What's New
Behavioral Health Services Prior Authorization (PA) Comparison
Kentucky Managed Care Plans Prior Authorization by Behavioral Health Service
Managed Care Forums
Medicaid Managed Care Forums are returning in 2024. Register by clicking the following links;
- Bowling Green
-
Owensboro
-
Louisville
- Covington
- Morehead
- Pineville
Federal Notice Regarding Change Healthcare Cyberattack
The U.S. Department of Health and Human Services has provided guidance regarding a cyberattack on Change Healthcare that has disrupted billing and claims operations for many state Medicaid programs. Read more or explore resources at the documents linked below.
Notice from HHS
Resources for Providers
Notice of Screening Risk Change for Skilled Nursing Facilities and Hospice Providers
Kentucky Medicaid has been notified of a screening risk level change in 42 C.F.R. § 424.518. for Skilled Nursing Facilities (SNFs) effective Jan. 1, 2023.
As of Jan. 1, 2023, SNFs enrolling or undergoing a change in ownership were elevated from the “limited” level of categorical screening to the “high” screening level. The final rule effectuating this change was published in the Federal Register on Nov. 18, 2022 (87 FR 69404). As a result, any SNF that newly enrolled or underwent a change in ownership/reported a new owner on or after Jan. 1, 2023, is required to be screened at the “high” screening level, resulting in the owner(s) being fingerprinted. Revalidating SNFs (so long as they are not reporting a change in ownership) fall under the “moderate” screening level.
For Hospice Providers:
Kentucky Medicaid has been notified that effective Jan. 1, 2024, newly enrolling hospices have been elevated from the “moderate” to the “high” screening level.
As of Jan. 1, 2024, Hospice providers enrolling or undergoing a change in ownership shall be elevated from the “limited” level of categorical screening to the “high” screening level. The final rule effectuating this change was published in the Federal Register on Nov. 13, 2023 (88 FR 77676). As a result, any Hospice provider that newly enrolls or undergoes a change in ownership/reported a new owner on or after Jan. 1, 2024, is required to be screened at the “high” screening level, resulting in the owner(s) being fingerprinted. Revalidating Hospice providers (so long as they are not reporting a change in ownership) fall under the “moderate” screening level. Important Note for All Medicaid Providers about Programs for All-Inclusive Care for the Elderly (PACE)
PACE is now enrolling individuals in Kentucky. When checking eligibility, please determine if the individual is enrolled in PACE. If so, all services must be approved and billing submitted through the individual's PACE organization.
Providers asked to report missed or canceled appointments
KYHealthNet now has a panel for entering missed and canceled appointments. The commonwealth recognizes that when a member misses an appointment or cancels with little notice this is a loss of revenue to your organization and delays another member access to quicker service. We ask you to take a few seconds and provide us information about those missed or canceled appointments so we can act to reduce those cases. Thank you in advance for your help in this effort.
This panel allows you to enter information when a patient either misses or cancels scheduled appointments. If you have any questions about how to enter information on this new panel, please see the
User Guide and Video.
Per
guidance issued May 21, 2021 Kentucky Medicaid providers are not permitted to charge members for missed or canceled appointments.
Correcting Medicaid Member Incarceration Status Errors
Kentucky Medicaid has a new form providers can use to help members who are incorrectly listed as incarcerated in
KYHealthNet. Please review the
guidance for reporting incarceration errors and the new
MAP-INC form for more information.
Eligibility and Benefits Transaction Saving Opportunities
The Centers for Medicare and Medicaid Services National Standards Group 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 Ancillary Services for Adults and Pediatrics
Technical Criteria for Reviewing Ancillary Services for Adults
Technical Criteria for Reviewing Ancillary Services for Pediatrics
Urine Drug Testing Policy
Urine Drug Testing Policy (Effective July 1, 2020)
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.
Kentucky Medicaid COVID-19 Information