205.634 Payments prohibited to out-of-state health facility providing services

337 words·~2 min read·/ky/205-634

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

without required certificate of need -- Nonreimbursement of out-of-state

providers of residential care for children -- Exception -- Administrative

regulations.

(1)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.

(2)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.

(3)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.

(4)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.