Public Notice: Changes to the Ambulance Services Reimbursement Language.
(Dec. 22, 2020) - The Cabinet for Health and Family Services, Department for Medicaid Services in accordance with 42 CFR 447.205, provides public notice of changes to the ambulance services reimbursement language in its state plan effective Jan. 1, 2021.
Read the public notice.
Public Notice: 1115 Waiver Substance Use Disorder Demonstration Proposed Amendment
(Sept. 20, 2020) In accordance with 42 CFR 431.408, the Cabinet for Health and Family Services Department for Medicaid Services announces its intention to file an 1115 Amendment Application with the Centers for Medicare and Medicaid Services (CMS) no later than Nov. 16, 2020, requesting Medicaid coverage for SUD services to incarcerated individuals. The changes outlined below will become effective upon CMS approval. Please note the public comment period for the SUD 1115 waiver amendment has been extended from Oct. 30 to Nov. 6, 2020.
1115 Waiver Amendment
SUD 1115 Incarceration Amendment Town Hall
1115 Waiver Town Hall #1 recording
1115 Waiver Town Hall #2 presentation
Public Comments for the 1115 Waiver Substance Use Disorder Demonstration
KY Health Community of Care for Incarcerated Members Amendment Completion Letter
Public Notice: Beneficiary Cost Sharing
In accordance with 42 CFR 447.57, the Cabinet for Health and Family Services Department for Medicaid Services provides public notice of its intent to file a state plan amendment with the Centers for Medicare and Medicaid Services no later than Sept. 1, 2020, amending the cost-sharing obligations of Kentucky Medicaid beneficiaries. The cost-sharing obligations become effective Dec. 1, 2020 and will be the same for all Medicaid beneficiaries; therefore, cost-sharing applies to the new eligibility groups authorized by the Affordable Care Act and the old or existing Medicaid eligibility groups.
Public Notice: CHIP Support
The Cabinet for Health and Family Services Department for Medicaid Services, in accordance with 42 CFR 447.205, provides public notice of its intent to file a state plan amendment, effective Oct. 24, 2019, to strengthen behavioral health coverage for children and pregnant women eligible through the Children’s Health Insurance Program (CHIP). Section 5022 of the SUPPORT Act amends section 2103(c)(5) of the Social Security Act to make behavioral health coverage a required benefit for CHIP effective Oct. 24, 2019.
Read the Public Notice.
Public Notice: School-Based Reimbursement
In accordance with 42 CFR 447.205, CHFS provides public notice of its intent to file a state plan amendment (SPA), effective July 1, 2020. The purpose of the SPA is to modify reimbursement for school-based services related to individualized service plan, section 504 accommodation plan pursuant to 34 C.F.R. § 104.36, individualized healthcare plan, individualized family service plan or otherwise medically necessary service including those described under Item 4.b. EPSDT in Supplement to Attachment 3.1-A/B, by a cost-reimbursement methodology. Final reimbursement is based on certified reports submitted using the methodology allowed under the Kentucky School-Based Cost Report approved by the Centers for Medicare and Medicaid Services.
Read the public notice.
Public Notice page
Administrative Regulations Filed
(Feb. 19, 2021) Feb. 12 2021 Administrative regulations filed Visit the DMS Regulation page for recently filed regulations.
Prior Authorization Information - Update
(Feb. 23, 2021)
Prior Authorization Guidance effective Feb. 1, 2021
Mass Adjustment of the 2020 Behavioral Health and Substance Abuse Fee Schedule
(Feb. 3, 2021) Because the 2020 Behavioral Health and Substance Abuse Fee Schedule was not implemented until Nov. 13, 2020, DMS must mass adjust claims back to the Jan. 1, 2020 effective date. Providers may see adjustments negatively or positively impact service reimbursement claims from Jan. 1, 2020 to Nov. 13, 2020. Providers should see adjustments on the cycle dated Feb. 12.
Supporting Kentucky Youth (SKY) Program
(Dec. 29, 2020) - Beginning January 2021, statewide managed care organization Aetna Better Health of Kentucky will manage the new Supporting Kentucky Youth program, also known as SKY. This means children and youth in foster care and out-of-home care, children receiving adoption assistance, dually involved youth and former foster care youth will be enrolled with Aetna for their Medicaid coverage.
1115 Waiver Demonstration - Kentucky Health - Continuity of Care for Incarcerated Members Amendment Request
(Dec. 9, 2020) Kentucky is requesting an amendment to its KY HEALTH section 1115 demonstration to provide targeted substance use disorder treatment services to eligible individuals incarcerated in state and county facilities. The federal public comment period will be open Dec. 9, 2020 through Jan. 8, 2021.
View/Submit Public Comment
CMS health care quality core set chart packs
Each year the Centers for Medicare and Medicaid Services publishes core measures of the quality-of-care and health outcomes for adults participating in Medicaid and children enrolled in the Medicaid Children’s Health Insurance Program. Please view:
Managed Care Open Enrollment Information - 2021
Open enrollment for recipients in a managed care plan will be conducted Nov. 2 - Dec. 15, 2020.
Please view the
open enrollment materials.
New Kentucky Level of Care System (KLOCS)
(July 17, 2020) - Aug. 3, 2020, all nursing facility providers, institutionalized hospice service providers and ICF/IID providers are required to use the Kentucky Level of Care System (KLOCS). Training materials will be available the week of July 27. Please refer to the
KLOCS page for more information.
(July 17, 2020)
907 KAR 1:604 (AAC) - Recipient cost-cost sharing eliminates co-pays for Medicaid Members.
Cost Report Update
(July 14, 2020) The Centers for Medicare and Medicaid Services authorized the delay of some Medicare cost reports. The KY Department for Medicaid Services grants the same extension to providers who received an extension approval through CMS or the designated Medicare administrative contractor. Please call (502) 564-8196 if you have any questions and ask for the staff referenced below based on provider type.
Fee for Service/Managed Care Organization Prior Authorization Announcement
(Jun. 30, 2020) - Effective with dates of service beginning Aug. 1, 2020 MCOs may resume their respective prior authorization policies with the exception of behavioral health and substance use disorder (SUD) services. Behavioral health and SUD services are defined as services provided by any behavioral health provider type (02, 03, 04, 05, 06, 23, 26, 30, 62, 63, 66, 67, 81, 82, 83, 84, 89, 92), services listed on the Behavioral Health and Substance Abuse Services Inpatient and Outpatient Fee Schedules and services listed on the Community Mental Health Center Mental Health Substance Abuse Codes and Units of Service Fee Schedule. For services scheduled in early Aug. 2020, it is recommended that providers be allowed the ability to obtain prior authorization in July 2020.
KY HEALTH Section 1115 Reissuance
KY Evaluation Design Approval Letter
KY HEALTH Section 1115 Demonstration
Public Charge Rule
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