Title XVII, Economic Security and Public Welfare

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…

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…

(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…

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…

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…

(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…

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…

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…

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…

(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…

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…

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…

(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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

(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 …

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…

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…

(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, …

(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…

(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…

(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…

(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 …