Title XVII, Economic Security and Public Welfare
31 chapters · 957 sections in this title.
KRS § 205.532 Definitions for KRS 205.532 to 205.536 -- Contracts for Medicaid services by managed care organizations -- Credentialing alliance -- Procedures -- Enrollment of and contracts with providers -- Failure to agree on terms and conditions -- Application date -- Credentialing verification by university hospitals -- Electronic verification of licensure information
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by managed care organizations -- Credentialing alliance -- Procedures -- Enrollment of and contracts with providers -- Failure to agree on terms and conditions -- Application date -- Credentialing verification by university hospitals -- Electronic verification of licensure inform…
KRS § 205.5321 Contracts for Medicaid services by managed care organizations -- Extension and procurement requirements -- Sunset
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Extension and procurement requirements -- Sunset. (1) Notwithstanding any provision of law to the contrary, the Department for Medicaid Services shall: (a) Extend all contracts with Medicaid managed care organizations in effect on April 14, 2026, through December 31, 2028; and (b…
KRS § 205.533 Website of managed care organization -- Requirements
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(1) A managed care organization shall maintain an interactive website, operated by the managed care organization, that allows providers to file grievances, appeals, and supporting documentation electronically in an encrypted format that complies with federal law and that allows a…
KRS § 205.534 Toll-free telephone line -- Duties relating to adverse determinations -- In-person meeting -- Reprocessing claims -- Internal appeals -- Provider audits -- Timely decisions on authorization and preauthorization requests -- Monthly and annual reports -- Penalties -- Administrative regulations
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person meeting -- Reprocessing claims -- Internal appeals -- Provider audits -- Timely decisions on authorization and preauthorization requests -- Monthly and annual reports -- Penalties -- Administrative regulations. (1) A Medicaid managed care organization with whom the departm…
KRS § 205.535 Medicaid enrollee not automatically assigned to managed care organization
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organization. The department shall not automatically assign a Medicaid enrollee to a managed care organization.
KRS § 205.5353 Dental services -- Administrative service organization delivery model -- Legislative findings -- Medicaid dental director -- Procurement -- Administrative regulations -- Dental Services Advisory Panel -- Annual report
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Legislative findings -- Medicaid dental director -- Procurement -- Administrative regulations -- Dental Services Advisory Panel -- Annual report. (1) The General Assembly finds and declares that: (a) Effective management of Medicaid-covered dental services is essential for the ov…
KRS § 205.5355 Identification and disenrollment of nonresidents and individuals concurrently enrolled in multiple states -- Procedures -- Notice -- Penalties
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concurrently enrolled in multiple states -- Procedures -- Notice -- Penalties. For the purpose of identifying and, when appropriate, disenrolling individuals from the Kentucky Medicaid program who are concurrently enrolled, or suspected of being concurrently enrolled, in one (1) …
KRS § 205.5356 Contracts for Medicaid services by managed care organizations -- Required terms and provisions -- Prohibited actions -- Requirements -- Disenrollment of beneficiary with unknown address -- Penalties
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Required terms and provisions -- Prohibited actions -- Requirements -- Disenrollment of beneficiary with unknown address -- Penalties. Any contract entered into, renewed, or extended on or after April 14, 2026, by the cabinet, or any subdivision thereof, and any managed care orga…
KRS § 205.5357 Medicaid managed care organization compliance fund
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(1) (a) There is hereby established in the State Treasury a restricted fund to be known as the Medicaid managed care organization compliance fund. (b) The fund shall consist of all penalties or fines imposed by the cabinet on a managed care organization for violations of KRS 205.…
KRS § 205.536 Utilization review -- Prohibition against prospective or concurrent review of prescription drug for alcohol or opioid use disorder. (Effective until January 1, 2028)
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of prescription drug for alcohol or opioid use disorder. (Effective until January 1, 2028) (1) A Medicaid managed care organization shall have a utilization review plan, as defined in KRS 304.17A-600, that meets the requirements established in 42 C.F.R. pts. 431, 438, and 456. If…
KRS § 205.5361 Utilization rates and expenditures for all Medicaid-covered behavioral health and substance use disorder services -- Annual report
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health and substance use disorder services -- Annual report. The Department for Medicaid Services shall monitor utilization rates and expenditures for all Medicaid-covered behavioral health and substance use disorder services and shall submit an annual report to the Legislative R…
KRS § 205.5363 Nonemergency medical transportation services -- Annual report
