Title XVII, Economic Security and Public Welfare
31 chapters · 957 sections in this title.
KRS § 205.5622 Kentucky Pharmaceutical Assistance Program -- Contingency for establishment -- Purpose -- Eligibility -- Enrollment priority
2.1K chars
establishment -- Purpose -- Eligibility -- Enrollment priority. (1) The Kentucky Pharmaceutical Assistance Program may be established, contingent upon approval from the Centers for Medicare and Medicaid Services. (2) If established, the program shall be administered by the depart…
KRS § 205.5623 Department's powers in providing program benefits
1.1K chars
(1) In providing program benefits, the department may: (a) Enter into a contract with one (1) or more prescription drug plans to coordinate the prescription benefits of the program and the federal law; (b) Preliminarily enroll beneficiaries into a preferred Medicare Part D plan, …
KRS § 205.5624 Payment of benefits -- Limitations -- Qualification for coverage
1.0K chars
(1) Benefits provided under the program shall be limited to the amount of appropriations. (2) The program shall be the payor of last resort. The program shall cover costs for participants that are not covered by the Medicare Part D program. (3) Except for dual eligibles during th…
KRS § 205.5625 Residency standards
0.8K chars
(1) A resident in the program shall be a person who has lived within this state for at least ninety (90) consecutive days immediately preceding the date that the person's application to participate in the program is received by the department. The applicant shall have or intend t…
KRS § 205.5631 Definitions for KRS 205.5631 to 205.5639
0.9K chars
(1) As used in KRS 205.5631 to 205.5639, "commissioner" means the commissioner of the Department for Medicaid Services. (2) As used in KRS 205.5632, "new drug" means a drug that is approved for marketing by the Federal Food and Drug Administration under a product licensing applic…
KRS § 205.5632 Prior authorization requirements -- Administrative regulations
1.1K chars
(1) Upon initial coverage by the Kentucky Medicaid program, a new drug shall be exempt from prior authorization unless: (a) There has been a review of the drug and recommendation regarding prior authorization by the Pharmacy and Therapeutics Advisory Committee as provided under K…
KRS § 205.5634 Coordination of use of utilization data -- Identification of appropriate use of pharmaceuticals -- Determination of need for educational intervention
0.7K chars
of pharmaceuticals -- Determination of need for educational intervention. (1) The Drug Management Review Advisory Board shall coordinate the use of utilization data to identify appropriate use of pharmaceuticals and determine any need for educational interventions. Prospective dr…
KRS § 205.5636 Drug Management Review Advisory Board -- Membership -- Officers -- Meetings
4.5K chars
Meetings. (1) A Drug Management Review Advisory Board is hereby established and attached to the Cabinet for Health and Family Services for administrative purposes. The board shall consist of sixteen (16) members to be appointed by the secretary of the Cabinet for Health and Famil…
KRS § 205.5638 Duties and responsibilities of board
3.8K chars
(1) The Drug Management Review Advisory Board shall have at least the following duties and responsibilities: (a) Review and make recommendations to the commissioner or designee on predetermined prospective drug use review standards submitted to the board by the Department for Med…
KRS § 205.5639 Effect of board recommendations -- Written exceptions -- Final decision -- Appeal
1.7K chars
- Appeal. (1) Any recommendation by the board is advisory to the commissioner. (2) Any interested party may request an opportunity to make a presentation or argument to the board on any item under consideration by the board. The Cabinet for Health and Family Services shall, by ad…
KRS § 205.564 Pharmacy and Therapeutics Advisory Committee -- Membership -- Duties -- Information posted on Web site -- Recommendations -- Presentations by interested parties -- Appeals -- Administrative regulations
5.9K chars
-- Information posted on Web site -- Recommendations -- Presentations by interested parties -- Appeals -- Administrative regulations. (1) The Pharmacy and Therapeutics Advisory Committee is established and attached to the Department for Medicaid Services for administrative purpos…
KRS § 205.5641 Prior authorization not required for medication-assisted therapies in pilot project -- No restrictions on participating pharmacies and pharmacists
0.7K chars
