Title 907 | Chapter 013 | Regulation 010
SUPERSEDED
This document is no longer current.
PREVIOUS VERSION
The previous document that this document is based upon is available.
CABINET FOR HEALTH AND FAMILY SERVICES
Department for Medicaid Services
Division of Health Policy
(Amendment)
907 KAR 13:010.Private duty nursing service coverage provisions and requirements.
Section 1.
Provider Participation.(1)
To be eligible to provide services under this administrative regulation, a provider shall be:(a)
Currently enrolled in the Kentucky Medicaid Program in accordance with 907 KAR 1:672;(b)
Except as established in subsection (2) of this section, currently participating in the Kentucky Medicaid Program in accordance with 907 KAR 1:671; and(c)
1.
A private duty nursing agency; or2.
A licensed home health agency.(2)
In accordance with 907 KAR 17:015, Section 3(3), a provider of a service to an enrollee shall not be required to be currently participating in the fee-for-service Medicaid Program.Section 2.
Coverage and Limit.(1)
The department shall reimburse for a private duty nursing service or supply if the service or supply is:(a)
Provided:1.
By a:a.
Registered nurse employed by a:(i)
Private duty nursing agency that meets the requirements established in Section 1 of this administrative regulation; or(ii)
Home health agency that meets the requirements established in Section 1 of this administrative regulation; orb.
Licensed practical nurse employed by a:(i)
Private duty nursing agency that meets the requirements established in Section 1 of this administrative regulation; or(ii)
Home health agency that meets the requirements established in Section 1 of this administrative regulation;2.
To a recipient in the recipient's home, except as provided in subsection (2) of this section; and3.
Under the direction of the recipient's physician in accordance with 42 C.F.R. 440.80;(b)
1.
Prescribed for the recipient by a physician; and2.
Stated in the recipient's plan of treatment developed by the prescribing physician;(c)
Established as being needed for the recipient in the recipient's home;(d)
Prior authorized; and(e)
Medically necessary.(2)
A private duty nursing service may be covered in a setting other than in the recipient's home, if the service is provided during a normal life activity of the recipient that requires the recipient to be out of his or her home.(3)
(a)
(b)
Section 3.
No Duplication of Service. The department shall not reimburse for any of the following services provided during the same time that a private duty nursing service is provided to a recipient:(1)
A personal care service;(2)
A skilled nursing service or visit; or(3)
A home health aide service.Section 4.
Conflict of Interest. The department shall not reimburse for a private duty nursing service provided to a recipient if the individual providing the service is:(1)
An immediate family member of the recipient; or(2)
A legally responsible individual who maintains his or her primary residence with the recipient.Section 5.
Records Maintenance, Protection, and Security.(1)
(a)
A provider shall maintain a current health record for each recipient.(b)
1.
A health record shall document each service provided to the recipient including the date of the service and the signature of the individual who provided the service.2.
The individual who provided the service shall date and sign the health record on the date that the individual provided the service.(2)
(a)
A provider shall maintain a health record regarding a recipient for at least five (5) years from the date of the service.(b)
If the United States Department of Health and Human Services secretary requires a longer document retention period than the period referenced in paragraph (a) of this subsection, pursuant to 42 C.F.R. 431.17, the period established by the secretary shall be the required period.(3)
A provider shall comply with 45 C.F.R. Part 164.Section 6.
Medicaid Program Participation Compliance.(1)
A provider shall comply with:(a)
907 KAR 1:671;(b)
907 KAR 1:672; and(c)
All applicable state and federal laws.(2)
(a)
If a provider receives any duplicate payment or overpayment from the department, regardless of reason, the provider shall return the payment to the department.(b)
Failure to return a payment to the department in accordance with paragraph (a) of this subsection may be:1.
Interpreted to be fraud or abuse; and2.
Prosecuted in accordance with applicable federal or state law.Section 7.
Third Party Liability. A provider shall comply with KRS 205.622.Section 8.
Use of Electronic Signatures.(1)
The creation, transmission, storage, and other use of electronic signatures and documents shall comply with the requirements established in KRS 369.101 to 369.120.(2)
A provider that chooses to use electronic signatures shall:(a)
Develop and implement a written security policy that shall:1.
Be adhered to by each of the provider's employees, officers, agents, or contractors;2.
Identify each electronic signature for which an individual has access; and3.
Ensure that each electronic signature is created, transmitted, and stored in a secure fashion;(b)
Develop a consent form that shall:1.
