1. The New Face of Kentucky Medicaid
FRYSC Conference July 14, 2015
Veronica Judy Cecil
Chief of Staff
Director, Division of Program Integrity
Kentucky Department for Medicaid Services

2. A long-awaited day in Medicaid…..
Our Changing World
A long-awaited day in Medicaid…..
Center for Medicare and Medicaid Services (CMS) authorized a State Plan Amendment for Kentucky:
Expanding eligibility
Expanding mental health and substance use treatment services
Expanding provider network to include individual and group providers as well as licensed organizations beyond community mental health centers
Kentucky Department for Medicaid Services

3. Elderly and Persons with Disabilities
Medicaid Expansion
Pregnant Women
Elderly and Persons with Disabilities
Children
Parents
Adults
*138% FPL = $15,856 for an individual and $26,951 for a family of three in 2013.
Kentucky Department for Medicaid Services

4. Member Enrollment
Mail in a paper application
Visit a DCBS office
Call kynect
Find a kynector
Enroll online at kynect
kyenroll.ky.gov
There are several ways for individuals to enroll in Medicaid.

5. Mandatory Benefits/Services
Cabinet for Health and Family Services

6. Benefit/Service Changes
Private Duty Nursing – Adds private duty nursing service as a new benefit, limited to 2000 hours per year.
Allergy Services – Clarifies benefit to include adults (children were already covered)
Prescription Drugs – Eliminates limit of 4 prescriptions per month
Eyeglasses – Eliminates annual dollar limit and sets a limit of one pair of eyeglasses per year, with an additional pair covered if first pair is lost or prescription changes. (Children only).
Physical, Occupational, Speech Therapy – Aligns the number of visits across eligibility groups to be 20 visits per year per therapy (combined for rehabilitative and habilitative).
Mental Health Services and Substance Use Services
Kentucky Department for Medicaid Services

7. Medicaid Expansion Population
More Screenings = Better Health
17,000 screened for colorectal cancer
26,000 received mammograms
34,000 screened for cervical cancer
46,000 screened for diabetes
13,000 received treatment for substance abuse
80,000 had preventive dental visits
Kentucky Department for Medicaid Services

8. BEHAVIORAL HEALTH SERVICES
Kentucky Department for Medicaid Services

9. Rehabilitation Services
Screening
Assessment
Psychological Testing  
Crisis Intervention
Mobile Crisis
Residential Crisis Stabilization
Day Treatment (Kids only)
Peer Support
Parent/Family Peer Support
Intensive Outpatient Program
Individual Outpatient Therapy
Group Outpatient Therapy
Family Outpatient Therapy
Collateral Outpatient Therapy (Kids only)
Partial Hospitalization
Service Planning (MH only)
Residential Services for Substance Use Disorders
Screening, Brief Intervention and Referral to Treatment (SU only)
Assertive Community Treatment (MH only)
Comprehensive Community Support Services (MH only)
Therapeutic Rehabilitation Program (MH only)
Commissioner Begley
Kentucky Department for Medicaid Services

10. Targeted Case Management
Children with Severe Emotional Disability (SED) and Adults with Severe Mental Illness (SMI)
Adolescents and Adults with Substance Use Disorders (SUD Moderate to Severe)
Adults and Children with Co-occurring Mental Health or Substance Use Disorders and Chronic or Complex Physical Health Issues (SMI, SED, or SUD and Physical Health conditions)
Commissioner Begley
Cabinet for Health and Family Services

11. NEW PROVIDER TYPES Kentucky Department for Medicaid Services
Commissioner Begley
Kentucky Department for Medicaid Services

12. Provider Network Expansion
Behavioral Health Services
Prior to January 1, 2014
After January 1, 2014
CMHC
Licensed Practitioner
Community Mental Health Center (CMHC)
Commissioner Begley
Licensed Organization
Provider Group
Kentucky Department for Medicaid Services

13. Provider Network Expansion
New individual and group provider types specific to Medicaid covered Behavioral Health Services include:
Individual Provider Types
Licensed Clinical Social Worker (LCSW)*
Licensed Psychologist (LP)*
Licensed Professional Clinical Counselor (LPCC)
Licensed Marriage and Family Therapist (LMFT)
Licensed Psychological Practitioner (LPP)
Certified Psychologists with Autonomous Functioning
Licensed Professional Art Therapist
Licensed Behavior Analyst
Group Provider Types
Behavioral Health Multi-Specialty Group (MSG)
* Previously limited to QMB
Commissioner Begley
The following provider types will no longer be limited to only being reimbursable for services provided to a Qualified Medicare Beneficiary (QMB).
Providers enrolled prior to 1/1/2014 may provide services to the entire Medicaid population effective 1/1/2014.
Kentucky Department for Medicaid Services

14. Provider Network Expansion
Providers who can perform services under supervision of a Medicaid-enrolled licensed practitioner:
Licensed Professional Counselor Associate
Marriage and Family Therapist Associate
Certified Social Worker – Master’s Level
Licensed Psychological Associate
Licensed Professional Art Therapist Associate
Licensed Assistant Behavioral Analyst
Commissioner Begley
Kentucky Department for Medicaid Services

