RELATES TO:

KRS 205.520

STATUTORY AUTHORITY:

KRS 194A.030(2), 194A.050(1), 205.520(3)

CERTIFICATION STATEMENT:

NECESSITY, FUNCTION, AND CONFORMITY:

The Cabinet for Health and Family Services, Department for Medicaid Services, has the responsibility to administer the Medicaid program. KRS 205.520(3) authorizes the cabinet, by administrative regulation, to comply with any requirement that may be imposed, or opportunity presented, by federal law to qualify for federal Medicaid funds. This administrative regulation establishes the reimbursement provisions of the RISE Program for individuals with serious mental illness or substance use disorder.

1. Section 1. General Reimbursement Requirements.

   1. (1) For the department to reimburse for a service or item, the requirements of 907 KAR Chapter 16 shall be met.
   2. (2) The department shall reimburse a participating provider for a covered service as established pursuant to the 1915(i) Fee Schedule as available at: https://www.chfs.ky.gov/agencies/dms/Pages/feesrates.aspx.

2. Section 2. Federal Approval and Federal Financial Participation. The department's reimbursement for services pursuant to this administrative regulation shall be contingent upon:

   1. (1) Receipt of federal financial participation for the reimbursement; and
   2. (2) Centers for Medicare and Medicaid Services' approval for the reimbursement.
3. Section 3. Appeals. A provider may appeal a department decision made pursuant to this administrative regulation in accordance with 907 KAR 1:671.

History

(907 KAR 016:025. 51 Ky.R. 1739, 52 Ky.R. 81; eff. 7-30-2025.)

FILED WITH LRC: June 10, 2025

CONTACT PERSON: Krista Quarles, Policy Analyst, Office of Legislative and Regulatory Affairs, 275 East Main Street 5 W-A, Frankfort, Kentucky 40621; phone 502-564-7476; fax 502-564-7091; email CHFSregs@ky.gov.