By Ginger - Site Admin on Tuesday, March 03, 2020 2:53 PM

The first quarter’s payment ($37 million in gross distributions) from the new Hospital Rate Improvement Program (HRIP) is now history. KHA extends a heartfelt thanks to the Kentucky Department for Medicaid Services and their consultants for their help in bringing this program to fruition.

The process for the second quarter’s claims paid/received (from October 1 through December 31, 2019) will begin March 9 with hospital payouts expected prior to the end of the month.

If you have any questions, please contact Carl Herde at KHA (cherde@kyha.com).

By Ginger - Site Admin on Friday, November 22, 2019 2:30 PM

After months of discussions with the Cabinet for Health and Family Services (CHFS) via the KHA Medicaid Technical Advisory Committee (TAC) meetings, monthly Medicaid managed care organization (MCO) issue list meetings, individual meetings with CHFS and presentations to the Medicaid Advisory Committee (MAC), the Cabinet has made a final decision regarding sepsis.

On Wednesday, Department for Medicaid Services (DMS) Medical Director Judy Ann Theriot released a memo detailing coding and reimbursement guidelines for sepsis. CHFS will follow the CMS DRG and ICD-10 definitions of sepsis. MCOs are directed to "...base utilization management for sepsis on sepsis-2 criteria until such time that CMS adopts sepsis-3 criteria."

View the memo for more details.

By Ginger - Site Admin on Thursday, October 03, 2019 3:12 PM

Earlier today, KHA submitted comments to the Cabinet for Health and Family Services (CHFS) Department of Medicaid Services (DMS) on the proposed changes to the 340B Policy and Procedures Manual.

KHA's comments outline how the proposed changes would impose additional and substantial burdens upon Kentucky hospitals without any corresponding benefit. Kentucky hospitals are in full support of assuring program integrity and expanded access to lower cost drugs to Covered Entities and their patients; however, the proposed changes, as written, should be delayed until clarified and improved

A full copy of the comment letter is available to members on the Policy page on the Advocacy section of KHA's website, www.kyha.com.

By Ginger - Site Admin on Monday, September 23, 2019 1:37 PM
KHA was successful in achieving favorable amendments to the Medicaid telehealth regulation. The Department for Medicaid Services (DMS) has issued revisions to its proposed regulation on telehealth service coverage and reimbursement.

KHA is very pleased that the regulation maintains payment parity. DMS will pay for telehealth services at 100% of the amount payable for an in-person service. Medicaid managed care organizations (MCOs) must reimburse the same amount as the department unless the MCO and provider have negotiated a different rate. DMS made several changes to their proposed rule in response to comments from KHA and other organizations.

A copy of the revised rule is available at http://www.new-kyha.com/Portals/5/NewsDocs/907KAR3_170.pdf. The revised rule must be reviewed by two legislative committees before it becomes final and effective which should occur by early November.

...
By Ginger - Site Admin on Wednesday, September 04, 2019 1:38 PM
The Kentucky Department for Medicaid Services (DMS) has entered into 12-month MCO contracts for State Fiscal Year 2020 effective July 1, 2019, to provide health care services to Kentuckians who meet eligibility requirements for Medicaid. The contracts below have been submitted to the Centers for Medicare and Medicaid Services (CMS) for approval.

Please note, the files below are large and will take additional time to load.

Aetna

Anthem

Humana

...
By Ginger - Site Admin on Tuesday, September 03, 2019 2:26 PM

The Kentucky Department for Medicaid Services (DMS) is requesting feedback on the proposed DMS 340B Policy and Procedures Manual. The Department is extending the deadline for all feedback to October 3. The effective date of the proposed policy will be set to January 1, 2020.

Please email all feedback to jade.range@ky.gov.

By Ginger - Site Admin on Wednesday, August 28, 2019 2:17 PM
The Kentucky Medicaid Partner Portal Application (KY MPPA) is now a web-based application that streamlines the process of applying to become a new Medicaid Service Provider. KY MPPA was created for Individuals, Groups and Entities applying for a Kentucky Medicaid ID, and allows current Medicaid providers to perform maintenance, revalidation and change of ownership online.

Due to the number of boards with license renewals coming up, the Kentucky Department of Medicaid Services (DMS) wants to remind everyone that KY MPPA is open to all Provider Types. To help save time, they recommend uploading a copy of the license renewal directly into KY MPPA. This will replace the previous process of sending in a paper copy of the license renewal to DMS.

To help you become more familiar with KY MPPA and its benefits:

Register for your KY MPPA Account

You can register for your KY MPPA account...
By Ginger - Site Admin on Wednesday, August 28, 2019 2:17 PM
The Kentucky Medicaid Partner Portal Application (KY MPPA) is now a web-based application that streamlines the process of applying to become a new Medicaid Service Provider. KY MPPA was created for Individuals, Groups and Entities applying for a Kentucky Medicaid ID, and allows current Medicaid providers to perform maintenance, revalidation and change of ownership online.

