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​Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources

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Contact Information

Members

Providers

  • For Billing Questions, contact DXC at 800-807-1232 or visit the website
  • For Provider Questions, contact Provider Services at 855-824 5615
  • For Provider Enrollment questions, contact Program Integrity at (877)838-5085
  • For KyHealth-net assistance, email EDI helpdesk
  • For General Questions, contactDMS Issues
  • Website Technical Questions, contact CHFS DMS Webmaster
  • To report Fraud and Abuse, contact Fraud Hotline at (502) 564-2348
  • For Member questions, contact Member Services at (800) 635-2570
  • For Pharmacy Questions, contact Pharmacy Support Center at (800) 432-7005
  • For Pharmacy Clinical Support questions, contact Clinical Support Center at (800) 477-3071
  • For Pharmacy Prior Authorization questions, contact Pharmacy Prior Authorization at (800) 477-3071

Agency News

​1915 C waiver Redesign Town Hall Notification

Please join the Kentucky Department for Medicaid Services (DMS) 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 (HCBS) Waivers
  • Share Navigant Consulting's proposed 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. The numbers are below.

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 formstated in the March 2017 Provider Letter has been delayed. Please continue to use the current Level I PASRR Screening formuntil 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

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

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.

Update

(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.

KY Department for Medicaid Services Managed Care Open Enrollment Information- 2017

The Department for Medicaid Services will conduct open enrollment for recipients in a Managed Care plan starting Oct. 24, 2016, and ending Dec. 16, 2016.

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 Jan. 1, 2017.

Announcement

The Cabinet for Health and Family Services is hosting a meeting for managed care organizations to provide input into the development of requirements for the Medicaid 1115 Waiver, Kentucky HEALTH. The Cabinet is specifically interested in hearing from MCOs with experience in cost sharing and premium collection. Other possible topics of discussion include quality payment initiatives, deductible account (My Rewards) coordination and identification of medically frail members.

The meeting will take place on Wednesday, Dec. 21, 2016 at 10 a.m. in the Auditorium of the Kentucky Transportation Cabinet, 200 Mero Street, Frankfort, KY 40622.

Please RSVP to Kristen Lee by 4:30 p.m. Dec. 20.

Notice

The Cabinet for Health and Family Services Department for Medicaid Services, in accordance with 42 CFR 447.205, hereby provides public notice of enhanced reimbursement rates it has implemented for certain preventive and wellness services provided Jan. 1, 2015 through June 30, 2016.

The enhanced reimbursement rates are the Medicaid Preventive and Wellness Enhanced Fee Schedule located on the Fee and Rate Schedule page.

Read the Wellness Reimbursement Public Notice.

Public Comment

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 30 days to:

Commissioner's Office
Department for Medicaid Services, 6W-A
275 E. Main Street
Frankfort, Kentucky 40621

2015 Medicaid Provider Forum Information  

Information regarding KY Kids Recovery grant program
Feb. 3, 2014 - The Substance Abuse Treatment Advisory Committee is seeking assistance spreading the word about submissions for the KyKidsRecovery juvenile substance abuse treatment grants.

Read the Office of the Attorney General press release

More information about the kids recovery program

You may also call: (855) 450-5646 #KYKidsRecovery.

Managed Care Contracts Awarded to Serve More Kentuckians Newly Eligible for Medicaid

FRANKFORT, Ky. (Sept. 13, 2013) - The Commonwealth of Kentucky has signed contracts with three managed care organizations to provide healthcare services to Kentuckians who will be newly eligible for coverage under the expansion of Medicaid, a provision of the Affordable Care Act.

Read the release

Cabinet Releases Medicaid Managed Care Request for Proposal

June 12, 2013 - The Finance and Administration Cabinet released a Medicaid Managed Care Request for Proposal (RFP) Affordable Care Act (ACA) Expansion. Services are to begin on Jan. 1, 2014, for members enrolled through Medicaid expansion under the federal ACA in seven Medicaid Regions and July 1, 2014, for specified members eligible for Medicaid under eligibility criteria in place prior to the ACA expansion for the same seven Managed Care Regions. The RFP is available on the Commonwealth of Kentucky eProcurement website. Any questions related to this procurement must be directed to the Office of Procurement Services, Finance and Administration Cabinet.

Medicaid Managed Care open enrollment information

(Wednesday, Aug. 22, 2012) - Medicaid recipients in 104 Kentucky counties currently have the opportunity to change their Managed Care Organization (MCO) without having to give a specific reason for the change as previously indicated in the news release regarding Medicaid Open Enrollment dated Aug. 17, 2012. Open Enrollment is from Aug. 19, 2012 through Oct. 20, 2012.

Members were notified by a letter regarding open enrollment and a member information packet about the options provided by the three available MCOs: CoventryCares of KentuckyKentucky Spirit Health Plan and WellCare of Kentucky.

Medicaid members in managed care who would like to change MCOs must do so by calling toll-free 1-855-446-1245 between the hours of 8 a.m. and 6 p.m. Eastern time.

Members can search the MCO provider directory to confirm which networks physicians and other health care providers have joined. Search for providers by using the Online Provider Search.

Members who choose to stay with their current MCO do not need to take any action.

All prescribing providers to enroll as credentialed practitioners

August 2010 - To better monitor prescriptions and care of Medicaid members, the Kentucky Department for Medicaid Services (DMS) will require all prescribing providers to enroll as credentialed practitioners. DMS will begin outreach to non-enrolled prescribers to assist with the enrollment process. Effective Sept. 1, 2010, DMS no longer will add non-Medicaid prescribers to its files. Effective Oct. 1, 2010, no reimbursement will be provided for prescriptions by non-Medicaid providers, which will result in prescriptions denying. Please notify your patients that if they accept a prescription from a non-Medicaid provider, DMS will not pay for the prescription. For information about enrollment and to download an application (MAP 811) please visit our website.

If you have any questions or need assistance in completing the enrollment documentation, please contact the Provider Services Branch at (877) 838-5085 Monday-Friday 10 a.m. to 4:30 p.m.

Attention All Providers

June 2010 - The Commonwealth of Kentucky, in an effort to reduce costs, will eliminate paper remittance advices (RAs) effective July 1. You currently can view your RA each week by accessing the KYHealthNET RA Viewer or by retrieving your RA electronically. If you wish to view your RA through the KyHealthNet, you must identify a specific user who will have RA viewer as his or her role and grant the user permission to retrieve the RA. If you are not already signed up with KYHealthnet, refer to the DMS KYHealthNet page for assistance.

Another way to receive your RAs is to become a trading partner. This will allow you to retrieve the 835 file from the bulletin board. You will need to complete the 835 enrollment form (MAP 380) which can be accessed on the KyHealthNet Provider Enrollment Forms page.

If you have any questions please contact HP Billing Inquiry at (800) 807-1232.

Archived News