Title XVII, Economic Security and Public Welfare
31 chapters · 957 sections in this title.
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…
KRS § 205.5622 Kentucky Pharmaceutical Assistance Program -- Contingency for establishment -- Purpose -- Eligibility -- Enrollment priority
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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
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(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
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(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
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(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
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(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
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(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
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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
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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
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(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
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- 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
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-- 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
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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
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(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
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(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
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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
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(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
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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…