Title XVII, Economic Security and Public Welfare

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…

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"…

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…

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…

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…

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…

(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…

(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 205.6481 to 205.6495 and KRS 304.17A-340 shall be known as the Kentucky Children's Health Insurance Program Act.

(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 …

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…

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…

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…

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…

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.

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, …

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…

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 …

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 …

(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…

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…

(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…

(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…

(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, …

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 …

(1) Any provider who has been found by a preponderance of the evidence in an administrative process, in conformity with any applicable federal regulations and with due process protections, to have knowingly submitted or caused claims to be submitted for payment for furnishing tre…

(1) The Attorney General, on behalf of the Commonwealth, may commence proceedings to enforce KRS 205.8451 to 205.8483, and to prosecute for all other criminal offenses that involve or are directly related to the use of any Medical Assistance Program funds or services provided und…

(1) The Commonwealth shall have a lien against all property of any provider or recipient who is found to have defrauded the Medicaid program for an amount equal to the sum defrauded plus any interest and penalties levied under KRS 205.8451 to 205.8483. The lien shall attach to al…

In a prosecution for any violation of the provisions of KRS 205.8451 to 205.8483, it shall be a defense if the person relied on the written advice of an employee or agent of the Cabinet for Health and Family Services, and the advice constitutes a defense under any of the provisio…

(1) Any professional, licensed or regulated by any agency of the Commonwealth of Kentucky, who upon final and unappealable decision by a court of competent jurisdiction, is convicted or pleads guilty to a violation of any of the criminal provisions of KRS 205.8451 to 205.8483, sh…

managed care entities -- Disclosure requirements for owners and investors of health facilities and health services -- When disclosure must be provided. (1) Each Medicaid provider, other than an individual practitioner or group of practitioners, fiscal agent that processes or pays…

Any provider licensed or certified under the laws of the Commonwealth whose license or certificate to practice is suspended, revoked, limited, or otherwise restricted shall have that fact reported to the medical assistance program by the respective licensure or regulatory board o…

General in private practice. No staff of the Office of the Attorney General shall, in private practice of law, serve as legal counsel to or represent any provider, as defined in KRS 205.8451. Designated staff of the Office of the Attorney General shall work in cooperation with th…

(1) The Office of the Inspector General in the Cabinet for Health and Family Services shall establish, maintain, and publicize a twenty-four (24) hour toll-free hotline for the purpose of receiving reports of alleged fraud and abuse by Medical Assistance Program recipients and pa…

As used in KRS 205.905 to 205.920: (1) "Cabinet" means the Cabinet for Health and Family Services. (2) "Evaluation team" means at least three (3) individuals employed as such by a qualified agency or organization. (3) "Personal care assistance services" means services which are r…

(1) The cabinet shall provide a subsidy for personal care assistance services to any adult who: (a) Has a severe physical disability; (b) Needs not less than fourteen (14) hours a week of personal care assistance services as defined by the secretary or needs an attendant at night…

Supplements other programs. (1) The cabinet shall establish by regulation an eligibility standard which takes into consideration the unique economic and social needs of severely physically disabled adults. (2) The subsidy shall not be considered income for any purpose to the exte…

(1) Within thirty (30) days of any recommendation of any decision by the cabinet, an aggrieved party may appeal. The Office of Administrative Hearings within the Department of Law shall appoint one (1) or more trained hearing officers to hear and decide the appeal. (2) Any party …

The secretary may promulgate regulations to implement KRS 205.905 to 205.915.

The cabinet shall implement the provisions of KRS 205.900 to 205.920 on a statewide basis and shall serve at least two hundred (200) severely physically disabled adults or more as provided in the state executive branch budget bill.

As used in KRS 205.940: (1) "Cabinet" means the Cabinet for Health and Family Services; (2) "Representative payee" means a person appointed by the Social Security Administration, United States Department of Veterans Affairs, or other nonprofit social service agency to provide fin…

(1) A representative payee fund shall be created for the purpose of providing grants to public or private organizations who provide representative payee services. The fund shall consist of moneys appropriated by the General Assembly. These moneys may also be supplemented by funds…

(1) Any person who violates any of the provisions of KRS 205.170 or subsections (1) to (3) of KRS 205.175 shall be guilty of a Class A misdemeanor. (2) Any person who violates subsection (4) of KRS 205.175 shall be guilty of a Class D felony. (3) Any person who willfully violates…

Any person violating the provisions of KRS 15.858 shall be fined not more than five hundred dollars ($500) or be imprisoned in the county jail for not more than one (1) year, or both.

As used in KRS 207.140 to 207.240 unless the context otherwise requires: (1) "Persons" means one (1) or more individuals, partnerships, municipalities, the state, or other political subdivisions within the state, associations, labor organizations, or corporations. (2) "Physical d…

prohibited. (1) Any person with acquired immunodeficiency syndrome, acquired immunodeficiency syndrome related complex, or human immunodeficiency virus shall have every protection made available to individuals with disabilities under KRS 207.130 to 207.240 and Section 504, Public…