KRS § 205.527 Managing of IMPACT Plus program by Medicaid managed care organization -- Continuation of services for eligible children -- Billing -- Gaps in service and lack of access.

205.527 Managing of IMPACT Plus program by Medicaid managed care organization -- Continuation of services for eligible children -- Billing -- Gaps in service and lack of access. (1) As used in this section, "IMPACT Plus" program means the program of community-based behavioral health services provided to an eligible IMPACT Plus recipient through an agreement between the Department for Medicaid Services and the Department for Public Health as the state agency for the federal Title V Maternal and Child Health Block Grant, 42 U.S.C. secs. 701 to 710 or as authorized under subsection (3) of this section. (2) Any Medicaid managed care organization that contracts with the Department for Medicaid Services shall, to the extent possible under the Title V agreement, manage aspects of the IMPACT Plus program for its members, including but not limited to the determination of a child's eligibility for IMPACT Plus services, processing and direct payment of claims, and audits. No state agency shall duplicate any function performed by the Medicaid managed care organizations for the IMPACT Plus program. Appeals of payments shall be submitted for review to the Department for Behavioral Health, Developmental and Intellectual Disabilities. (3) Children eligible for the IMPACT Plus program may continue to receive services, if the family and provider agree, from: (a) An individual IMPACT Plus therapist if the child is relocated outside of the provider's service area; and (b) The same provider if a child is eligible for those services, but no longer eligible for IMPACT Plus services, and the provider meets the participation standards to provide services under the acquired brain injury, the Michelle P. waiver, the supports for community living, or the home and community based waiver programs. (4) IMPACT Plus providers shall bill for all IMPACT Plus services, including case management, under their IMPACT Plus provider identification. IMPACT Plus providers shall not be required to obtain a Medical Assistance Identification Number (MAID). Nothing in this section shall preclude an IMPACT Plus provider from applying for a MAID number, providing they meet all necessary criteria. (5) Medicaid managed care organizations may report documented gaps in IMPACT Plus services or lack of access to IMPACT Plus services to the Department for Behavioral Health, Developmental and Intellectual Disabilities. The Department for Behavioral Health, Developmental and Intellectual Disabilities shall verify or not verify the reported gaps. (6) If the Department for Behavioral Health, Developmental and Intellectual Disabilities verifies gaps in IMPACT Plus services or lack of access to IMPACT Plus services, IMPACT Plus providers may be utilized for additional IMPACT Plus services and additional IMPACT Plus providers may be utilized. Effective: June 25, 2013 History: Created 2013 Ky. Acts ch. 118, sec. 9, effective June 25, 2013.