Title XVII, Economic Security and Public Welfare

(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…

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…

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…

(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…

- 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…

-- 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…

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 …

(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…

(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…

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…

(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…

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…

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…

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…

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)…

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 …

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…

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…

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…

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…

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 …

(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…

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…

(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…

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.

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…

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…

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…

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.

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.

(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…

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…

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…

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…

(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…

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…

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…

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 …

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 …

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 205.6317 may be cited as the Kevin Webb and Kim Brown Self-Determination Act.

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…

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 …

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…

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…

The Cabinet for Health and Family Services shall by promulgation of administrative regulations enhance third-party resource collection capacity in Medicaid cases through utilization of in-house personnel and selective contracting for high-volume or high- technological services.