{"data":{"id":"us-ky/krs-205.6333","jurisdiction":"us-ky","citation":"KRS 205.6333","heading":"Reimbursement for in -network suppliers of durable medical equipment,","body":"prosthetics, orthotics, and supplies -- Reimbursement rate -- Timeframe for\nclaim submissions.\n(1) (a) As used in this section, \"durable medical equipment\" means equipment which:\n1. Can withstand repeated use;\n2. Is primarily and customarily used to serve a medical purpose;\n3. Generally is not useful to a person in the absence of an illness or injury;\nand\n4. Is appropriate for use in the home.\n(b) As used in this section, \"durable medical equipment\" does not include:\n1. Enteral nutrition;\n2. Eye prosthetics;\n3. Home infusion;\n4. Orthotics;\n5. Prosthetics; or\n6. Automated external defibrillators under Healthcare Common Procedure\nCodes K0606 and E0617.\n(2) The Department for Medicaid Services shall reimburse a supplier of durable\nmedical equipment, prosthetics, orthotics, and supplies at no less than ninety\npercent (90%) of the state Medicaid program durable medical equipment fee\nschedule and shall require M edicaid managed care organizations to reimburse the\nsame amount as the Department for Medicaid Services reimburses for the same\nservice or item of durable medical equipment, prosthetics, orthotics, and supplies.\nThis subsection shall apply to those healthc are codes and services included in\nSection 1903(i)(27) of Title XIX of the Social Security Act.\n(3) The department shall require Medicaid managed care organizations to reimburse\nsuppliers of durable medical equipment, prosthetics, orthotics, and supplies f or\nmanually priced items in the Medicaid program durable medical equipment fee\nschedule at the manufacturer's suggested retail price minus eighteen percent (18%)\npricing where there is a manufacturer's suggested retail price, and at invoice price\nplus twen ty percent (20%) for miscellaneous Healthcare Common Procedure\nCoding System codes where there is no manufacturer's suggested retail price.\n(4) The department shall require Medicaid managed care organizations to cover, at a\nminimum, the same Healthcare Com mon Procedure Coding System codes and the\nsame quantities of medical supplies, equipment, or services as are established on the\nKentucky Medicaid program durable medical equipment fee schedule or Kentucky\nMedicaid medical policy.\n(5) The department shall e nsure that the allowable timeframe for claim submissions by\nsuppliers of durable medical equipment, prosthetics, orthotics, and supplies shall\nequal the timeframe allowed for any discrepancy during the Medicaid managed care\norganization audit or recoupment process for that claim.\n(6) The reimbursement for suppliers of durable medical equipment established pursuant\nto this section shall only be available to a durable medical equipment supplier who\nis an in-network provider of the beneficiary's Medicaid managed care organization.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=49309","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:04Z","sha256":"ceeaae9a95936e6b90efa11947fc35eea66d05e0ecd356cf29c58366a6c23c40","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.6332","next":"us-ky/krs-205.6334"},"notice":"GroundRules: Original legal text. Not legal advice."}