project -- No restrictions on participating pharmacies and pharmacists. (1) A prior authorization shall not be required for noncontrolled medication-assisted therapies for community pharmacies as part of the pilot project established in KRS 194A.800. (2) A pharmacy or pharmacist …
KRS § 205.565 Cabinet to recognize unique costs of pediatric teaching hospital
0.7K chars
(1) For the purposes of this section, a "pediatric teaching hospital" is defined as an acute-care hospital as licensed under KRS Chapter 216B and which has designated and operates no less than one hundred fifty (150) beds for pediatric services and which is either operated by one…
KRS § 205.566 Electronic medical record database
1.3K chars
(1) (a) To the extent allowable by federal law, any Medicaid-participating health care provider who provides services to any medical assistance recipient may, at the discretion of the health care provider, maintain in an electronic medical record database the medical record for e…
KRS § 205.585 Review of services and treatment for sickle cell disease -- Annual report -- Short title
1.5K chars
Short title. (1) The cabinet shall conduct an annual review of all medications, services, and forms of treatment for enrollees with a diagnosis of sickle cell disease that are eligible for coverage under the Kentucky medical assistance program. The purpose of the annual review sh…
KRS § 205.590 Technical advisory committees
8.2K chars
(1) The following technical advisory committees shall be established for the purpose of acting in an advisory capacity to the Advisory Council for Medical Assistance with respect to the administration of the medical assistance program and in performing the function of peer review…
KRS § 205.591 "Fair market value" of applicant's property if used to determine eligibility
0.6K chars
eligibility. If the Department for Medicaid Services considers the fair market value of an applicant's property for purposes of determining eligibility, "fair market value" means: (1) An estimate of the value of an asset if sold at the prevailing price at the time it was actually…
KRS § 205.592 Eligibility of pregnant women, new mothers, and children up to age 1 to participate in Kentucky Medical Assistance Program
0.8K chars
participate in Kentucky Medical Assistance Program. (1) Except as provided in subsection (2) of this section, pregnant women, new mothers up to twelve (12) months postpartum, and children up to age one (1) shall be eligible for participation in the Kentucky Medical Assistance Pro…
KRS § 205.593 Prohibition against health insurer's considering individual's eligibility for or receipt of medical assistance in enrollment or payment of benefits -- Application of claims payment requirements to Medicaid services
0.8K chars
or receipt of medical assistance in enrollment or payment of benefits -- Application of claims payment requirements to Medicaid services. (1) In enrolling an individual or making any payments for benefits to the individual or on the individual's behalf, health insurers are prohib…
KRS § 205.594 Health coverage for child under medical child support order -- Duties of health insurers
1.7K chars
health insurers. As used in KRS 205.593 to 205.598, the term "insurer" includes a group health plan, as defined in Section 607(1) of the Employment Retirement Income Security Act of 1974, a health maintenance organization, and an entity offering a health service benefit plan. (1)…
KRS § 205.595 Health coverage for child under medical child support order -- Duties of employers
1.9K chars
employers. If a parent is required by a court or administrative order to provide health coverage for a child and the parent is eligible for family health coverage through an employer doing business in the Commonwealth, the employer is required: (1) To permit the parent to enroll …
KRS § 205.596 Prohibition against health insurer's imposing requirements on state agency assigned rights of individual eligible for medical assistance that are different from those applicable to agent or assignee of other covered individual
0.5K chars
assigned rights of individual eligible for medical assistance that are different from those applicable to agent or assignee of other covered individual. Health insurers are prohibited from imposing requirements on a state agency which has been assigned the rights of an individual…
KRS § 205.597 Health coverage through insurer of noncustodial parent of child under medical child support order
0.6K chars
medical child support order. If a child has health coverage through the insurer of a noncustodial parent, the insurer is required: (1) To provide information to the custodial parent as necessary for the child to obtain benefits for the coverage; (2) To permit the custodial parent…