Be completed and executed by each individual using an electronic signature;2.
Attest to the signature's authenticity; and3.
Include a statement indicating that the individual has been notified of his or her responsibility in allowing the use of the electronic signature; and(c)
Provide the department, immediately upon request, with:1.
A copy of the provider's electronic signature policy;2.
The signed consent form; and3.
The original filed signature.Section 9.
Auditing Authority. The department shall have the authority to audit any claim, medical record, or documentation associated with any claim or medical record.Section 10.
Federal Approval and Federal Financial Participation. The department's coverage of services pursuant to this administrative regulation shall be contingent upon:(1)
Receipt of federal financial participation for the coverage; and(2)
Centers for Medicare and Medicaid Services' approval for the coverage.Section 11.
Appeal Rights.(1)
An appeal of an adverse action by the department regarding a service and a recipient who is not enrolled with a managed care organization shall be in accordance with 907 KAR 1:563.(2)
An appeal of an adverse action by a managed care organization regarding a service and an enrollee shall be in accordance with 907 KAR 17:010.LISA D. LEE, Commissioner
ERIC FRIEDLANDER, Secretary
APPROVED BY AGENCY: January 5, 2024
FILED WITH LRC: January 11, 2023 at 2:25 p.m.
PUBLIC HEARING AND COMMENT PERIOD: A public hearing on this administrative regulation shall, if requested, be held on March 25, 2024, at 9:00 a.m. using the CHFS Office of Legislative and Regulatory Affairs Zoom meeting room. The Zoom invitation will be emailed to each requestor the week prior to the scheduled hearing. Individuals interested in attending this virtual hearing shall notify this agency in writing by March 18, 2024, five (5) workdays prior to the hearing, of their intent to attend. If no notification of intent to attend the hearing is received by that date, the hearing may be canceled. This hearing is open to the public. Any person who attends virtually will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to be heard at the public hearing, you may submit written comments on this proposed administrative regulation until March 31, 2024. Send written notification of intent to attend the public hearing or written comments on the proposed administrative regulation to the contact person. Pursuant to KRS 13A.280(8), copies of the statement of consideration and, if applicable, the amended after comments version of the administrative regulation shall be made available upon request.
CONTACT PERSON: Krista Quarles, Policy Specialist, Office of Legislative and Regulatory Affairs, 275 East Main Street 5 W-A, Frankfort, Kentucky 40621; phone 502-564-7476; fax 502-564-7091; email CHFSregs@ky.gov.
REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT
Contact Person:
Krista Quarles
(1) Provide a brief summary of:
(a) What this administrative regulation does:
This administrative regulation establishes the Department for Medicaid Services' policy requirements regarding private duty nursing services and supplies.
(b) The necessity of this administrative regulation:
This administrative regulation is necessary to establish the Department for Medicaid Services' policy requirements regarding private duty nursing services and supplies.
(c) How this administrative regulation conforms to the content of the authorizing statutes:
This administrative regulation conforms to the content of the authorizing statutes by establishing the Department for Medicaid Services' policy requirements regarding private duty nursing services and supplies.
(d) How this administrative regulation currently assists or will assist in the effective administration of the statutes:
This administrative regulation will assist in the effective administration of the authorizing statutes by establishing the Department for Medicaid Services' policy requirements regarding private duty nursing services and supplies.
(2) If this is an amendment to an existing administrative regulation, provide a brief summary of:
(a) How the amendment will change this existing administrative regulation:
This amendment coordinates with amendments made to 907 KAR 13:015 in order to implement an increased rate for the reimbursement for private duty nursing services and increases the number of units that can be reimbursed per twelve month period. The specific amendments to this administrative regulation remove a unit limitation. On an ongoing basis the unit limitation will be in 907 KAR 13:015.
(b) The necessity of the amendment to this administrative regulation:
These amendments are necessary to increase the rate for the reimbursement for private duty nursing services and to increase the number of units that can be reimbursed per twelve month period.
(c) How the amendment conforms to the content of the authorizing statutes:
The amendments conform to the content of the authorizing statutes by establishing an increased rate for the reimbursement for private duty nursing services and increases the number of units that can be reimbursed per twelve month period.
(d) How the amendment will assist in the effective administration of the statutes:
The amendments will assist in the effective administration of the authorizing statutes by establishing an increased rate for the reimbursement for private duty nursing services and increases the number of units that can be reimbursed per twelve month period.
