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Showing 10 posts in Kentucky’s Department for Medicaid Services.

Coronavirus: Section 1135 Waivers Bring Relief to Healthcare Providers

Invoking powers under the National Emergency Act and the Stafford Act on March 13, 2020, the President declared a national emergency, which, in turn, authorized the Secretary of Health and Human Services to waive conditions of participation requirements for payment for healthcare providers through waivers provided under Section 1135 of the Social Security Act.  The 1135 waivers do not replace 1115 waivers that require states to individually submit requests for waiver of selected Medicaid requirements, but the 1135 waivers are designed to temporarily give healthcare providers more flexibility in providing services during the pandemic crisis. The 1135 waiver is very helpful but does not address all situations or answer all questions, and it creates ambiguity in certain circumstances.   More >

RHCs and FQHCs – It’s time to take a second look at Alternate Payment Methodology

Posted In Federally Qualified Health Centers (“FQHCs”), Kentucky’s Department for Medicaid Services, Medicaid, Rural Health Centers (“RHCs”)

In July of 2014, Kentucky Medicaid established an Alternate Payment Methodology (“APM”) for all Federally-Qualified Health Centers (“FQHCs”) and Rural Health Clinics (“RHCs”) as an alternative to the all-inclusive encounter rate per patient under the standard prospective payment system (“PPS”) of 42 U.S.C. 1369a(aa). The APM allows for qualified centers to be reimbursed at a rate of 125% of the 2014 Medicare Upper Payment Limit for RHCs in place of the PPS system ($99.75 per covered visit). There are more advantages to APM than meet the eye, however, and qualified centers currently using PPS method should at the very least reevaluate APM, as proposed changes will make APM even more attractive and potentially risk-free. More >

A Shot in the Arm of Preventive Health Services

Posted In Kentucky’s Department for Medicaid Services, Medicaid

The ripple effects of recent changes to the health care industry are still being measured, but Kentucky is already touting what it views as a positive impact of the Commonwealth’s decision to accept the Medicaid expansion under the law. More >

Changes and Challenges for Mental and Behavioral Health Providers

Posted In Kentucky’s Department for Medicaid Services, Medicaid, Mental Health Care

As Kentucky’s Senate Bill 192 highlights, coverage and treatment of substance abuse problems is dramatically changing as the current penal model is slowly being replaced with a treatment model. Even terminology for what has been called "drug addiction" is now referred to as a "substance disorder" problem. Behavioral health has become the new catchall name for both mental health and substance disorders. As substance disorders become medical problems rather than drug abuse problems, the Federal Mental Health Parity Act and the Affordable Care Act now mandate that substance disorders and mental health problems, which often go hand in hand, must be covered by health insurance just as medical problems are covered. As of January 1, 2015, these illnesses must also covered by Medicare and Medicaid. Paving the road for coverage, however, has not been easy as a wealth of new federal and state government regulations are creating a complicated framework with a host of changes for behavioral health providers. While Kentucky struggles to provide and pay for services for the 150,000+ new Medicaid beneficiaries, these new laws and regulations significantly affect not just behavioral health providers, but also employers as the struggle to treat individuals who suffer from these maladies is addressed. More >

Kentucky to Establish Hospital-to-Home Transition Care

One of the last-minute laws passed by Kentucky’s General Assembly and signed by Governor Beshear was a statute that authorizes Medicaid reimbursement for “Hospital-to-Home Transition Care,” which becomes effective on June 24, 2015. More >

Medication-Assisted Therapies, Behavioral Health Services Organizations and Issues Facing Behavioral Health Providers, Part One

Posted In Kentucky Board of Medical Licensure, Kentucky’s Department for Medicaid Services

Kentucky seems to be losing physicians who treat opioid addicted patients with buprenorphine therapy as tough new standards for prescribing the medication have been enacted by the Kentucky Board of Medical Licensure (“KBML”). At the same time, Kentucky’s Cabinet for Health and Family Services has created new types of providers that can offer behavioral health and substance disorder services, and, the Department of Medicaid Services (“DMS”) has eliminated the ability of physicians to provide medication assisted therapy to Medicaid patients in a cash only practice. Physicians facing increased regulations must be vigilant about compliance with these new regulatory hurdles, but may also find opportunity in providing the same services through a provider other than a private practice. More >

CMS 2014 Call Letter: A Bright Future for CMS Star Rating System

Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Kentucky’s Department for Medicaid Services, Medicaid, Medicare

On February 15, the Centers for Medicare & Medicaid Services (CMS) issued the draft calendar year (CY) 2014 Call Letter for the Medicare Advantage (MA) and Part D programs (Call Letter). It contains information that MA organizations and Part D plan sponsors (collectively, Plan Sponsors) need to prepare their 2014 bids and operations. More >


Posted In Health Care Law, House Bill 1, House Bill 4, Kentucky Board of Medical Licensure, Kentucky’s Department for Medicaid Services

In a Special Session, the Kentucky General Assembly enacted House Bill 1, sweeping legislation designed to combat prescription drug abuse through increased regulation of pain clinics and greater scrutiny of prescribing practices by various agencies of state government.  Governor Beshear signed the legislation into law, and it will become effective in July, 2012.  In addition to placing significant limits on the ownership of pain clinics and imposing a host of requirements governing the operations of pain clinics, the legislation also strengthens licensing standards for physicians and other practitioners and requires practitioners to take specific steps prior to prescribing or dispensing a Schedule II or Schedule III controlled substance. More >


Unlike the Department of Health and Human Services Office of Inspector General (“OIG”) which publishes a Work Plan each year, the Department of Medicaid Services (“Medicaid”) generally does not publish guidance on the areas which it plans to investigate and/or audit. In fact, Medicaid’s website states … “Medicaid does not provide guidance on how companies should bill for services, but will direct you to applicable regulations.  If you receive direction from staff about how to bill, the Department will not be bound by such instruction, unless it was given by a Director or Commissioner.” Because the federal integrity programs are now moving through the process, Kentucky Medicaid providers are starting to see lots of audit activities. Unlike the OIG audits, we don’t know the precise subject matter of the Medicaid audits, but the process for appeal is outlined below in addition to the areas announced for review by the OIG. More >

Courier Journal publishes online prescription database

Posted In Health Care Law, Kentucky Board of Medical Licensure, Kentucky’s Department for Medicaid Services, Medicaid

The Courier Journal recently published an online database allowing the public to search, by prescriber last name or zip code, the number of prescriptions Kentucky doctors and other prescribers wrote between 2001 and 2011 for seven commonly-abused drugs: alprazolam, diazepam, morphine, methadone, fentanyl, oxycodone and hydrocodone. The newspaper accessed information from Kentucky’s Department for Medicaid Services via the Open Records Law, so the database is limited to Medicaid claims data. As Senator Grassley (R-IA) and other senators raise concerns that over-prescribing may constitute fraud and abuse, it is important for Kentucky physicians and prescribers to comply with compliance plans, state and federal laws, as well as Kentucky Board of Medical Licensure guidelines. More >

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