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(1) The provision of nonemergency medical transportation services to eligible Medicaid enrolled beneficiaries in the Commonwealth shall comply with 42 U.S.C. sec. 1396a(a)(87), 42 C.F.R. sec. 431.53, 42 C.F.R. sec. 440.170, any other relevant federal law or regulation, and this s…
KRS § 205.5365 Prohibition on expenditure of Medicaid funds for cross-sex hormones for treatment of gender dysphoria or gender reassignment surgery
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treatment of gender dysphoria or gender reassignment surgery. Notwithstanding any provision of law to the contrary and unless required under federal law, the Department for Medicaid Services and any managed care organization with whom the department contracts for the delivery of …
KRS § 205.5366 Coverage for prescription drugs prescribed primarily for weight loss prohibited
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prohibited. Notwithstanding any provision of law to the contrary, the Kentucky Medicaid program, including the Department for Medicaid Services and any managed care organization with which the department contracts for the delivery of Medicaid services, shall not provide coverage …
KRS § 205.5367 Prohibition of coverage for psychoeducational services
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Notwithstanding any provision of law to the contrary, the Kentucky Medicaid program, including the Department for Medicaid Services and any managed care organization with which the department contracts for the delivery of Medicaid services, shall not provide coverage for individu…
KRS § 205.5369 Report to the Legislative Research Commission on prior authorization. (Effective January 1, 2027)
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(Effective January 1, 2027) The commissioner of the Department for Medicaid Services shall: (1) (a) Submit a written report not later than September 30 of each year to the Legislative Research Commission for referral to the Interim Joint Committees on Banking and Insurance and He…
KRS § 205.5370 Waiver programs -- Definitions for section -- Application -- Waitlists -- Assessments and reevaluations -- Eligibility -- Report of possible violations -- Quarterly report
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Assessments and reevaluations -- Eligibility -- Report of possible violations -- Quarterly report. (1) As used in this section: (a) "Department": 1. Means the Department for Medicaid Services; and 2. Includes any other agency of state government or nongovernmental entity contract…
KRS § 205.5371 Demonstrated community engagement -- Definitions for section
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(1) (a) The cabinet shall, no later than January 1, 2027, for applicable individuals as defined in 42 U.S.C. sec. 1396a(xx)(9), condition eligibility for enrollment or continued enrollment in the Medicaid program on demonstrated community engagement as defined in and required und…
KRS § 205.5372 Specific authorization from General Assembly required to exercise state's option to develop basic health program under federal law or make changes related to eligibility, coverage, or benefits -- Fiscal impact assessment required -- Construction
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option to develop basic health program under federal law or make changes related to eligibility, coverage, or benefits -- Fiscal impact assessment required -- Construction. (1) Notwithstanding any provision of law to the contrary, including but not limited to KRS 205.460 and 205.…
KRS § 205.5373 Department's duties when limited in ability to disenroll individuals from state medical assistance program
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state medical assistance program. (1) When the Department for Medicaid Services receives federal funding for the state's medical assistance program which is contingent on temporary maintenance of effort restrictions, such as those restrictions imposed under Pub. L. No. 116-127 se…
KRS § 205.5374 Limitation on designation of cabinet or Department for Medicaid Services as qualified health entity
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Services as qualified health entity. Unless expressly required under federal law, neither the cabinet nor the Department for Medicaid Services shall be designated as a qualified health entity for the purpose of making presumptive eligibility determinations for the state's medical…
KRS § 205.5375 Definitions for section -- Presumptive eligibility -- Determination -- Requirements -- Administrative regulations
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Requirements -- Administrative regulations. (1) As used in this section: (a) "Department" means the Department for Medicaid Services; (b) "Period of presumptive eligibility" has the same meaning as in 42 C.F.R. sec. 435.1101; and (c) "Qualified hospital" has the same meaning as i…
KRS § 205.5376 Substance use disorder treatment for incarcerated individuals -- Requirements
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Requirements. To the extent permitted under federal law, the state's medical assistance program shall provide coverage for substance use disorder treatment, including peer support services and substance use disorder treatment and patient navigation provided by a licensed clinical…
KRS § 205.538 Statistics report on cancer services for colorectal cancer among Medicaid recipients
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recipients. The Department for Medicaid Services shall present statistics on cancer services related to colorectal cancer among Medicaid recipients to the Colon Cancer Screening and Prevention Advisory Committee annually and upon request.