(3) List the type and number of individuals, businesses, organizations, or state and local governments affected by this administrative regulation:
Private Duty Nursing organizations will be affected by this regulation. There are currently 23 Private Duty Nursing organizations.
(4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:
(a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment:
As appropriate, providers may need to refer to 907 KAR 13:015 to determine reimbursement rates.
(b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3):
Providers and provider groups will not incur additional costs as a result of the changes to this administrative regulation.
(c) As a result of compliance, what benefits will accrue to the entities identified in question (3):
Providers and provider groups will benefit due to removing unit limits as established by this updated administrative regulation.
(5) Provide an estimate of how much it will cost the administrative body to implement this administrative regulation:
(a) Initially:
DMS does not anticipate any additional costs in implementing this amendment on an initial basis.
(b) On a continuing basis:
DMS does not anticipate any additional costs in implementing this amendment on a continuing basis.
(6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation:
Sources of funding to be used for the implementation and enforcement of this administrative regulation are federal funds authorized under Title XIX and Title XXI of the Social Security Act, and state matching funds of general and agency appropriations.
(7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new, or by the change if it is an amendment:
At this time, DMS does not assess that an increase in fees or funding is necessary to implement this administrative regulation.
(8) State whether or not this administrative regulation establishes any fees or directly or indirectly increases any fees:
This administrative regulation neither establishes nor increases any fees.
(9) TIERING: Is tiering applied?
Tiering was not appropriate in this administrative regulation because the administration regulation applies equally to all those individuals or entities regulated by it.
FISCAL NOTE
(1) What units, parts, or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation?
DMS will be affected by this administrative regulation.
(2) Identify each state or federal statute or federal regulation that requires or authorizes the action taken by the administrative regulation.
KRS 194A.030(2), 194A.050(1), 205.520(3)
(3) Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.
(a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year?
This administrative regulation is not expected to generate revenue for state or local government.
(b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years?
This administrative regulation is not expected to generate revenue for state or local government.
(c) How much will it cost to administer this program for the first year?
DMS does not anticipate any additional costs in implementing this amendment on an initial basis.
(d) How much will it cost to administer this program for subsequent years?
DMS does not anticipate any additional costs in implementing this amendment in subsequent years.
Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.
Revenues (+/-):
Expenditures (+/-):
Other Explanation:
(4) Estimate the effect of this administrative regulation on the expenditures and cost savings of regulated entities for the first full year the administrative regulation is to be in effect.
(a) How much cost savings will this administrative regulation generate for the regulated entities for the first year?
DMS does not anticipate that cost savings will be generated for regulated entities as a result of the amendments to this administrative regulation in the first year.
(b) How much cost savings will this administrative regulation generate for the regulated entities for subsequent years?
DMS does not anticipate that cost savings will be generated for regulated entities as a result of the amendments to this administrative regulation in subsequent years.
(c) How much will it cost the regulated entities for the first year?
DMS does not anticipate that regulated entities will incur costs as a result of this amendment in the first year.
(d) How much will it cost the regulated entities for subsequent years?
DMS does not anticipate that regulated entities will incur costs as a result of this amendment in subsequent years.
Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.
Cost Savings (+/-):
Expenditures (+/-):
Other Explanation:
(5) Explain whether this administrative regulation will have a major economic impact, as defined below.
"Major economic impact" means an overall negative or adverse economic impact from an administrative regulation of five hundred thousand dollars ($500,000) or more on state or local government or regulated entities, in aggregate, as determined by the promulgating administrative bodies. [KRS 13A.010(13)] The administrative regulation will not have a major economic impact – as defined by KRS 13A.010 – on regulated entities.
FEDERAL MANDATE ANALYSIS COMPARISON
(1) Federal statute or regulation constituting the federal mandate.
There is no federal mandate to establish the reimbursement rate or unit limits in an administrative regulation.
(2) State compliance standards.
KRS 194A.030(2) states, "The Department for Medicaid Services shall serve as the single state agency in the Commonwealth to administer Title XIX of the Federal Social Security Act."
(3) Minimum or uniform standards contained in the federal mandate.
There is no federal mandate to establish the reimbursement rate in an administrative regulation.
(4) Will this administrative regulation impose stricter requirements, or additional or different responsibilities or requirements, than those required by the federal mandate?
The administrative regulation does not impose stricter or different responsibilities than the federal requirements.
(5) Justification for the imposition of the stricter standard, or additional or different responsibilities or requirements.
