2014 Kentucky Revised Statutes CHAPTER 205 - PUBLIC ASSISTANCE AND MEDICAL ASSISTANCE 205.634 Payments prohibited to out-of-state health facility providing services without required certificate of need -- Nonreimbursement of out-of-state providers of residential care for children -- Exception -- Administrative regulations.
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205.634 Payments prohibited to out-of-state health facility providing services
without required certificate of need -- Nonreimbursement of out-of-state
providers of residential care for children -- Exception -- Administrative
regulations.
(1)
(2)
(3)
(4)
No medical assistance payments shall be made under this chapter to any
out-of-state health facility or health service providing services within the
geographic boundaries of the Commonwealth who does not have a certificate
of need if the health facility or health service would be required to obtain a
certificate of need under KRS Chapter 216B if the facility or service were
located within the geographic boundaries of the Commonwealth.
The Department for Medicaid Services and the Department for Community
Based Services shall not reimburse an out-of-state provider of residential care
for children whose care is paid by state general funds or state administered
federal funds, unless the Department for Medicaid Services or the Department
for Community Based Services or a designated agent thereof has determined
that there is no provider within the Commonwealth that is capable and willing to
provide comparable services at a comparable cost per child to those that would
be delivered by the out-of-state provider. An exception may be made if:
(a) The identified in-state resource is farther away from the child's parent or
guardian than a similar out-of-state resource; or
(b) The services offered by the out-of-state resource is deemed by either
department or a designated agent thereof to be more appropriate for the
individual child than the services offered by the in-state provider.
Prior to promulgating administrative regulations governing the determination of
the availability of providers of residential care within the Commonwealth, the
Department for Medicaid Services and the Department for Community Based
Services shall establish uniform conditions, requirements, and exceptions for
the determination of the availability of providers of residential care within the
Commonwealth.
Each department shall promulgate an administrative regulation in accordance
with KRS Chapter 13A that contains the uniform conditions, requirements, and
exceptions for the determination of the availability of providers of residential
care within the Commonwealth established under subsection (3) of this section.
Effective:July 14, 2000
History: Amended 2000 Ky. Acts ch. 14, sec. 35, effective July 14, 2000. -Amended 1998 Ky. Acts ch. 527, sec. 5, effective July 15, 1998. -- Created 1996
Ky. Acts ch. 371, sec. 35, effective July 15, 1996.
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