Prior Authorization Information - Update
(March 23, 2021) Prior Authorization Guidance update effective Feb. 1, 2021
Eligibility and Benefits Transaction Saving Opportunities
The Centers for Medicare an Medicaid Services National Standards Group has released a new Administrative Simplification fact sheet detailing potential health care industry time and cost savings from conducting fully electronic eligibility and benefits inquiry and response transactions.
Technical criteria for reviewing Ancilliary Services for Adults and Pediatrics
Technical Criteria for Reviewing Ancillary Services for Adults
Technical Criteria for Reviewing Ancillary Services for Pediatrics
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 claims reimbursement for services from Jan. 1, 2020 to Nov. 13, 2020. Providers should see adjustments on the cycle dated Feb. 12.
COVID 19 Vaccine Provider Letter
(Dec. 30, 2020) - All Kentucky Department for Medicaid Services providers seeking to receive and administer the COVID-19 vaccine must enroll with the Kentucky Department for Public Health (KDPH) as soon as possible at
vaccine provider enrollment.
A vaccine provider enrollment checklist is provided with instructions for enrollment. After reviewing the information, direct questions related to vaccine provider enrollment to
Urine Drug Testing Policy
Urine Drug Testing Policy (Effective July 1, 2020)
DME Updated Notice - Due to the ongoing COVID-19 Public Health Emergency, Medicaid has suspended the 2020 DME fee schedule changes due to become effective Nov. 15, 2020. However, Medicaid will update the DME fee schedule in compliance with the required upper payment limit demonstration and publish a new fee schedule effective Jan. 1, 2021.
Each year Kentucky Medicaid is required to provide an upper payment limit demonstration for CMS on all DME codes covered by Medicaid. The demonstration must show rates are the same as or less than Medicare rates. CMS notified Medicaid that it had not provided the upper payment limit demonstration for 2020. A rate change adjustment was appliced, first retroactive until Jan. 1, 2020, which triggered recoupments. Medicaid reprocessed and repaid any recouped claims and posted a notice that the fee schedule changes would take effect on Nov. 15, 2020. At this time no changes will be made to the 2020 DMS fee schedule. Medicaid apologizes for the inconvenience and confusion caused by these decisions.
Revised Provider Relief Fund eligibility and reporting requirement
(Oct. 27, 2020) The Department of Health and Human Services (HHS) recently
revised Provider Relief Fund (PRF) eligibility and reporting requirements for the upcoming phase 3 general distribution. Changes expand eligibility to a broader group of provider types including those who do not serve Medicare and Medicaid beneficiaries, including allopathic and osteopathic physicians; nursing service and related providers; hospice providers; respiratory, developmental, rehabilitative and restorative service providers; residential treatment facilities; laboratories; and ambulatory health care facilities, among others.
All phase 3 applicants have until Nov. 6, 2020 at 11:59 p.m. Eastern time to submit applications. Providers with validated applications will receive up to 2 percent of annual revenue from patient care plus an add-on payment that considers changes in operating revenues and expenses from patient care, including coronavirus-related expenses.
Additionally, HHS is
reporting instructions to give providers more flexibility in how they may apply PRF money toward lost revenues due to coronavirus. Providers first must reimburse patient care expenses related to coronavirus not reimbursed by other sources; but, then may use remaining PRF funds to cover lost revenue, which HHS defines as a negative change in year-over-year actual revenue from patient care related sources.
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.
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 also 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 services provided by provider types 02, 03, 04, 05, 06, 23, 26, 30, 62, 63, 66, 67, 81, 82, 83, 84, 89 and 92 and listed on the Behavioral Health and Substance Abuse Services Inpatient and Outpatient, Community Mental Health Center Mental Health Substance Abuse Codes and Units of Service fee schedules. For services scheduled in early August 2020, it is recommended that providers be allowed the ability to obtain prior authorization in July 2020.
Kentucky Medicaid COVID-19 Information