Title XVII, Economic Security and Public Welfare
31 chapters · 957 sections in this title.
KRS § 205.6324 Cabinet to enhance third-party resource collection capacity
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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.
KRS § 205.6326 Review of Medicaid reimbursement systems -- Implementation of a standardized patient assessment tool and consistent quality-of-care mandates
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standardized patient assessment tool and consistent quality-of-care mandates. The Cabinet for Health and Family Services shall review all medical assistance reimbursement systems for appropriateness and cost-effectiveness. The review shall include: (1) Review of cost-based reimbu…
KRS § 205.6328 Medicaid managed care contracts after March 27, 2025, to include provision for collection of expenditure data -- Quarterly budget analysis report required -- Applicability of Open Records Act -- Quarterly reports from managed care companies to department -- Quarterly enrollee demographics report -- Quarterly health care provider tax and assessment report
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provision for collection of expenditure data -- Quarterly budget analysis report required -- Applicability of Open Records Act -- Quarterly reports from managed care companies to department -- Quarterly enrollee demographics report -- Quarterly health care provider tax and assess…
KRS § 205.6332 System for monitoring use of covered services using appropriate technology and identification card
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technology and identification card. The Department for Medicaid Services shall develop and implement a system for monitoring the use of Medical Assistance Program covered services by medical assistance recipients using appropriate technology in conjunction with an identification …
KRS § 205.6333 Reimbursement for in-network suppliers of durable medical equipment, prosthetics, orthotics, and supplies -- Reimbursement rate -- Timeframe for claim submissions
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prosthetics, orthotics, and supplies -- Reimbursement rate -- Timeframe for claim submissions. (1) (a) As used in this section, "durable medical equipment" means equipment which: 1. Can withstand repeated use; 2. Is primarily and customarily used to serve a medical purpose; 3. Ge…
KRS § 205.6334 Request for necessary waivers of federal law
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The Cabinet for Health and Family Services shall request any waivers of federal law that are necessary to implement the provisions of KRS 205.6310 to 205.6332.
KRS § 205.6338 Implementation of pilot projects to provide health care to frail elderly Medicaid-eligible individuals
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Medicaid-eligible individuals. (1) Within one (1) year of obtaining necessary waivers from the Federal Health Care Financing Administration, the Secretary of the Cabinet for Health Services shall take all necessary steps to implement from one (1) to three (3) pilot projects to pr…
KRS § 205.634 Payments prohibited to out-of-state health facility providing services without required certificate of need -- Nonreimbursement of out-of-state providers of residential care for children -- Exception -- Administrative regulations
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without required certificate of need -- Nonreimbursement of out-of-state providers of residential care for children -- Exception -- Administrative regulations. (1) No medical assistance payments shall be made under this chapter to any out-of-state health facility or health servic…
KRS § 205.635 Skilled nursing services provided to Medicaid recipients by adult day health care programs
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health care programs. An adult day health care program shall be required to provide skilled nursing services to Medicaid recipients only during the posted hours of operation.
