Title XVII, Economic Security and Public Welfare
31 chapters · 957 sections in this title.
KRS § 205.592 Eligibility of pregnant women, new mothers, and children up to age 1 to participate in Kentucky Medical Assistance Program
0.8K chars
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…
KRS § 205.593 Prohibition against health insurer's considering individual's eligibility for or receipt of medical assistance in enrollment or payment of benefits -- Application of claims payment requirements to Medicaid services
0.8K chars
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…
KRS § 205.594 Health coverage for child under medical child support order -- Duties of health insurers
1.7K chars
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)…
KRS § 205.595 Health coverage for child under medical child support order -- Duties of employers
1.9K chars
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 …
KRS § 205.596 Prohibition against health insurer's imposing requirements on state agency assigned rights of individual eligible for medical assistance that are different from those applicable to agent or assignee of other covered individual
0.5K chars
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…
KRS § 205.597 Health coverage through insurer of noncustodial parent of child under medical child support order
0.6K chars
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…
KRS § 205.598 Withholding of income and state tax refund of person required by court to provide cost of child's health service -- Priority of claims for child support over costs of reimbursement of child medical support
0.9K chars
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…
KRS § 205.615 Use of allowable Medicaid funding for trauma care costs
0.5K chars
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…
KRS § 205.617 Expansion of Medicaid coverage for screening and treatment of breast or cervical cancer or precancerous conditions -- Short title
2.6K chars
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 …
KRS § 205.618 Coverage for tobacco cessation medications and services
1.9K chars
(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…
KRS § 205.619 Medicaid plan amendment to permit establishing of Kentucky Long-Term Care Partnership Insurance Program
1.5K chars
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…
KRS § 205.621 Increased reimbursement for Medicaid
0.5K chars
(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…
KRS § 205.622 Billing of third party by vendor for medical services
0.2K chars
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.
KRS § 205.623 Information on claims paid for insurance policyholders and dependents -- Use of data -- Confidentiality of information -- Prohibited fees
1.7K chars
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…
KRS § 205.624 Assignment to cabinet by recipient of rights to third-party payments -- Right of recovery by cabinet
3.3K chars
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…
KRS § 205.626 Time assignment becomes enforceable -- Payment to cabinet -- Attorney's fees
0.9K chars
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…
KRS § 205.628 Liability of recipient
0.3K chars
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.
KRS § 205.629 Notification of cabinet in actions seeking recovery for recipient
0.2K chars
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.
KRS § 205.630 Prohibited activity by cabinet -- Injunctive relief
0.7K chars
(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…
KRS § 205.631 Life settlement proceeds for long-term care services not considered as 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
2.5K chars
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…
KRS § 205.6310 Cabinet to establish system to reduce unnecessary hospital emergency room utilization and costs
1.6K chars
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…
KRS § 205.6311 Substance use disorder treatment benefit -- Administrative regulations -- Contracts with Medicaid managed care organizations -- Annual report
1.8K chars
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…
KRS § 205.6312 Cost-sharing requirements
2.2K chars
(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…
KRS § 205.6313 Medicaid reimbursement for primary care practitioners at community mental health centers
1.3K chars
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…
KRS § 205.6314 Review of reimbursement rates for emergency transportation providers -- Promulgation of administrative regulations relating to emergency transportation providers
1.2K chars
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…
KRS § 205.6315 Requirements when private peer review organization is contracted with to conduct reviews of levels of care
4.9K chars
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 …
KRS § 205.6316 Review of procedures for medical assistance reimbursement of pharmacists to reduce fraud and abuse -- Dispensing fee
1.0K chars
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 …
KRS § 205.6317 Department for Medicaid Services to develop strategies for reimbursing and paying persons participating in the Supports for Community Living Waiver Program -- Allocation of slots -- Administrative regulations -- Funding
2.0K chars
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 § 205.63171 Short title for KRS 205.6317
0.1K chars
KRS 205.6317 may be cited as the Kevin Webb and Kim Brown Self-Determination Act.
KRS § 205.6318 Cabinet to establish integrated system to enhance program integrity of Medical Assistance Program
2.5K chars
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…
KRS § 205.632 Pilot project to create coverage provisions and reimbursement criteria for telemonitoring services based on evidence-based best practices provided by a qualified medical provider or community action agency
2.0K chars
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 …
KRS § 205.6320 Cabinet to strengthen managed care component of KenPAC Program and to establish standards for access and quality for organizations serving Medicaid recipients
3.2K chars
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…
KRS § 205.6322 Cabinet to seek to prohibit sheltering of assets in long-term-care cases
1.1K chars
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…
KRS § 205.6324 Cabinet to enhance third-party resource collection capacity
0.3K chars
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
1.0K chars
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
8.3K chars
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
0.8K chars
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
2.8K chars
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
0.2K chars
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
0.8K chars
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
2.3K chars
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
0.2K chars
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
2.1K chars
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
3.5K chars
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
0.7K chars
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
6.8K chars
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
20.7K chars
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
0.4K chars
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
0.5K chars
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
6.6K chars
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…