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.