KRS § 205.636 Temporary COVID-19 personal care attendant -- Training and competency requirements -- Application for waiver or plan amendment
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requirements -- Application for waiver or plan amendment. (1) As used in this section: (a) "COVID-19 pandemic" means the national emergency declaration concerning COVID-19 as declared by the President of the United States and the United States Department of Health and Human Servi…
KRS § 205.637 Enhanced Medicaid payments to county-owned or operated hospitals -- Payments to other hospitals
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Payments to other hospitals. (1) (a) A county-owned or operated hospital shall receive an enhanced Medicaid payment in an amount, calculated from the most recent cost report filed by that hospital with the department as of June 30 of each year, equal to the difference between the…
KRS § 205.638 Portion of hospital provider tax collections to fund enhancements to inpatient payments to hospitals
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inpatient payments to hospitals. Notwithstanding KRS 205.640 or any other provision of the Kentucky Revised Statutes to the contrary, the amount of twenty-six million six hundred seventy-three thousand seven hundred sixty-four dollars ($26,673,764) from hospital provider tax coll…
KRS § 205.639 Definitions for KRS 205.639 to 205.640
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As used in KRS 205.639 to 205.640, unless the context otherwise requires: (1) "Acute care hospital" means an acute care hospital licensed under KRS 216B.0425 except that it shall not include a critical access hospital, private psychiatric hospital, or state mental hospital; (2) "…
KRS § 205.640 Medical Assistance Revolving Trust Fund (MART) -- Distribution of disproportionate share funds -- Authority for administrative regulations -- Duties of hospitals receiving funds from MART
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disproportionate share funds -- Authority for administrative regulations -- Duties of hospitals receiving funds from MART. (1) The commissioner of Medicaid services shall adopt a disproportionate share program consistent with the requirements of Title XIX of the Social Security A…
KRS § 205.6401 Penalty for failure of Medicaid managed care organization to provide accurate paid claims listing
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accurate paid claims listing. A Medicaid managed care organization that does not provide a hospital with an accurate and complete paid claims listing as required under KRS 205.640(8)(c) shall be subject to a penalty of one thousand dollars ($1,000) per day, starting on the first …
KRS § 205.6403 Administrative regulations to comply with change in federal law -- Payments contingent on federal participation
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Payments contingent on federal participation. (1) If federal law governing disproportionate share hospital payments changes, the Department for Medicaid Services may promulgate administrative regulations in accordance with KRS Chapter 13A to comply with the changes. (2) All payme…
KRS § 205.6405 Definitions for KRS 205.6405 to 205.6408
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As used in KRS 205.6405 to 205.6408: (1) "Assessment" means the hospital assessment authorized by KRS 205.6406; (2) "Commissioner" means the commissioner of the Department for Medicaid Services; (3) "Department" means the Department for Medicaid Services; (4) "Excess disproportio…
KRS § 205.6406 Hospital rate improvement programs -- Calculation and payment of assessment on hospitals to provide state matching dollars for federal Medicaid funds -- Supplemental payments to hospitals -- Federal participation and approval required for implementation of programs -- Modification upon approval of supplemental payment formula -- Program to increase outpatient reimbursement
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assessment on hospitals to provide state matching dollars for federal Medicaid funds -- Supplemental payments to hospitals -- Federal participation and approval required for implementation of programs -- Modification upon approval of supplemental payment formula -- Program to inc…
KRS § 205.6407 Hospital Medicaid assessment fund
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(1) There is hereby established in the State Treasury the hospital Medicaid assessment fund for the purpose of holding assessments collected under KRS 205.6406 and funds transferred pursuant to KRS 205.6408. (2) All assessments collected shall be deposited into the fund and trans…
KRS § 205.6408 Uses of excess disproportionate share taxes
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Beginning in state fiscal year 2020 and continuing thereafter, the qualifying hospital disproportionate share percentage of the excess disproportionate share taxes shall be transferred to the hospital Medicaid assessment fund and used for the state matching dollars for the paymen…
KRS § 205.6411 Definitions for KRS 205.6411 and 205.6412
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As used in this section and KRS 205.6412: (1) "Department" means the Department for Medicaid Services; (2) "Managed care" means the provision of Medicaid benefits through Medicaid managed care organizations under contract with the department pursuant to 42 C.F.R. sec. 438; (3) "M…
KRS § 205.6412 Rate improvement programs for certain qualifying hospitals -- Terms -- Eligibility -- Federal participation and approval required for implementation of programs
