency criteria and are on the SCL emergency waiting list.

Slots:
As part of the renewal, 240 additional slots have been approved. Information will be provided in the near future about allocation of these slots.

LOC and POC process:

  • For applications submitted in the Medicaid Waiver Management Application (MWMA): All LOC assessments and POCs must be submitted within MWMA.
  • For applications not submitted within MWMA: Fax the initial LOC assessment and initial person centered service plan to Carewise Health at (800) 807-8843.

Upon approval of the person-centered service plan the case manager is to transition the person into MWMA and complete all subsequent LOC assessments and person centered service plans within MWMA.

All future applications for placement on the SCL waiting list must be submitted through MWMA.

We are pleased that CMS has moved forward with the SCL waiver renewal approval. Thank you for your important work for people engaged in the SCL waiver program.

Ordering, Referring and Prescribing Provider Information

A General Provider Letter - Ordering, Referring and Prescribing Providers (PDF) and FAQ document (PDF) was mailed to provider on Feb. 1, 2017 regarding ordering, referring and prescribing providers enrolling as Medicaid providers.

Questions regarding this notice may be directed to DMS Provider Services at (855) 824-5615, Monday through Friday, 8 a.m. to 5:30 p.m. Eastern time.

Third Party Review Process (SB20)

Senate Bill 20 established the right for a provider who has exhausted the written internal appeals process of a Medicaid managed care organization (MCO) to an external independent third-party review of the MCO final decision that denies, in whole or part, a health care service to an enrollee or a claim for reimbursement to a provider for a health care service rendered by the provider to an enrollee of the MCO. The legislation also afforded a provider or an MCO the right to an administrative hearing.

907 KAR 17:035 establishes the process for the external independent third-party review and 907 KAR 17:040 establishes the process for an administrative hearing.

Beginning with the dates of service on or after Dec. 1, 2016, providers may submit a request for an external independent third-party review within 60 calendar days of receiving a final decision from the MCO internal appeal process.

Provider Letter #A-102 Senate Bill 20

MCO Contact Information

Attention Providers - HCB and SCL Waiver Therapy Transition

Attention HCB and SCL Waiver Providers - Please see guidance for providers and use the referenced forms below to transition physical therapy, occupational therapy and speech language pathology services from the Waivers to State Plan. This applies only to members in the HCB and SCL Waiver.

If you have any questions about transition of prior authorizations or billing, please email HPE. If you have questions about the State Plan therapy benefit, please contact DMS Division of Policy and Operations by email or by phone at 502-564-6890

Update: (Feb. 15, 2017) - Please view the presentation and the materials from the SCL Waiver Transition webinar

Update: (May 31, 2016) - Please view the Presentations materials from the HCBS Waiver Transition Webinar.

(Mar. 17, 2016) - Provider type 76 - Multi-Therapy Agency, is expected 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.

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Public Notices

Public Notice for DSH Reimbursement

The Cabinet for Health and Family Services, Department for Medicaid Services, pursuant to the requirements of 42 CFR § 447.205, hereby provides public notice of the following actions regarding the disproportionate share hospital distribution language in its State Plan Effective Jan. 1, 2018.

Covered Outpatient Drug Reimbursement

The Cabinet for Health and Family Services, Department for Medicaid Services (DMS), pursuant to the requirements of 42 CFR § 447.205, hereby provides public notice of the following actions regarding pharmacy reimbursement to be effective April 1, 2017.

view the Public notice for Covered Outpatient Drug Reimbursement

Public Notices

The Kentucky Department for Medicaid Services gives notice of the following proposed actions regarding Community Mental Health Centers services and reimbursement provided under the state plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

View Public Notices.

HCBS Final Rules - Heightened Scrutiny

The Cabinet for Health and Family Services Department for Medicaid Services, in accordance with 42 CFR 441.301, hereby provides a 30-day public notice and comment period for its first submission of Home and Community Based Services waiver settings requiring heightened scrutiny.

View Public Notice for HCBS Final Rules - Heightened Scrutiny

ABI Public Notice - Waiver Renewal Application

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 (ABI) waiver. The current ABI waiver expired on Dec. 31, 2016 and a renewed waiver must be submitted. The renewal of ABI 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).