KRS § 205.598 Withholding of income and state tax refund of person required by court to provide cost of child's health service -- Priority of claims for child support over costs of reimbursement of child medical support
0.9K chars
provide cost of child's health service -- Priority of claims for child support over costs of reimbursement of child medical support. (1) The Cabinet for Health and Family Services shall withhold the wages, salary, or other employment income of, and require withholding amounts fro…
KRS § 205.615 Use of allowable Medicaid funding for trauma care costs
0.5K chars
It shall be a priority of the Department for Medicaid Services to use any additional funding allocated to the Medicaid program to provide annual supplemental payments to increase the percentage of cost covered by Medicaid reimbursement with the goal of covering full allowable cos…
KRS § 205.617 Expansion of Medicaid coverage for screening and treatment of breast or cervical cancer or precancerous conditions -- Short title
2.6K chars
cervical cancer or precancerous conditions -- Short title. (1) The Department for Medicaid Services shall expand Medicaid coverage to offer benefits to uninsured women who: (a) Are under age sixty-five (65); (b) Are not otherwise eligible for Medicaid; (c) Have been screened for …
KRS § 205.618 Coverage for tobacco cessation medications and services
1.9K chars
(1) Notwithstanding any provision of law to the contrary, the Department for Medicaid Services or a managed care organization contracted to provide Medicaid services shall, at a minimum, provide coverage for all United States Food and Drug Administration-approved tobacco cessatio…
KRS § 205.619 Medicaid plan amendment to permit establishing of Kentucky Long-Term Care Partnership Insurance Program
1.5K chars
Care Partnership Insurance Program. (1) By October 30, 2008, the Cabinet for Health and Family Services shall submit to the Center for Medicare and Medicaid Services an amendment to the State Medicaid Plan to permit the establishment of a Kentucky Long-Term Care Partnership Insur…
KRS § 205.621 Increased reimbursement for Medicaid
0.5K chars
(1) Reimbursement for physicians and dentists providing services to Medicaid recipients shall be increased to reflect budgeted provider profiles beginning October 1, 1990. (2) Beginning October 1, 1992, reimbursement to physicians and dentists shall be increased annually in incre…
KRS § 205.622 Billing of third party by vendor for medical services
0.2K chars
Prior to billing the Kentucky Medical Assistance Program, all participating vendors shall submit billings for medical services first to a third party when such vendor has knowledge that such third party may be liable for payment of the services.
KRS § 205.623 Information on claims paid for insurance policyholders and dependents -- Use of data -- Confidentiality of information -- Prohibited fees
1.7K chars
Use of data -- Confidentiality of information -- Prohibited fees. (1) All health insurers and administrators as defined under KRS Chapter 304 shall provide upon request to the Department for Medicaid Services, by electronic means and in the format prescribed by the department, po…
KRS § 205.624 Assignment to cabinet by recipient of rights to third-party payments -- Right of recovery by cabinet
3.3K chars
Right of recovery by cabinet. (1) An applicant or recipient shall be deemed to have made to the cabinet an assignment of his rights to third-party payments to the extent of medical assistance paid on behalf of the recipient under Title XIX of the Social Security Act. The applican…
KRS § 205.626 Time assignment becomes enforceable -- Payment to cabinet -- Attorney's fees
0.9K chars
fees. (1) The assignment provided for by KRS 205.624 shall be binding and enforceable after the third parties have actual notice of the assignment. The third party shall be discharged from liability under the assignment when it makes payment to a vendor for medical care and servi…
KRS § 205.628 Liability of recipient
0.3K chars
An applicant or recipient of medical assistance shall be liable to the Kentucky Medical Assistance Program for any payment received from a third party to the extent of medical assistance paid on the recipients' behalf under Title XIX of the Social Security Act.
KRS § 205.629 Notification of cabinet in actions seeking recovery for recipient
0.2K chars
In any action seeking to recover damages on behalf of a recipient, the cabinet shall receive notice from the recipient's attorney in the same manner as provided in KRS 411.188 (2) for notifying parties with subrogation rights.