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Eligibility -- Federal participation and approval required for implementation of programs. To the extent permitted under federal law and in addition to, and separate from, the programs developed pursuant to KRS 205.6406, the department shall develop programs to improve quality of…
KRS § 205.642 Pervasive developmental disorders -- Definition for KRS 200.654, 200.660, 347.020, and 387.510 -- Waiver application -- Report
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200.660, 347.020, and 387.510 -- Waiver application -- Report. (1) As used in this section and KRS 200.654, 200.660, 347.020, and 387.510, "pervasive developmental disorders" has the same meaning as in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM…
KRS § 205.643 IMPACT Plus Program -- Provider to receive copy of criteria used in audit, evaluation, or review
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audit, evaluation, or review. (1) As used in this section, "IMPACT Plus Program" means the program of community-based behavioral health services provided to an eligible IMPACT Plus recipient through an agreement between the Department for Medicaid Services and the Department for …
KRS § 205.645 Recognition of varying overhead costs
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Notwithstanding any provision of KRS 205.560, the Cabinet for Health and Family Services shall recognize the reasonable and appropriate varying overhead costs associated with different areas of specialty for the purposes of establishing the standard reimbursement rate for physici…
KRS § 205.646 External independent third-party review of Medicaid managed care organization's final decision denying a health care service or a claim for reimbursement -- Submission of multiple claims in a single review -- Appeal -- Administrative regulations -- Applicability of statute
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organization's final decision denying a health care service or a claim for reimbursement -- Submission of multiple claims in a single review -- Appeal -- Administrative regulations -- Applicability of statute. (1) As used in this section: (a) "Administrative appeals hearing" mean…
KRS § 205.647 State pharmacy benefit manager's report to Department for Medicaid Services -- Requirements for Medicaid services contracts entered into or renewed on or after March 27, 2020 -- Administrative regulations -- Reimbursement rates between pharmacy benefit manager and contracted pharmacy
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Services -- Requirements for Medicaid services contracts entered into or renewed on or after March 27, 2020 -- Administrative regulations -- Reimbursement rates between pharmacy benefit manager and contracted pharmacy. (1) As used in this section, "state pharmacy benefit manager"…
KRS § 205.648 Plan amendment, waiver, or alternative payment model for services of certified community health workers -- Reimbursement -- Services provided -- Not be considered duplicative -- Administrative regulations and approvals
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certified community health workers -- Reimbursement -- Services provided -- Not be considered duplicative -- Administrative regulations and approvals. (1) As used in this section, "certified community health worker" has the same meaning as in KRS 309.460. (2) (a) By January 1, 20…
KRS § 205.6481 Legislative findings
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The General Assembly hereby finds that: (1) All citizens of the Commonwealth should have access to affordable health care; and (2) It is estimated by the Legislative Research Commission that one hundred twenty- five thousand (125,000) children in the Commonwealth have no health i…
KRS § 205.6483 Kentucky Children's Health Insurance Program -- Purposes
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There is hereby created within the Cabinet for Health and Family Services the Kentucky Children's Health Insurance Program (KCHIP) for the purposes of: (1) Providing health care coverage and other coordinated services to children through the age of eighteen (18) years at or below…
KRS § 205.6485 State child health plan -- Eligibility criteria -- Schedule of benefits -- Premium contributions -- Access. (Effective until January 1, 2027)
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Premium contributions -- Access. (Effective until January 1, 2027) (1) As used in this section, "KCHIP" means the Kentucky Children's Health Insurance Program. (2) The Cabinet for Health and Family Services shall: (a) Prepare a state child health plan, known as KCHIP, meeting the…
KRS § 205.6487 Establishment of trust fund -- Maintenance
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(1) A "Kentucky Children's Health Insurance Program Trust Fund" shall be established for the purpose of receiving all appropriated funds, premiums, or other revenue received by the Kentucky Children's Health Insurance Program to be used for the payment of costs and services assoc…
KRS § 205.6489 Administration -- Outreach -- Data collection
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(1) The Kentucky Children's Health Insurance Program shall be administered by the Cabinet for Health and Family Services in terms of conducting eligibility determination and providing oversight over enrollment and claims payment. (2) The program shall include a system of outreach…
KRS § 205.6495 Short title for KRS 205.6481 to 205.6495 and KRS 304.17A-340
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KRS 205.6481 to 205.6495 and KRS 304.17A-340 shall be known as the Kentucky Children's Health Insurance Program Act.
