205.634 Payments prohibited to out-of-state health facility providing services without required certificate of need -- Nonreimbursement of out-of-state providers of residential care for children -- Ex - Kentucky Statutes

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Page 1 of 1 205.634 Payments prohibited to out-of-state health facility providing services 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. Effective: July 14, 2000
History: Amended 2000 Ky. Acts ch. 14, sec. 35, effective July 14, 2000. -- Amended 1998 Ky. Acts ch. 527, sec. 5, effective July 15, 1998. -- Created 1996 Ky. Acts
ch. 371, sec. 35, effective July 15, 1996.