Skip to Main Content

Notice of Kentucky Medicaid Legislative Changes Impacting DME Providers

Effective June 27, 2019, WellCare of Kentucky is revising your reimbursement to comply with legislation recently enacted by the 2019 General Assembly.

In accordance with House Bill 224:

  • WellCare will pay 90% of the rate on the Department for Medicaid Services (DMS) Durable Medical Equipment (DME) Fee Schedule for a code covered by Medicare that is also listed on the DMS DME fee schedule (described in House Bill 224 as codes included in Section 1903(i)(27) of Title XIX of the Social Security Act)
  • For a manually priced item for which a manufacturer’s suggested retail price (MSRP) exists on the DMS DME fee schedule, WellCare will pay the MSRP minus 18%

Also, for a manually priced item for which no MSRP exists on the DMS DME fee schedule, WellCare will continue to pay the invoice price plus 20%.

Providers may access the Kentucky Medicaid DME fee schedule via the DMS website.

This notice complies with Section 9.9 of your provider agreement, which states:

Incorporation of Laws / Program Requirements / Accreditation Standards. All terms and conditions of this Agreement are subject to Laws, Program Requirements, and accreditation standards. Any term, condition or provision now or hereafter required to be included in the Agreement by Laws, Program Requirements, or accreditation standards shall be deemed incorporated herein and binding upon and enforceable against the Parties, regardless of whether or not the term, condition or provision is expressly stated in this
Agreement. Health Plan may amend this Agreement upon notice to Contracted Provider to comply with Laws, Program Requirements, or accreditation standards, and such amendment shall be effective upon receipt.

We appreciate your participation and commitment to serve our members. If you have questions about this notice, please contact your Provider Relations representative.