205.6311 Substance use disorder treatment benefit -- Administrative regulations --
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/ky/205-6311A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Contracts with Medicaid managed care organizations -- Annual report.
(1)The Department for Medicaid Services shall provide a substance use disorder
benefit consistent with federal laws and regulations which shall include a broad
array of treatment options for those with heroin and other substance use disorders.
(2)The department shall promulgate administrative regulations to implement this
section and to expand the behavioral health network to allow providers to provide
services within their licensure category.
(3)Providers of peer-mediated, recovery-oriented, therapeutic community models of
care shall have the opportunity to contract with managed care organizations to be
reimbursed for any portion of those services that are provided by licensed or
certified providers in accordance with approved billing codes.
(4)A Medicaid managed care organization shall:
(a)Authorize treatment for each diagnosis related to substance use disorder and
co-occurring mental health and substance use disorder covered by Medicaid
that is identified within the most updated edition of the Diagnostic and
Statistical Manual of Mental Disorders issued by the American Psychiatric
Association that meets the criteria for medical necessity and level of care; and
(b)Approve coverage and payment for continuing care at the appropriate level of
care.
(5)Beginning January 1, 2016, the Department for Medicaid Services shall provide an
annual report to the Legislative Research Commission detailing the number of
providers of substance use disorder treatment, the type of services offered by each
provider, the geographic distribution of providers, and a summary of expenditures
on substance use disorder treatment services provided by Medicaid.