KRS § 205.630 Prohibited activity by cabinet -- Injunctive relief
0.7K chars
(1) The cabinet is prohibited from collecting, attempting to collect, or threatening to collect moneys due from any individual person for services rendered at a cabinet facility as a means of coercing or attempting to coerce the person into removing any person for whom they are r…
KRS § 205.631 Life settlement proceeds for long-term care services not considered as resource or asset for Medicaid eligibility -- Notice of exhaustion of proceeds -- Medicaid and applied income payments to begin immediately upon exhaustion of life settlement proceeds -- Administrative regulations
2.5K chars
resource or asset for Medicaid eligibility -- Notice of exhaustion of proceeds -- Medicaid and applied income payments to begin immediately upon exhaustion of life settlement proceeds -- Administrative regulations. (1) (a) To the extent allowable under state or federal law, the p…
KRS § 205.6310 Cabinet to establish system to reduce unnecessary hospital emergency room utilization and costs
1.6K chars
room utilization and costs. The Cabinet for Health and Family Services shall establish a system within the Medical Assistance Program to reduce unnecessary hospital emergency room utilization and costs by redefining and controlling hospital emergency utilization. The cabinet shal…
KRS § 205.6311 Substance use disorder treatment benefit -- Administrative regulations -- Contracts with Medicaid managed care organizations -- Annual report
1.8K chars
Contracts with Medicaid managed care organizations -- Annual report. (1) The Department for Medicaid Services shall provide a substance use disorder benefit consistent with federal laws and regulations which shall include a broad array of treatment options for those with heroin a…
KRS § 205.6312 Cost-sharing requirements
2.2K chars
(1) The Department for Medicaid Services and each managed care organization contracted by the department to provide Medicaid services pursuant to this chapter shall establish cost-sharing requirements for Medicaid enrollees in accordance with this section. (2) Unless otherwise re…
KRS § 205.6313 Medicaid reimbursement for primary care practitioners at community mental health centers
1.3K chars
mental health centers. (1) For the purposes of this section: (a) "Advanced practice registered nurse" has the same meaning as in KRS 314.011; (b) "Physician" has the same meaning as in KRS 311.550; and (c) "Physician assistant" has the same meaning as in KRS 311.840. (2) The Cabi…
KRS § 205.6314 Review of reimbursement rates for emergency transportation providers -- Promulgation of administrative regulations relating to emergency transportation providers
1.2K chars
Promulgation of administrative regulations relating to emergency transportation providers. The Cabinet for Health and Family Services shall review the Medical Assistance Program reimbursement rates for emergency transportation providers to determine if existing rates are fair and…
KRS § 205.6315 Requirements when private peer review organization is contracted with to conduct reviews of levels of care
4.9K chars
to conduct reviews of levels of care. When the cabinet contracts with any private peer review organization to conduct utilization reviews of the levels of care of the state's Medicaid program recipients, the following shall apply: (1) In determining the appropriate level of care …
KRS § 205.6316 Review of procedures for medical assistance reimbursement of pharmacists to reduce fraud and abuse -- Dispensing fee
1.0K chars
pharmacists to reduce fraud and abuse -- Dispensing fee. The Cabinet for Health and Family Services shall review the procedures for medical assistance reimbursement of pharmacists to reduce fraud and abuse. The cabinet shall by promulgation of administrative regulation, pursuant …
KRS § 205.6317 Department for Medicaid Services to develop strategies for reimbursing and paying persons participating in the Supports for Community Living Waiver Program -- Allocation of slots -- Administrative regulations -- Funding
2.0K chars
and paying persons participating in the Supports for Community Living Waiver Program -- Allocation of slots -- Administrative regulations -- Funding. (1) As used in this section: (a) "Supports for Community Living Waiver Program" means funding from the Department for Medicaid Ser…
KRS § 205.63171 Short title for KRS 205.6317
0.1K chars
KRS 205.6317 may be cited as the Kevin Webb and Kim Brown Self-Determination Act.
KRS § 205.6318 Cabinet to establish integrated system to enhance program integrity of Medical Assistance Program
2.5K chars
Medical Assistance Program. The Cabinet for Health and Family Services shall review the available technology associated with the medical assistance system to determine which technology is best suited to enhance program service operation, monitoring ability, and fraud and abuse de…
KRS § 205.632 Pilot project to create coverage provisions and reimbursement criteria for telemonitoring services based on evidence-based best practices provided by a qualified medical provider or community action agency
2.0K chars
telemonitoring services based on evidence-based best practices provided by a qualified medical provider or community action agency. (1) As used in this section: (a) "Department" means the Department for Medicaid Services; (b) "Evidence-based best practices" means the integration …
KRS § 205.6320 Cabinet to strengthen managed care component of KenPAC Program and to establish standards for access and quality for organizations serving Medicaid recipients
3.2K chars
to establish standards for access and quality for organizations serving Medicaid recipients. (1) The Cabinet for Health and Family Services shall seek to strengthen the managed care component of the KenPAC Program. The cabinet shall by promulgation of administrative regulation, p…
KRS § 205.6322 Cabinet to seek to prohibit sheltering of assets in long-term-care cases
1.1K chars
The Cabinet for Health and Family Services shall seek to prohibit the sheltering of assets in medical assistance long-term-care cases by promulgation of administrative regulations, pursuant to KRS Chapter 13A, that establish the following: (1) Consideration of assets placed in Me…