KRS § 205.539 Coverage and reimbursement for at-home anticoagulation management -- Administrative regulations
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Administrative regulations. (1) The Department for Medicaid Services and any managed care organization with whom the department contracts for the delivery of Medicaid services shall provide coverage and reimbursement for at-home prothrombin time or international normalized ratio …
KRS § 205.540 Advisory Council for Medical Assistance -- Membership -- Expenses -- Meetings -- Qualifications of members
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Meetings -- Qualifications of members. (1) An Advisory Council for Medical Assistance shall be established in the state government. The council shall consist of twenty-two (22) members. The secretary for health and family services shall be an ex officio member. The other twenty-o…
KRS § 205.541 Application of clinical criteria for sepsis
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To encourage the early identification and treatment of sepsis, and for consistency with the ICD-10 coding classification system utilized by the federal Centers for Medicare and Medicaid Services, the Department for Medicaid Services and any managed care organization with which th…
KRS § 205.550 Subjects on which council advises
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(1) The council shall advise the Cabinet for Health and Family Services about health and medical care services. (2) The council shall have the opportunity for participation in policy development and program administration and shall advise the Cabinet for Health and Family Service…
KRS § 205.5510 Definitions for KRS 205.5510 to 205.5520
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As used in KRS 205.5510 to 205.5520, unless the context otherwise requires: (1) "Department" means the Department for Medicaid Services; (2) "Managed care organization" has the same meaning as in KRS 205.532; (3) "Pharmacy benefit manager" has the same meaning as in KRS 304.9-020…
KRS § 205.5512 Selection of and contract with third-party administrator as pharmacy benefit manager for Medicaid managed care organizations -- Requirements for department’s contracts, procurement process, disclosure of information, and legislative committee review
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benefit manager for Medicaid managed care organizations -- Requirements for department’s contracts, procurement process, disclosure of information, and legislative committee review. (1) By December 31, 2020, the department, in accordance with KRS Chapter 45A, shall select and con…
KRS § 205.5514 Department’s duties regarding state pharmacy benefit management
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(1) The department shall: (a) Establish a single preferred drug list to be used by the state pharmacy benefit manager for each managed care organization with whom the department contracts for the delivery of Medicaid services; and (b) Promulgate administrative regulations that es…
KRS § 205.5516 Compliance of payment arrangements with state and federal laws and regulations
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regulations. All payment arrangements between the department, managed care organizations, and the state pharmacy benefit manager shall comply with state and federal statutes, regulations adopted by the Centers for Medicare and Medicaid Services, and any other agreement between th…
KRS § 205.5518 Required and prohibited actions by pharmacy benefit manager -- Penalty for violation
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for violation. (1) Notwithstanding any provisions of law to the contrary, beginning on March 27, 2020, and continuing until December 31, 2020, a pharmacy benefit manager contracted with a managed care organization to administer Medicaid benefits shall not: (a) Adjust, modify, cha…
KRS § 205.5520 Annual recommendations regarding pharmacy benefit reimbursement methodologies and dispensing fees
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methodologies and dispensing fees. By December 1, 2020, and at least annually thereafter, the Technical Advisory Committee on Pharmacy established in KRS 205.590 shall make recommendations to the department regarding the reimbursement methodologies and dispensing fees used by the…
KRS § 205.553 Kentucky Medicaid pharmaceutical rebate fund
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(1) There is hereby established within the Cabinet for Health and Family Services a restricted fund to be known as the Kentucky Medicaid pharmaceutical rebate fund. All moneys received by the Cabinet for Health and Family Services or the Department for Medicaid Services as compen…
KRS § 205.556 Coverage for lactation consultation, breastfeeding equipment, in-home programs for pregnant and postpartum women, and telehealth or digital health services related to maternity care
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programs for pregnant and postpartum women, and telehealth or digital health services related to maternity care. (1) As used in this section: (a) "Breast pump kit" means a collection of tubing, valves, flanges, bottles, and other parts required to extract human milk using a breas…
KRS § 205.557 Medicaid reimbursement for advocacy center's child medical evaluation -- Waivers -- Administrative regulations
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evaluation -- Waivers -- Administrative regulations. (1) For the purposes of this section: (a) "Advanced practice registered nurse" has the same meaning as in KRS 314.011; (b) "Children's advocacy center" has the same meaning as in KRS 620.020; (c) "Child medical evaluation" mean…
KRS § 205.558 Prescreening and admissions review system
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(1) To prevent inappropriate placement and to contain costs related thereto, the secretary for health and family services shall implement a statewide prescreening and admissions review system, including the imposition of a resource means test, for all long-term-care facilities an…
