Title 907 | Chapter 013 | Regulation 015
PREVIOUS VERSION
The previous document that this document is based upon is available.
907 KAR 13:015.Private duty nursing service or supply reimbursement provisions and requirements.
Section 1.
General Requirements. For the department to reimburse for a private duty nursing service or supply under this administrative regulation, the:(1)
Provider shall meet the provider requirements established in 907 KAR 13:010; and(2)
The service or supply shall meet the coverage and related requirements established in 907 KAR 13:010.Section 2.
Reimbursement. The department shall:(1)
Reimburse for private duty nursing services at a specific rate that is established pursuant to the current fee schedule utilized by the department and authorized by state and federal law. As appropriate, billing and reimbursement information shall be included in the Medicaid Physician Fee Schedule established in 907 KAR 3:010, available at https://www.chfs.ky.gov/agencies/dms/Pages/feesrates.aspx, per fifteen (15) minutes, which shall constitute one (1) unit;(2)
Not reimburse for more than:(a)
Ninety-six (96) units per recipient per twenty-four (24) hour period; or(b)
35,040 units per twelve (12) consecutive month period per recipient; and(3)
Reimburse for supplies as established on the Private Duty Nursing Supplies Fee Schedule posted at https://www.chfs.ky.gov/agencies/dms/Pages/feesrates.aspx.Section 3.
Not Applicable to Managed Care Organizations. A managed care organization shall not be required to reimburse the same amount as established in this administrative regulation for a service or supply covered pursuant to 907 KAR 13:010 and this administrative regulation.Section 4.
Federal Approval and Federal Financial Participation. The department's reimbursement for services or supplies pursuant to this administrative regulation shall be contingent upon:(1)
Receipt of federal financial participation for the reimbursement; and(2)
Centers for Medicare and Medicaid Services' approval for the reimbursement.Section 5.
Appeal Rights.(1)
An appeal of a negative action regarding a Medicaid recipient shall be in accordance with 907 KAR 1:563.(2)
An appeal of a negative action regarding Medicaid eligibility of an individual shall be in accordance with 907 KAR 1:560.(3)
An appeal of a negative action regarding a Medicaid provider shall be in accordance with 907 KAR 1:671..HISTORY: (40 Ky.R. 2062; 2777; eff. 7-7-2014; Cert eff. 12-6-2019; 50 Ky.R. 1795; eff. 6-18-2024.)
LISA D. LEE, Commissioner
ERIC C. FRIEDLANDER, Secretary
APPROVED BY AGENCY: January 5, 2024
FILED WITH LRC: January 11, 2024 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; 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' reimbursement provisions and 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' reimbursement provisions and 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' reimbursement provisions and 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' reimbursement provisions and 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 implements an increased rate for the reimbursement for private duty nursing services, with a specific rate to be set in the current fee schedule. The regulation also increases the number of units that can be reimbursed per twelve month period from 8,000 to 35,040.
(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 this administrative regulation 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 the additional clarity provided by the amendments included in 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.
907 KAR 13:015.Private duty nursing service or supply reimbursement provisions and requirements.
Section 1.
General Requirements. For the department to reimburse for a private duty nursing service or supply under this administrative regulation, the:(1)
Provider shall meet the provider requirements established in 907 KAR 13:010; and(2)
The service or supply shall meet the coverage and related requirements established in 907 KAR 13:010.Section 2.
Reimbursement. The department shall:(1)
Reimburse for private duty nursing services at a specific rate that is established pursuant to the current fee schedule utilized by the department and authorized by state and federal law. As appropriate, billing and reimbursement information shall be included in the Medicaid Physician Fee Schedule established in 907 KAR 3:010, available at https://www.chfs.ky.gov/agencies/dms/Pages/feesrates.aspx,(2)
Not reimburse for more than:(a)
Ninety-six (96) units per recipient per twenty-four (24) hour period; or(b)
35,040(3)
Reimburse for supplies as established on the Private Duty Nursing Supplies Fee Schedule posted at https://www.chfs.ky.gov/agencies/dms/Pages/feesrates.aspx.Section 3.
Not Applicable to Managed Care Organizations. A managed care organization shall not be required to reimburse the same amount as established in this administrative regulation for a service or supply covered pursuant to 907 KAR 13:010 and this administrative regulation.Section 4.
Federal Approval and Federal Financial Participation. The department's reimbursement for services or supplies pursuant to this administrative regulation shall be contingent upon:(1)
Receipt of federal financial participation for the reimbursement; and(2)
Centers for Medicare and Medicaid Services' approval for the reimbursement.Section 5.
Appeal Rights.(1)
An appeal of a negative action regarding a Medicaid recipient shall be in accordance with 907 KAR 1:563.(2)
An appeal of a negative action regarding Medicaid eligibility of an individual shall be in accordance with 907 KAR 1:560.(3)
An appeal of a negative action regarding a Medicaid provider shall be in accordance with 907 KAR 1:671.Section 6.
(1)
(2)
(a)
(b)
HISTORY: (40 Ky.R. 2062; 2777; eff. 7-7-2014; Cert eff. 12-6-2019; 50 Ky.R. 1795; eff. 6-18-2024.)
LISA D. LEE, Commissioner
ERIC C. FRIEDLANDER, Secretary
APPROVED BY AGENCY: January 5, 2024
FILED WITH LRC: January 11, 2024 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; 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' reimbursement provisions and 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' reimbursement provisions and 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' reimbursement provisions and 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' reimbursement provisions and 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 implements an increased rate for the reimbursement for private duty nursing services, with a specific rate to be set in the current fee schedule. The regulation also increases the number of units that can be reimbursed per twelve month period from 8,000 to 35,040.
(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 this administrative regulation 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 the additional clarity provided by the amendments included in 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.