Section 1135 Waiver Flexibilities
Department of Health & Human ServicesCenters for Medicare & Medicaid Services7500 Security Boulevard, Mail Stop S2-26-12Baltimore, Maryland 21244-1850
Kentucky Department for Medicaid Services275 East Main, 6W-A
Re: Section 1135 Flexibilities Requested in March 19, 2020 Communication
Dear Commissioner Lee:
Your communication to CMS on March 19, 2020, detai1ed a number of federal Medicaid, the Childrens Health Insurance Program , and Medicare requirements that pose issues or challenges for the health care delivery system in all counties in KY and requested a waiver or modification of those requirements. Attached, please find a response to your requests for waivers or modifications, pursuant to section 1135 of the Social Security Act, to address the challenges posed by COVID-19. This approval addresses those requests related to Medicaid, Medicare and CHIP, as applicable.
To streamline the section 1135 waiver request and approval process, CMS has issued a number of blanket waivers for many Medicare provisions, which primarily affect requirements for individual facilities, such as hospitals, long term care facilities, home health agencies, and so on. Waiver or modification of these provisions does not require individualized approval, and, therefore, these authorities are not addressed in this letter. Please refer to the current blanket waiver issued by CMS.
Sincerely,
APPROVAL OF FEDERAL SECTION 1135 WAIVER REQUESTS
CMS Response: March 25, 2020
Provider Enrollment
Why Choose Humana Healthy Horizons
We designed Humana Healthy Horizons to provide you with the care and support you needso you have more time to focus on what you love. Now more than ever, your health and healthcare coverage are important. Humana Healthy Horizons makes available to Kentucky Medicaid enrollees access to the high-quality healthcare coverage, opens new window you want and extras you need.
We have easy ways for you to find a doctor or a specialist. We can send your medicines to your home, so you dont have to go to a pharmacy. And along with your medical care, you get:
Humana is proud of our strong relationship with Kentucky Medicaid. Were focused on helping you make the most of your plan so you can focus on what matters most.
Here are some things you should know about Medicaid enrollment in Kentucky:
Reasons Why Kentuckians Are Disenrolled From Medicaid
The Kentucky Department of Medicaid Services removes thousands of people from Medicaid coverage each month for dozens of reasons. The most common reasons are that Kentuckians incomes are higher than the limit or that they failed to provide information when the agency requested it.
It is possible many of those who lose Medicaid coverage for any number of reasons regain it later in the same month, or in the coming months. This is known as churn.
Recently, because the Families First Coronavirus Response Act required states to cease most disenrollments in order to receive more federal funding, the number of Kentuckians who lose coverage each month has dramatically fallen.
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About Humana Healthy Horizons In Kentucky
Humana Healthy Horizons® in Kentucky is more than a health plan. We are committed to providing what you need to give our enrollees the best care possible. Humana Healthy Horizons features great medical benefits and more, including our Go365 for Humana Healthy Horizons rewards program, expanded vision services and childcare assistance, and helpful digital tools will help enrollees better manage their health.
Humana contracted with the Kentucky Cabinet for Health and Family Services to provide services to Medicaid enrollees through Humana Healthy Horizons. Medicaid provides healthcare coverage for income-eligible children, seniors, disabled adults, pregnant women, and other eligible adults. It is funded by both the state and federal governments.
Humana medical coverage policies are available on . Humana uses nationally recognized medical necessity guidelines . Criteria are readily available for review by the Kentucky Department for Medicaid Services , practitioners, the public, or enrollees on request at no cost. MCG guidelines are available either verbally or in writing for Kentucky DMS, practitioners, the public, or enrollees on request. For providers and practitioners, the process to obtain criteria is communicated annually in the provider newsletter and in the provider manual.
Do You Want To Join The Aetna Better Health Of Kentucky Network
Here is how it works:
Step 1
To join our network, you must first be enrolled in Kentucky Medicaid. To enroll in Kentucky Medicaid, please go to the Medicaid Provider Portal Application .
Step 2
Providers who are not participating need to request a contract by completing the provider nomination form. Once completed please return to .
Step 3
Once the nomination form is received and reviewed, someone from the contracting team will send you a contract and credentialing packet. Please complete and return the both via the instructions.
Step 4
While the contract is being reviewed, the credentialing information is forwarded to our Credentialing Verification Organization Aperture Health. Aperture Health is responsible for direct credentialing for our network of providers.
**Independent Physician Practice Associations and Hospital Organizations that currently have a delegated credentialing agreement are excluded from this process. For complete information about the credentialing process and other requirements for participation, you can download our provider manual .
Step 5
Once credentialing is completed, your contract will be finalized, and you will receive your welcome materials from your assigned Network Manager.
If you need more information about our application and credentialing process, email or see Credentialing links below.
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Medicaid Enrollment By Race And Eligibility
Kentucky, like all states, has a long history of economic, political and social barriers to race equity including health coverage. Even policies that have been repealed continue to reverberate in society today. Because of this, Kentuckians of color are disproportionately like to work in jobs that pay too little and therefore more likely to qualify for Medicaid. Statewide, 13.3% of Kentuckians report as a race other than white.
Percent of Medicaid enrollees who reported race other than white April 2021
Start The Contracting Process
Fill out the New Health Partner Contract Form to get started.
If you offer medical services and want more information about becoming a participating provider, please submit the New Health Partner Contract Form.
Your Application Status
Once you submit your application, you will receive a confirmation email. Please save this email, as it will contain your Application ID.
You can check your application status on the Provider Portal. You will need to enter your NPI and Application ID to view your status.
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Medicaid Enrollment By Eligibility Type
Medicaid enrollment in Kentucky had been generally declining since the beginning of 2018 after reaching a high-point of over 1.4 million.
Since February, however, enrollment has risen as the COVID-19 related economic downturn has meant more people are turning to Medicaid for health coverage.
Note: Beginning in July, 2020 certain children ages 6 to 18 are counted under the Kentucky Childrens Health Insurance Program rather than Medicaid. For other monthly Medicaid statistics, visit .
Total Medicaid enrollment April 2021
Special Temporary Medicaid Coverage
In response to the COVID-19 pandemic and subsequent downturn that led to hundreds of thousands of Kentuckians losing their jobs, and often their health coverage, Kentucky received permission from the federal government to provide Medicaid on a temporary basis to anyone who is uninsured and under 65 years old. This type of coverage is called presumptive eligibility a form of which was already in place for low-income, uninsured patients who signed up for it when they had to got to the hospital.
This graph shows both regular hospital PE and the special COVID-19 PE.
Current
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Why Our Network
Well work with you to understand your business and meet your needs no matter what services you offer or where you offer them. When you take part in our strong provider network, you benefit from:
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Ongoing support and learning opportunities
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Timely and efficient claims processing
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Advanced technology to help enhance patient care