Due to the number of boards with license renewals coming up, the Kentucky Department of Medicaid Services (DMS) wants to remind everyone that KY MPPA is open to all Provider Types. To help save time, they recommend uploading a copy of the license renewal directly into KY MPPA. This will replace the previous process of sending in a paper copy of the license renewal to DMS.

To help you become more familiar with KY MPPA and its benefits:

Register for your KY MPPA Account

You can register for your KY MPPA account...
By Ginger - Site Admin on Wednesday, March 20, 2019 11:01 AM
The Department for Medicaid Services (DMS) responded to the comments submitted by KHA on proposed changes to the regulation governing hospital disproportionate share distributions, and they have agreed to revise the regulation in the most critical areas as recommended by KHA .

Specifically, and most importantly, the proposed rule would have denied a hospital from receiving a final DSH payment if that hospital failed to submit an updated DSH survey. KHA took issue with this proposal since there is no statutory authority to eliminate a DSH payment so long as the hospital has submitted a DSH survey. The only statutory penalty is a reduction of 20% in the amount of the final payment if the survey is submitted late. KHA also commented that resubmission of an original DSH survey would be burdensome if there were no changes. KHA is pleased that DMS agreed to amend the regulation to (1) delete its proposal to suspend or recoup a DSH payment if a DSH survey was not updated and (2) allow a hospital...
By Ginger - Site Admin on Tuesday, June 13, 2017 7:58 AM
With the implementation of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) requires all ordering, referring and prescribing providers to be enrolled in the state Medicaid program. Further, all Attending Providers must also be enrolled in Kentucky Medicaid and be eligible on the claim's date of service.

The Department for Medicaid Services implemented new claim editing to monitor this requirement on April 1, 2017. As such, this requirement is applicable to all claims with dates of service beginning on that date and going forward. In order to allow providers time to comply with this requirement, claims with dates of service between April 1. 2017, and July 1, 2017, that do not meet this requirement will continue to be paid and providers will receive an "informational" EOB indicating that incorrect Attending Provider data has been submitted. 

Claims submitted for dates of service beginning on and after July 1, 2017, that do not comply with this...
By Ginger - Site Admin on Tuesday, May 02, 2017 7:55 AM

The Kentucky Department for Medicaid Services (DMS) will host its 2017 Spring Webinar in May. One of the topics this session will be the federally mandated Ordering Referring and Prescribing (ORP) changes.

You must register at http://www.kymmis.com/ in order to participate in this webinar. There a several scheduled workshops to accommodate all providers, and each workshop is exactly the same.

Choose a time: 

  • 10:00 a.m. (ET)
  • 3: 00 p.m. (ET)

Choose a date:

  • Monday, May 15
  • Wednesday, May 17 
  • Tuesday, May 23 
  • Tuesday, May 30 

If you have any questions regarding the webinars, contact DMS Provider Inquiry (800-807-1232).

By Ginger - Site Admin on Friday, October 14, 2016 9:23 AM
The Kentucky Department for Medicaid Services, in conjunction with Hewlett Packard Enterprise will host a 2016 Fall Webinar for Medicaid Providers on the following dates:

Monday, November 14 Wednesday, November 16 Friday, November 18 Monday, November 28 Each workshop is exactly the same and is for all provider types. There will be two sessions on each date - 10:00 a.m. or 3:00 p.m. (ET).

Attendees are encouraged to print or download the webinar materials for reference during the webinar. The materials will be available prior to the workshop at www.kymmis.com under the Provider Relations/Provider Workshop heading.

You MUST REGISTER in order to attend the workshop. Find the date and time you would like to attend at http://www.kymmis.com/workshop/default.aspx and follow the link to register....
By Ginger - Site Admin on Wednesday, January 14, 2015 1:54 PM
By a letter dated December 16, 2014, The Department for Medicaid Services (DMS) distributed preliminary reconciliation of the Wrap-around payments made to Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) for the for dates of service November 1, 2011, through June 30, 2014.  

DMS is unable to provide KHA with a list of hospitals that received the letter, therefore, yesterday KHA sent this correspondence to all Kentucky hospital chief financial officers.   

There are at least three significant problem areas in the reconciliations that DMS distributed to providers: the Coventry Claims for all practical purposes are excluded from the reconciliation, many dental-related claims are not included and Dual Eligibles are understated as a result of the Medicaid managed care organizations (MCOs) initially denying the claims instead of processing them as “Zero Pay” that would have allowed that visit to be included in the volume count.

A 30-day extension will be granted to all hospitals that make a request to DMS. Requests are to be sent to David Dennis and he will forward them to Myers and Stauffer.  E-mailed requests for an extension will be accepted.  David Dennis’ email is:  David.Dennis@ky.gov...
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