View the ABI waiver renewal application.

If you would like to receive a hard copy of the ABI waiver renewal application, please email or call (502) 564-4321

Public Comment - Please email comments or submit via postal mail by Feb. 25, 2017 to:
Department for Medicaid Services
ABI Waiver Renewal
Commissioners Office
275 E. Main St., 6W-A
Frankfort KY 40621

MPW Public Notice - Waiver Renewal Application

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 (CMS) a renewal for the Michelle P. waiver (MPW). The current MPW expired Aug. 31, 2016, and a renewed waiver must be submitted. The renewal of MPW 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).

View the MPW Waiver Renewal Application Part A - MPW Waiver Renewal Application Part B

To receive a hard copy of the MPW waiver renewal application, please email or call 502-564-4321.

ABI-LTC Waiver Renewal

(May. 6, 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

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

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.

Past Training and Webinar Information

PASSR Statewide Training Information

(March 10, 2017) -The Departments for Medicaid Services (DMS) and Behavioral Health, Developmental and Intellectual Disabilities (BHDID) have worked with the Centers for Medicare and Medicaid Services (CMS), to develop a more comprehensive Preadmission Screening and Resident Review (PASRR) process. The statewide implementation date for both forms is July 1, 2017.

Read the Nursing Facility/ICF/IID Provider Letter - Pre-admission Screening and Resident Review Revisions (Mar. 10, 2017)

Two statewide training sessions are available as listed below:

First Training Session:
Date: Wednesday, April 26, 2017 (a.m. and p.m. sessions)
AM Session: Registration: 8:30 to 9 a.m. and Training Session: 9 a.m. to noon
PM Session: Registration: 12:30 to 1 p.m. and Training Session: 1 to 4 p.m.
Training site: GAPS Training Room, 801 Teton Trail, Frankfort, KY. 40601
Note: There are no vending machines available at the GAPS Training site

2nd Training Session
Date: Wednesday, May 24, 2107 (a.m. and p.m. sessions)
AM Session: Registration: 8:30 to 9 a.m. and Training Session: 9 a.m. to noon
PM Session: Registration: 12:30 to 1 p.m. and Training Session: 1 to 4 p.m.
Training site: GAPS Training Room, 801 Teton Trail, Frankfort, KY. 40601
Note: There are no vending machines available at the GAPS Training site.

Registration is limited to two employees per ICF/IID and/or nursing facility.

On-line registration

Materials Needed for Training

Training Room Parking Information

Webinar announcement

The Power of Partnerships: Behavioral health and public health working together to combat smoking in Kentucky

Date:  Sept. 19, 2017
Time: 1 p.m.
Contact: Jennifer Matekuare or call 1-877-509-3786.
Register for Webinar 

Read the Webinar information

Webinar announcement

Level of Care Policy and Process Changes

DMS has begun new project to transform its level of care (LOC) policies and processes for nursing facility, hospice and intermediate care facility for individuals with intellectual disabilities services. This project will transition the existing paper-based LOC processes to a technology system where providers will be able to electronically submit their LOCs through a self-service portal.

DMS is hosting a virtual webinar to share the upcoming LOC policy and process changes with providers. This webinar will review changes to the existing process and policies, as well as new policies that will be instituted as a part of the LOC transformation. DMS strongly encourages attendance, as the content will prepare providers to transition to the new processes.

The webinar is offered on two days to best accommodate providers' schedules. The webinar content will be the same on both dates. The webinar lobby will be open 30 minutes prior to each webinar.

Wednesday, Aug. 23, 2017
10 a.m. - noon, Eastern Time

Thursday, Aug. 31, 2017
10 a.m. - noon, Eastern Time

Webinar Information
Everyone is a guest. Guest access and entry into the webinar is blocked until the webinar room opens at 9:30 a.m. Eastern Time.

Join The Webinar here on the announced date. The 2017 DMS Webinars page will open. Click Enter as a Guest and type your agency name or your first name and last name in the field marked Name, then click on the box that says Enter Room.

 

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Last Updated 4/23/2018