The administrative regulation does not impose stricter or different responsibilities than the federal requirements.
CABINET FOR HEALTH AND FAMILY SERVICES
Department for Medicaid Services
Division of Health Policy
(Amendment)
907 KAR 13:010.Private duty nursing service coverage provisions and requirements.
Section 1.
Provider Participation.(1)
To be eligible to provide services under this administrative regulation, a provider shall be:(a)
Currently enrolled in the Kentucky Medicaid Program in accordance with 907 KAR 1:672;(b)
Except as established in subsection (2) of this section, currently participating in the Kentucky Medicaid Program in accordance with 907 KAR 1:671; and(c)
1.
A private duty nursing agency; or2.
A licensed home health agency.(2)
In accordance with 907 KAR 17:015, Section 3(3), a provider of a service to an enrollee shall not be required to be currently participating in the fee-for-service Medicaid Program.Section 2.
Coverage and Limit.(1)
The department shall reimburse for a private duty nursing service or supply if the service or supply is:(a)
Provided:1.
By a:a.
Registered nurse employed by a:(i)
Private duty nursing agency that meets the requirements established in Section 1 of this administrative regulation; or(ii)
Home health agency that meets the requirements established in Section 1 of this administrative regulation; orb.
Licensed practical nurse employed by a:(i)
Private duty nursing agency that meets the requirements established in Section 1 of this administrative regulation; or(ii)
Home health agency that meets the requirements established in Section 1 of this administrative regulation;2.
To a recipient in the recipient's home, except as provided in subsection (2) of this section; and3.
Under the direction of the recipient's physician in accordance with 42 C.F.R. 440.80;(b)
1.
Prescribed for the recipient by a physician; and2.
Stated in the recipient's plan of treatment developed by the prescribing physician;(c)
Established as being needed for the recipient in the recipient's home;(d)
Prior authorized; and(e)
Medically necessary.(2)
A private duty nursing service may be covered in a setting other than in the recipient's home, if the service is provided during a normal life activity of the recipient that requires the recipient to be out of his or her home.Section 3.
No Duplication of Service. The department shall not reimburse for any of the following services provided during the same time that a private duty nursing service is provided to a recipient:(1)
A personal care service;(2)
A skilled nursing service or visit; or(3)
A home health aide service.Section 4.
Conflict of Interest. The department shall not reimburse for a private duty nursing service provided to a recipient if the individual providing the service is:(1)
An immediate family member of the recipient; or(2)
A legally responsible individual who maintains his or her primary residence with the recipient.Section 5.
Records Maintenance, Protection, and Security.(1)
(a)
A provider shall maintain a current health record for each recipient.(b)
1.
A health record shall document each service provided to the recipient including the date of the service and the signature of the individual who provided the service.2.
The individual who provided the service shall date and sign the health record on the date that the individual provided the service.(2)
(a)
A provider shall maintain a health record regarding a recipient for at least five (5) years from the date of the service.(b)
If the United States Department of Health and Human Services secretary requires a longer document retention period than the period referenced in paragraph (a) of this subsection, pursuant to 42 C.F.R. 431.17, the period established by the secretary shall be the required period.(3)
A provider shall comply with 45 C.F.R. Part 164.Section 6.
Medicaid Program Participation Compliance.(1)
A provider shall comply with:(a)
907 KAR 1:671;(b)
907 KAR 1:672; and(c)
All applicable state and federal laws.(2)
(a)
If a provider receives any duplicate payment or overpayment from the department, regardless of reason, the provider shall return the payment to the department.(b)
Failure to return a payment to the department in accordance with paragraph (a) of this subsection may be:1.
Interpreted to be fraud or abuse; and2.
Prosecuted in accordance with applicable federal or state law.Section 7.
Third Party Liability. A provider shall comply with KRS 205.622.Section 8.
Use of Electronic Signatures.(1)
The creation, transmission, storage, and other use of electronic signatures and documents shall comply with the requirements established in KRS 369.101 to 369.120.(2)
A provider that chooses to use electronic signatures shall:(a)
Develop and implement a written security policy that shall:1.
Be adhered to by each of the provider's employees, officers, agents, or contractors;2.
Identify each electronic signature for which an individual has access; and3.
Ensure that each electronic signature is created, transmitted, and stored in a secure fashion;(b)
Develop a consent form that shall:1.
Be completed and executed by each individual using an electronic signature;2.