15. Provider Network Expansion
Non-licensed professionals, including:
Targeted Case Managers
Individual, provider group and licensed organization
Community Support Associates
Licensed organization
Peer Support Specialists
Provider group and licensed organization
Certified Alcohol and Drug Counselors**
** House Bill 92
Kentucky Department for Medicaid Services

16. Provider Network Expansion
Behavioral Health Services Organization (BHSO)
New licensure category developed by CHFS Office of Inspector General to provide clinical behavioral health services.
If a BHSO provides outpatient behavioral health services to treat individuals with substance use disorders or co-occurring disorders in which substance use disorder is the primary diagnosis, the BHSO will be required to be dually licensed as an AODE.
In addition to providing outpatient behavioral health services, BHSOs may provide residential services for substance use disorders, in which case the BHSO must also be dually licensed as an AODE.
BHSO Webinar Link:
Commissioner Begley
Kentucky Department for Medicaid Services

17. Provider Network Expansion
BHSOs will be licensed to provide one or more of the following behavioral health services as described in the Medicaid State Plan:
Screening
Assessment
Psychological testing
Crisis intervention
Mobile crisis
Day treatment
Peer support
Intensive outpatient services
Individual, group, family, or collateral outpatient therapy
Service planning for mental health disorders
Screening, brief intervention and referral to treatment for substance abuse
Assertive community treatment for mental health disorders
Targeted case management
Comprehensive community support services
Residential Substance Use (with AODE licensure)
Therapeutic rehabilitation for adults with a serious mental illness or children with severe emotional disabilities.
Limited to
Licensed
Organizations
Commissioner Begley
Kentucky Department for Medicaid Services

18. Provider Network Expansion
Residential Crisis Stabilization Units
New separate licensure category developed by CHFS Office of Inspector General for residential crisis stabilization units.
Because Community Mental Health Centers and Psychiatric Residential Treatment Facilities may provide crisis stabilization under their existing licenses, CMHCs and PRTFs will not be required to obtain separate licensure as a residential crisis stabilization unit to provide the service.
Commissioner Begley
Kentucky Department for Medicaid Services

19. Provider Network Expansion
Non-Behavioral Health:
Speech Language Pathologist
Physical Therapist
Occupational Therapist
Cabinet for Health and Family Services

20. MANAGED CARE ORGANIZATIONS
MEDICAID
MANAGED CARE ORGANIZATIONS
Commissioner Begley
Kentucky Department for Medicaid Services

21. Managed Care Organizations (MCO)
Expanded in November 2011
Except for Long Term Care and Waiver Services
Currently have 5 Managed Care Organizations
Anthem
CoventryCares (Aetna)
Humana
Passport
Wellcare
Kentucky Department for Medicaid Services

22. KY Medicaid Population Total Current Medicaid Recipients
1,319,137
MCOs = 1,198,405
Fee-for-service = 117,037
Run Date 04/27/15
Kentucky Department for Medicaid Services

23. MCO OVERSIGHT Monthly Operational Meetings Reporting
Quarterly
Annual
Actions Taken in 2013 and 2014
2 Inquiry Letters
44 Letters of Concern
94 Corrective Action Plans (CAP)
Kentucky Department for Medicaid Services

24. MCO OVERSIGHT
Contract with Department of Insurance to investigate timely payment complaints
Rector and Associates – Market Conduct Survey and Financial Review
External Quality Review Organization (EQRO)
Island Peer Review Organization (IPRO)
Performance Improvement Plans (PIP)
EQRO Studies
Website for Program Quality and Outcomes
Kentucky Department for Medicaid Services

25. NON-EMERGENCY MEDICAL TRANSPORTATION
Commissioner Begley
Kentucky Department for Medicaid Services

26. Non-Emergency Medical Transportation
Medicaid contracts with the Office of Transportation Delivery (OTD) in the Transportation Cabinet to administer the Non-Emergency Medical Transportation (NEMT) benefit
OTD contracts with brokers throughout the state a list of brokers can be found at this site:
Brokers contract with individual providers
Individuals can be transported to Medicaid covered services, including services outlined in their plan of care if they are in waiver
Individuals cannot be transported to the pharmacy
Why the change in fonts?
Cabinet for Health and Family Services

27. Non-Emergency Medical Transportation
In order to receive non-emergency transportation services an individual:
Must be eligible on the date of service
Cannot have a car registered in their name or in their household
If the car is not in working order they can get a mechanic’s note
If the car is used for work related purposes only, they need to get documentation to that effect – note of work hours
Must call at least 72 hours prior to their appointment unless emergency
Must go to the closest medical provider in their area unless the service is not available in that area, then they can be transported outside of their service are (service area designated by broker regions)
Cabinet for Health and Family Services

28. Non-Emergency Medical Transportation
Individuals do not have to pay anything for the trip – not subject to copayment
Can have an escort if they need one – for example, if they are developmentally disabled and need someone to attend the appointment with them
Escorts/guardians do not have to pay for the service
Children under 14 must be accompanied by an adult
Any issues obtaining NEMT can be directed to OTD at (888) or Medicaid at (800)
Medicaid’s website:
Cabinet for Health and Family Services

29. QUESTIONS Veronica Cecil Veronica.Cecil@ky.gov
Tena
Kentucky Department for Medicaid Services