KRS § 205.6497 Required provisions in plans
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(1) As permitted by federal law, in any plan submitted for federal Title XXI approval of a children's health insurance program for Kentucky, the cabinet shall include provisions for a preventive health insurance program for children with no copayment, deductible, coinsurance, or …
KRS § 205.690 Reports to General Assembly
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The secretary shall submit a written report to the General Assembly upon written request or appear in person before any joint interim committee of the General Assembly within thirty (30) days of a request. The following information related to the implementation of KRS 205.2003 sh…
KRS § 205.702 Educational and vocational programs for parents receiving public assistance -- Reports by cabinet
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assistance -- Reports by cabinet. (1) The cabinet shall take all necessary actions to ensure that parents receiving public assistance may engage in educational and vocational programs where assessment shows their chances of achieving self-sufficiency will improve. (2) The cabinet…
KRS § 205.703 Educational and vocational programs eligible for supportive services -- Prohibition against discontinuance of service to low income parents except under certain circumstances
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Prohibition against discontinuance of service to low income parents except under certain circumstances. (1) The cabinet shall honor parents' requests to volunteer for basic, secondary, post- secondary, and vocational education programs, including work study and internships; where…
KRS § 205.704 Preparation and submission of strategic plan to further education of low-income parents -- Parties included in planning process
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income parents -- Parties included in planning process. (1) The cabinet shall undertake a joint planning process with appropriate state, local, and private education institutions, interested agencies, and citizens to ensure that opportunities for low-income parents to continue or…
KRS § 205.705 Legislative intent regarding child support statutes
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It is the intent of the General Assembly that requirements relating to child support or paternity established by KRS Chapters 205, 403, 405, 406, and 407 shall be in compliance with the provisions of 42 U.S.C. secs. 651 et seq.
KRS § 205.830 Legislative intent
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It is the intent of KRS 205.835 to assist the cabinet in ascertaining eligibility of applicants for or recipients of benefits under programs administered by the cabinet and to prevent abuse of such programs by imposing a public duty upon all banks, savings and loan associations, …
KRS § 205.835 Disclosure of financial data pertinent to applicants for or recipients of benefits -- Fee -- Written consent
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benefits -- Fee -- Written consent. (1) Notwithstanding any existing state statute or regulation to the contrary, all banks, savings and loan associations, credit unions, and other financial institutions shall, upon request of the secretary, inform such representative, no later t…
KRS § 205.8451 Definitions for KRS 205.8451 to 205.8483
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As used in KRS 205.8451 to 205.8483, unless the context otherwise requires: (1) "Benefit" means the receipt of money, goods, or anything of pecuniary value from the Medical Assistance Program. (2) "Fraud" means an intentional deception or misrepresentation made by a recipient or …
KRS § 205.8453 Responsibility for control of fraud and abuse
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It shall be the responsibility of the Cabinet for Health and Family Services and the Department for Medicaid Services to control recipient and provider fraud and abuse by: (1) Informing recipients and providers as to the proper utilization of medical services and methods of cost …
KRS § 205.8455 Recipient Utilization Review Committee -- Authority
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(1) To implement provisions of this section, the commissioner of the Department for Medicaid Services shall create, no later than July 30, 1994, a Recipient Utilization Review Committee with the authority to: (a) Review individual recipient utilization or program benefits, recipi…
KRS § 205.8457 Responsibility of managed care primary physician
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Any provider agreeing to participate as a managed care primary physician of the state's Medical Assistance Program shall be responsible for prior approval of all medical-related services and goods, except transportation, of recipients assigned to the primary physician's care as s…
KRS § 205.8459 Emergency service
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(1) Any provider presented with a request for an emergency service, for a nonlife- threatening condition or a condition that would not result in irreparable harm, by a Medicaid recipient participating in a managed care program but not in a restricted Medicaid status, shall not pr…
KRS § 205.8461 Unlawful referral practices of provider -- Penalties
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(1) Except as otherwise provided in KRS 205.510 to 205.630, no provider shall knowingly solicit, receive, or offer any remuneration (including any kickback, bribe, or rebate) for furnishing medical assistance benefits or in return for purchasing, leasing, ordering, or arranging f…
KRS § 205.8463 Fraudulent acts -- Penalties
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(1) No person shall knowingly or wantonly devise a scheme or plan a scheme or artifice, or enter into an agreement, combination, or conspiracy to obtain or aid another in obtaining payments from any medical assistance program under this chapter by means of any fictitious, false, …
KRS § 205.8465 Mandatory reporting of violations -- Confidentiality -- Prohibition against employer discrimination or retaliation
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against employer discrimination or retaliation. (1) Any person who knows or has reasonable cause to believe that a violation of this chapter has been or is being committed by any person, corporation, or entity, shall report or cause to be reported to the Office of Medicaid Fraud …