Attest to the signature's authenticity; and3.
Include a statement indicating that the individual has been notified of his or her responsibility in allowing the use of the electronic signature; and(c)
Provide the department, immediately upon request, with:1.
A copy of the provider's electronic signature policy;2.
The signed consent form; and3.
The original filed signature.Section 9.
Auditing Authority. The department shall have the authority to audit any claim, medical record, or documentation associated with any claim or medical record.Section 10.
Federal Approval and Federal Financial Participation. The department's coverage of services pursuant to this administrative regulation shall be contingent upon:(1)
Receipt of federal financial participation for the coverage; and(2)
Centers for Medicare and Medicaid Services' approval for the coverage.Section 11.
Appeal Rights.(1)
An appeal of an adverse action by the department regarding a service and a recipient who is not enrolled with a managed care organization shall be in accordance with 907 KAR 1:563.(2)
An appeal of an adverse action by a managed care organization regarding a service and an enrollee shall be in accordance with 907 KAR 17:010.LISA D. LEE, Commissioner
ERIC FRIEDLANDER, Secretary
APPROVED BY AGENCY: January 5, 2024
FILED WITH LRC: January 11, 2023 at 2:25 p.m.
PUBLIC HEARING AND COMMENT PERIOD: A public hearing on this administrative regulation shall, if requested, be held on March 25, 2024, at 9:00 a.m. using the CHFS Office of Legislative and Regulatory Affairs Zoom meeting room. The Zoom invitation will be emailed to each requestor the week prior to the scheduled hearing. Individuals interested in attending this virtual hearing shall notify this agency in writing by March 18, 2024, five (5) workdays prior to the hearing, of their intent to attend. If no notification of intent to attend the hearing is received by that date, the hearing may be canceled. This hearing is open to the public. Any person who attends virtually will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to be heard at the public hearing, you may submit written comments on this proposed administrative regulation until March 31, 2024. Send written notification of intent to attend the public hearing or written comments on the proposed administrative regulation to the contact person. Pursuant to KRS 13A.280(8), copies of the statement of consideration and, if applicable, the amended after comments version of the administrative regulation shall be made available upon request.
CONTACT PERSON: Krista Quarles, Policy Specialist, Office of Legislative and Regulatory Affairs, 275 East Main Street 5 W-A, Frankfort, Kentucky 40621; phone 502-564-7476; fax 502-564-7091; email CHFSregs@ky.gov.
REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT
Contact Person:
Krista Quarles
(1) Provide a brief summary of:
(a) What this administrative regulation does:
This administrative regulation establishes the Department for Medicaid Services' policy requirements regarding private duty nursing services and supplies.
(b) The necessity of this administrative regulation:
This administrative regulation is necessary to establish the Department for Medicaid Services' policy requirements regarding private duty nursing services and supplies.
(c) How this administrative regulation conforms to the content of the authorizing statutes:
This administrative regulation conforms to the content of the authorizing statutes by establishing the Department for Medicaid Services' policy requirements regarding private duty nursing services and supplies.
(d) How this administrative regulation currently assists or will assist in the effective administration of the statutes:
This administrative regulation will assist in the effective administration of the authorizing statutes by establishing the Department for Medicaid Services' policy requirements regarding private duty nursing services and supplies.
(2) If this is an amendment to an existing administrative regulation, provide a brief summary of:
(a) How the amendment will change this existing administrative regulation:
This amendment coordinates with amendments made to 907 KAR 13:015 in order to implement an increased rate for the reimbursement for private duty nursing services and increases the number of units that can be reimbursed per twelve month period. The specific amendments to this administrative regulation remove a unit limitation. On an ongoing basis the unit limitation will be in 907 KAR 13:015.
(b) The necessity of the amendment to this administrative regulation:
These amendments are necessary to increase the rate for the reimbursement for private duty nursing services and to increase the number of units that can be reimbursed per twelve month period.
(c) How the amendment conforms to the content of the authorizing statutes:
The amendments conform to the content of the authorizing statutes by establishing an increased rate for the reimbursement for private duty nursing services and increases the number of units that can be reimbursed per twelve month period.
(d) How the amendment will assist in the effective administration of the statutes:
The amendments will assist in the effective administration of the authorizing statutes by establishing an increased rate for the reimbursement for private duty nursing services and increases the number of units that can be reimbursed per twelve month period.
