MEDICAID SERVICES COVERED AND NOT COVERED BY THE CONTRACTOR. The Contractor must provide Covered Services under current administrative regulations. The scope of services may be expanded with approval of the Department and as necessary to comply with federal mandates and state laws. Certain Medicaid services are currently excluded from the Contractor benefits package, but continue to be covered through the traditional fee-for-service Medicaid Program. The Contractor will be expected to be familiar with these Contractor excluded services, designated Medicaid “wrap-around” services and to coordinate with the Department’s providers in the delivery of these services to Members. Information relating to these excluded services’ programs may be accessed by the Contractor from the Department to aid in the coordination of the services.
MEDICAID SERVICES COVERED AND NOT COVERED BY THE CONTRACTOR. The Contractor must provide Covered Services under current administrative regulations. The scope of services may be expanded with approval of the Department and as necessary to comply with federal mandates and state laws. Certain Medicaid services are currently excluded from the Contractor benefits package, but continue to be covered through the traditional fee-for-service Medicaid Program. The Contractor will be expected to be familiar with these Contractor excluded services, designated Medicaid “wrap-around” services and to coordinate with the Department’s providers in the delivery of these services to Members. Information relating to these excluded services’ programs may be accessed by the Contractor from the Department to aid in the coordination of the services.
A. Health Services Not Covered Under Kentucky Medicaid Under federal law, Medicaid does not receive federal matching funds for certain services. Some of these excluded services are optional services that the Department may or may not elect to cover. The Contractor is not required to cover services that Kentucky Medicaid has elected not to cover for Members. Following are services currently not covered by the Kentucky Medicaid Program: • Any laboratory service performed by a provider without current certification in accordance with the Clinical Laboratory Improvement Amendment (CLIA). This requirement applies to all facilities and individual providers of any laboratory service; • Cosmetic procedures or services performed solely to improve appearance; • Hysterectomy procedures, if performed for hygienic reasons or for sterilization only; • Medical or surgical treatment of infertility (e.g., the reversal of sterilization, invitro fertilization, etc.); • Induced abortion and miscarriage performed out-of-compliance with federal and Kentucky laws and judicial opinions; • Paternity testing; • Personal service or comfort items; • Post mortem services; • Services, including but not limited to drugs, that are investigational, mainly for research purposes or experimental in nature; • Sex transformation services; • Sterilization of a mentally incompetent or institutionalized member; • Services provided in countries other than the United States, unless approved by the Secretary of the Kentucky Cabinet for Health and Family Services; • Services or supplies in excess of limitations or maximums set forth in federal or state laws, judicial opinions and Kentucky Medicaid program regulations referenced herein; • ...
