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.
On April 30, KHA submitted comments to the Kentucky Office of Legal Services regarding 907 KAR 10:830 on the proposed diagnosis-related group (DRG) reimbursement methodology for the Medicaid fee-for-service population. The Association's comments addressed a long-standing concern and request by the Medicaid Hospital Technical Advisory Committee (TAC) for providing a transition period to new rates and retaining the existing rate appeal process. KHA also requested changes to maintain budget neutrality in updating rates and clarification on several other aspects of the proposed new methodology.
A copy of the comments is available on the Policy page of the Members Only section of www.kyha.com.
If you have any questions, please contact Nancy Galvagni at KHA (502-426-6220 or 800-945-4542 or via email at firstname.lastname@example.org).
Post Office Box 436629
Louisville, Kentucky 40253-6629