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Agency 129

Department of Health and Environment—Division of Health Care Finance

Article 5.—Provider Participation, Scope of Services, and Reimbursements for the Medicaid (Medical Assistance) Program

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129-5-118. Scope of federally qualified health center services. For purposes of this regulation, a federally qualified health center shall mean a community health center, federally qualified health center (FQHC) look-alike, or an urban Indian organization receiving funds under the Indian health care improvement act that is accepted by the centers for medicare and medicaid to furnish federally qualified health center services for participation under medicare and medicaid. An FQHC look-alike shall mean an organization that meets all of the eligibility requirements of an organization that receives a public health service (PHS) section 330 grant but does not receive grant funding. (a) The services provided by the following health care professionals shall be billable as federally qualified health center services:
(1) Physician and physician assistant pursuant to K.A.R. 129-5-88;
(2) advanced registered nurse practitioner pursuant to K.A.R. 30-5-113;
(3) dentist and dental hygienist pursuant to K.A.R. 30-5-100;
(4) licensed mental health practitioner pursuant to K.A.R. 30-5-104;
(5) clinical social worker pursuant to K.A.R. 30-5-86;
(6) visiting nurse pursuant to K.A.R. 30-5-89; and
(7) for kan be healthy nursing assessments only, registered nurse pursuant to K.A.R. 30-5-87.
(b) Covered services of federally qualified health centers shall include the following:
(1) The services and supplies furnished as an incident to the professional services provided by the health care professionals specified in subsection (a); and
(2) other ambulatory services covered under the medicaid state plan, if provided by the federally qualified health center.
(c) (1) Preventive primary services shall be furnished by or under the direct supervision of any of the following:
(A) Physician;
(B) nurse practitioner;
(C) physician assistant;
(D) nurse midwife;
(E) licensed mental health practitioner;
(F) clinical social worker; or
(G) either a member of the center's health care staff who is an employee of the center or a physician under arrangements with the center.
(2) Preventive primary services shall include only drugs and biologicals that cannot be self-administered, unless §1861(s) of the social security act provides for coverage of the drug regardless of whether the drug is self-administered.
(d) The following preventive primary services may be covered when provided by federally qualified health centers to medicaid beneficiaries:
(1) Medical social services;
(2) nutritional assessment and referral;
(3) preventive health education;
(4) children's eye and ear examinations;
(5) prenatal and postpartum care;
(6) prenatal services;
(7) well child care, including periodic screening;
(8) providing immunizations, including tetanus-diphtheria booster and influenza vaccine;
(9) voluntary family planning services;
(10) taking patient history;
(11) blood pressure measurement;
(12) weight measurement;
(13) physical examination targeted to risk;
(14) visual acuity screening;
(15) hearing screening;
(16) cholesterol screening;
(17) stool testing for occult blood;
(18) dipstick urinalysis;
(19) risk assessment and initial counseling regarding risks; and
(20) the following services, for women only:
(A) Clinical breast exam;
(B) referral for mammography; and
(C) thyroid function test.
(3) Preventive primary services shall not include group or mass information programs, health education classes, and group education activities, which may include media productions and publication and services for eyeglasses and hearing aids.
(e) "Visiting nurse" shall include a registered nurse or licensed practical nurse who provides part-time or intermittent nursing care to a patient at the beneficiary's place of residence under a written plan of treatment prepared by a physician. The place of residence shall not include a hospital or long-term care facility. This nursing care shall be covered only if there is no home health agency in the area.
(f) Federally qualified health center services provided at a location other than a federally qualified health center shall meet the following conditions:
(1) No services are provided at an inpatient hospital, outpatient hospital, or hospital emergency room.
(2) The services provided are listed in subsection (b).
(3) The services are provided to a patient of a federally qualified health center.
(4) The health professional providing the services is an employee of a federally qualified health center or under contract with a federally qualified health center and is required to seek compensation for that person's services from the federally qualified health center. (Authorized by K.S.A. 2008 Supp. 75-7403 and 75-7412; implementing K.S.A. 2008 Supp. 75-7405 and 75-7408; effective June 2, 2006; amended March 19, 2010.)
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