(3) List the type and number of individuals, businesses, organizations, or state and local governments affected by this administrative regulation:
Private Duty Nursing organizations will be affected by this regulation. There are currently 23 Private Duty Nursing organizations.
(4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:
(a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment:
As appropriate, providers may need to refer to 907 KAR 13:015 to determine reimbursement rates.
(b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3):
Providers and provider groups will not incur additional costs as a result of the changes to this administrative regulation.
(c) As a result of compliance, what benefits will accrue to the entities identified in question (3):
Providers and provider groups will benefit due to removing unit limits as established by this updated administrative regulation.
(5) Provide an estimate of how much it will cost the administrative body to implement this administrative regulation:
(a) Initially:
DMS does not anticipate any additional costs in implementing this amendment on an initial basis.
(b) On a continuing basis:
DMS does not anticipate any additional costs in implementing this amendment on a continuing basis.
(6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation:
Sources of funding to be used for the implementation and enforcement of this administrative regulation are federal funds authorized under Title XIX and Title XXI of the Social Security Act, and state matching funds of general and agency appropriations.
(7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new, or by the change if it is an amendment:
At this time, DMS does not assess that an increase in fees or funding is necessary to implement this administrative regulation.
(8) State whether or not this administrative regulation establishes any fees or directly or indirectly increases any fees:
This administrative regulation neither establishes nor increases any fees.
(9) TIERING: Is tiering applied?
Tiering was not appropriate in this administrative regulation because the administration regulation applies equally to all those individuals or entities regulated by it.
FISCAL NOTE
(1) What units, parts, or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation?
DMS will be affected by this administrative regulation.
(2) Identify each state or federal statute or federal regulation that requires or authorizes the action taken by the administrative regulation.
KRS 194A.030(2), 194A.050(1), 205.520(3)
(3) Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.
(a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year?
This administrative regulation is not expected to generate revenue for state or local government.
(b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years?
This administrative regulation is not expected to generate revenue for state or local government.
(c) How much will it cost to administer this program for the first year?
DMS does not anticipate any additional costs in implementing this amendment on an initial basis.
(d) How much will it cost to administer this program for subsequent years?
DMS does not anticipate any additional costs in implementing this amendment in subsequent years.
Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.
Revenues (+/-):
Expenditures (+/-):
Other Explanation:
(4) Estimate the effect of this administrative regulation on the expenditures and cost savings of regulated entities for the first full year the administrative regulation is to be in effect.
(a) How much cost savings will this administrative regulation generate for the regulated entities for the first year?
DMS does not anticipate that cost savings will be generated for regulated entities as a result of the amendments to this administrative regulation in the first year.
(b) How much cost savings will this administrative regulation generate for the regulated entities for subsequent years?
DMS does not anticipate that cost savings will be generated for regulated entities as a result of the amendments to this administrative regulation in subsequent years.
(c) How much will it cost the regulated entities for the first year?
DMS does not anticipate that regulated entities will incur costs as a result of this amendment in the first year.
(d) How much will it cost the regulated entities for subsequent years?
DMS does not anticipate that regulated entities will incur costs as a result of this amendment in subsequent years.
Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.
Cost Savings (+/-):
Expenditures (+/-):
Other Explanation:
(5) Explain whether this administrative regulation will have a major economic impact, as defined below.
"Major economic impact" means an overall negative or adverse economic impact from an administrative regulation of five hundred thousand dollars ($500,000) or more on state or local government or regulated entities, in aggregate, as determined by the promulgating administrative bodies. [KRS 13A.010(13)] The administrative regulation will not have a major economic impact – as defined by KRS 13A.010 – on regulated entities.
FEDERAL MANDATE ANALYSIS COMPARISON
(1) Federal statute or regulation constituting the federal mandate.
There is no federal mandate to establish the reimbursement rate or unit limits in an administrative regulation.
(2) State compliance standards.
KRS 194A.030(2) states, "The Department for Medicaid Services shall serve as the single state agency in the Commonwealth to administer Title XIX of the Federal Social Security Act."
(3) Minimum or uniform standards contained in the federal mandate.
There is no federal mandate to establish the reimbursement rate in an administrative regulation.
(4) Will this administrative regulation impose stricter requirements, or additional or different responsibilities or requirements, than those required by the federal mandate?
The administrative regulation does not impose stricter or different responsibilities than the federal requirements.
(5) Justification for the imposition of the stricter standard, or additional or different responsibilities or requirements.
The administrative regulation does not impose stricter or different responsibilities than the federal requirements.