907 Ky. Admin. Regs. 1:270

Current through Register Vol. 51, No. 6, December 1, 2024

Section 907 KAR 1:270 - Podiatry program services

RELATES TO: KRS 205.520, 205.560, 42 C.F.R. 440.60, 42 U.S.C. 1396a, b, d

NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and Family Services, Department for Medicaid Services, has responsibility to administer the Medicaid Program. KRS 205.520(3) authorizes the cabinet, by administrative regulation, to comply with a requirement that may be imposed or opportunity presented by federal law to qualify for Medicaid funds. This administrative regulation establishes the coverage provisions relating to podiatry services for which payment shall be made by the Medicaid Program on behalf of both categorically needy and medically needy beneficiaries.

Section 1. Coverage. The Medicaid program shall cover a medical or surgical service provided to an eligible Medicaid recipient by a licensed, participating podiatrist if the service falls within the scope of the practice of podiatry except as provided in Section 2 of this administrative regulation.

Section 2. Exclusions From Coverage.

(1) Except as provided in Section 3 of this administrative regulation, routine foot care shall not be covered by the Medicaid program.

(2) Routine foot care excluded by this section shall include:

(a) The cutting or removal of a corn or callus;

(b) The trimming of a nail; or

(c) Other hygienic or preventive maintenance care in the realm of self-care including:

1. Cleaning or soaking a foot;

2. The use of a skin cream to maintain skin tone of an ambulatory or bedfast patient; or

3. A service performed in the absence of localized illness, injury, or symptom involving the foot.

Section 3. Covered Services.

(1)

(a) Payment shall be made for routine foot care if:

1. The patient has a systematic disease of sufficient severity such as arteriosclerosis, chronic thrombophlebitis, diabetes, or a peripheral neuropathy;

2. Unskilled performance of a procedure included in paragraph (b) of this subsection would be hazardous; and

3. The patient's condition results from:

a. Severe circulatory embarrassment; or

b. An area of desensitization in a leg or foot.

(b) Routine foot care covered under this subsection shall include the cutting or removing of a:

1. Corn;

2. Callus; or

3. Nail.

(2) A service ordinarily considered routine shall be covered if the service is performed as a necessary and integral part of an otherwise covered service, including the diagnosis or treatment of:

(a) A diabetic ulcer;

(b) A wound; or

(c) An infection.

(3) A diagnostic or treatment service for a foot infection shall be covered.

907 KAR 1:270

Recodified from 904 KAR 1:270, 5-2-1986; 18 Ky.R. 1647; eff. 1-10-1992; 23 Ky.R. 4241; 24 Ky.R. 385; eff. 7-16-1997; 45 Ky.R. 2212, 2684; eff. 4-5-2019.

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