Kentucky Revised Statutes Title XVII. Economic Security and Public Welfare § 205.6333.Reimbursement for in-network suppliers of durable medical equipment, prosthetics, orthotics, and supplies; reimbursement rate; timeframe for claim submissions

(2) The Department for Medicaid Services shall reimburse a supplier of durable medical equipment, prosthetics, orthotics, and supplies at no less than ninety percent (90%) of the state Medicaid program durable medical equipment fee schedule and shall require Medicaid managed care organizations to reimburse the same amount as the Department for Medicaid Services reimburses for the same service or item of durable medical equipment, prosthetics, orthotics, and supplies. This subsection shall apply to those healthcare codes and services included in Section 1903(i)(27) of Title XIX of the Social Security Act.

(3) The department shall require Medicaid managed care organizations to reimburse suppliers of durable medical equipment, prosthetics, orthotics, and supplies for manually priced items in the Medicaid program durable medical equipment fee schedule at the manufacturer's suggested retail price minus eighteen percent (18%) pricing where there is a manufacturer's suggested retail price, and at invoice price plus twenty percent (20%) for miscellaneous Healthcare Common Procedure Coding System codes where there is no manufacturer's suggested retail price.

(4) The department shall require Medicaid managed care organizations to cover, at a minimum, the same Healthcare Common Procedure Coding System codes and the same quantities of medical supplies, equipment, or services as are established on the Kentucky Medicaid program durable medical equipment fee schedule or Kentucky Medicaid medical policy.

(5) The department shall ensure that the allowable timeframe for claim submissions by suppliers of durable medical equipment, prosthetics, orthotics, and supplies shall equal the timeframe allowed for any discrepancy during the Medicaid managed care organization audit or recoupment process for that claim.

(6) The reimbursement for suppliers of durable medical equipment established pursuant to this section shall only be available to a durable medical equipment supplier who is an in-network provider of the beneficiary's Medicaid managed care organization.