KRS § 205.559 Requirements for Medicaid reimbursement to participating providers for telehealth consultations -- Reimbursement for rural health clinics, federally qualified health centers, and federally qualified health center look-alikes -- Location in state not required if provider offers services exclusively by telehealth -- Audio-only encounters
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telehealth consultations -- Reimbursement for rural health clinics, federally qualified health centers, and federally qualified health center look-alikes -- Location in state not required if provider offers services exclusively by telehealth -- Audio-only encounters. (1) The Cabi…
KRS § 205.5591 Medicaid providers using telehealth -- Duties of cabinet, Department for Medicaid Services, and managed care organizations -- Administrative regulations -- Policies and guidelines
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Medicaid Services, and managed care organizations -- Administrative regulations -- Policies and guidelines. (1) For purposes of this section, "equivalent" has the same meaning as in KRS 304.17A-138. (2) The cabinet shall provide oversight, guidance, and direction to Medicaid prov…
KRS § 205.560 Scope of care to be designated by administrative regulations -- Reimbursements mandated or prohibited -- Payments to community mental health centers -- Participation of providers in Medical Assistance Program
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Reimbursements mandated or prohibited -- Payments to community mental health centers -- Participation of providers in Medical Assistance Program. (1) The scope of medical care for which the Cabinet for Health and Family Services undertakes to pay shall be designated and limited b…
KRS § 205.5601 Cabinet’s reimbursement for qualifying ground ambulance service transports
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transports. Upon approval by the Centers for Medicare and Medicaid Services of the assessment imposed under KRS 142.318 for fee-for-service rates effective on or after July 1, 2020, the cabinet shall reimburse each ground ambulance provider that provided qualifying ground ambulan…
KRS § 205.5602 Definitions for this section and KRS 205.5601 and 205.5603 -- Duties of Department for Medicaid Services regarding ground ambulance service transports -- Assessment amount and administration -- Need for state plan or waiver amendment -- Reports
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Department for Medicaid Services regarding ground ambulance service transports -- Assessment amount and administration -- Need for state plan or waiver amendment -- Reports. (1) For purposes of this section and KRS 205.5601 and 205.5603: (a) "Ground ambulance provider" means a gr…
KRS § 205.5603 Ambulance service assessment fund -- Appropriation and transfer of fund moneys -- Sole purposes of fund -- Effect of invalidity of KRS 205.5602
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fund moneys -- Sole purposes of fund -- Effect of invalidity of KRS 205.5602. (1) There is established in the State Treasury the ambulance service assessment fund for the purpose of depositing assessments imposed under KRS 142.318. (2) The fund shall consist of the assessments an…
KRS § 205.5604 Department for Medicaid Services to submit Medicaid preprint to establish supplemental payment program for public ground ambulance providers -- Administration of program -- Funding -- Eligibility
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establish supplemental payment program for public ground ambulance providers -- Administration of program -- Funding -- Eligibility. (1) As used in this section, "public ground ambulance provider" means a ground ambulance provider licensed in accordance with administrative regula…
KRS § 205.5605 Definitions for KRS 205.5605 to 205.5607
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As used in KRS 205.5605 to 205.5607, unless the context otherwise requires: (1) "Budget allowance" means the amount of money made available each month to a consumer to purchase covered services and supports. The amount of money shall not exceed the amount that would have been all…
KRS § 205.5606 Kentucky Independence Plus Through Consumer-Directed Services Program -- Consumer participation -- Responsibilities of cabinet and fiscal intermediary -- Background screening -- Regulations
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Program -- Consumer participation -- Responsibilities of cabinet and fiscal intermediary -- Background screening -- Regulations. (1) The Cabinet for Health and Family Services shall establish the Kentucky Independence Plus Through Consumer-Directed Services Program that shall pro…
KRS § 205.5607 Applicability of KRS Chapter 342
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Notwithstanding any provision of law to the contrary, the provisions of KRS Chapter 342 shall not apply to the provision of any service under KRS 205.5606 between the provider and the state or any state agency or political subdivision, the provider and the consumer, or as arrange…
KRS § 205.561 Report on the dispensing of prescription medications
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(1) The cabinet shall submit a report to the Governor and the Legislative Research Commission on the dispensing of prescription medications to persons eligible under KRS 205.560 upon request. The report shall also include current data on the most utilized and abused drugs in the …
KRS § 205.5621 Definitions for KRS 205.5621 to 205.5625
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As used in KRS 205.5621 to 205.5625: (1) "Asset test" means the asset limits as defined by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Pub. L. No. 108-173; (2) "Commissioner" means the commissioner of the Department for Medicaid Services; (3) "Cont…