AN ACT relating to Medicaid, making an appropriation therefor, and declaring an emergency.

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AN ACT relating to Medicaid, making an appropriation therefor, and declaring an 1
emergency. 2
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 3
Section 1. KRS 205.5371 is amended to read as follows: 4
(1) (a) The cabinet[, to the extent permitted under federal law,] shall, no later than 5
January 1, 2027, for applicable individuals as defined in 42 U.S.C. sec. 6
1396a(xx)(9), condition eligibility for enrollment or continued enrollment in 7
the Medicaid program on demonstrated community engagement as defined 8
in and required unde r 42 U.S.C. sec. 1396a(xx) [ implement a mandatory 9
community engagement waiver program for able -bodied adults without 10
dependents who have been enrolled in the state's medical assistance program 11
for more than twelve (12) months]. 12
(b) In the case of an applicable individual who is applying for enrollment in the 13
Medicaid program, in order to be eligible for enrollment the individual shall 14
be required to demonstrate community engagement for the month 15
immediately preceding the month during which the individual ap plies for 16
enrollment. 17
(c) In the case of an applicable individual who is enrolled and receiving 18
Medicaid benefits, in order to remain eligible for continued enrollment, at 19
the time of eligibility redetermination, the individual shall be required to 20
demonstrate community engagement for three (3) months during the period 21
of time since the individual's most recent eligibility determination or 22
redetermination. 23
(2) Notwithstanding any provision of state law to the contrary, the cabinet shall not 24
request an exemption, waiver, or any other delay, including but not limited to a 25
good-faith-effort exemption, in implementing the requirements of 42 U.S.C. sec. 26
1396a(xx) or subsection (1) of this section that may be available to the state under 27
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42 U.S.C. sec. 1396a(xx)(11) unless specifically authorized by the General 1
Assembly to do so [If the federal Centers for Medicare and Medicaid Services 2
approves the implementation of a mandatory community engagement waiver 3
program pursuant to subsection (1) of this section: 4
(a) The program may, for the purpose of defining qualifying community 5
engagement activities, utilize the same requirements established in 7 C.F.R. 6
sec. 273.24; 7
(b) Participation in the job placement assistance program established in KRS 8
151B.420 shall constitute qualifying community engagement activities; and 9
(c) The cabinet shall, on a monthly basis, provide the Education and Labor 10
Cabinet with the name and contact i nformation of each individual 11
participating in the community engagement program]. 12
(3) [(a) ]The cabinet shall begin, no later than September 1, 2026, providing notice 13
to all applicable individuals, as defined in 42 U.S.C. sec. 1396a(xx)(9), of the 14
requirement to demonstrate community engagement as established under 42 15
U.S.C. sec. 1396a(xx) and subsection (1) of this section. Notice provided under 16
this subsection shall comply with the requirements of 42 U.S.C. sec. 17
1396a(xx)(8)[The cabinet is hereby authorized, as is required under KRS 205.5372, 18
and is directed to submit a waiver application to the Centers for Medicare and 19
Medicaid Services requesting approval to establish the mandatory community 20
engagement waiver program for able-bodied adults without dependents described in 21
subsections (1) and (2) of this section within ninety (90) days after March 27, 2025. 22
(b) As required in KRS 205.525, the cabinet shall provide a copy and summary of 23
the waiver application submitted pursuant to this section to the Legisla tive 24
Research Commission for referral to the Medicaid Oversight and Advisory 25
Board, the Interim Joint Committee on Appropriations and Revenue, and the 26
Interim Joint Committee on Health Services concurrent with submitting the 27
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application to the Centers for Medicare and Medicaid Services and shall 1
provide an update on the status of the application at least quarterly]. 2
(4) If at any time on or after the effective date of this Act, the federal community 3
engagement requirements established in 42 U.S.C. sec. 1396 a(xx) are abolished, 4
repealed, or otherwise diminished, the cabinet shall: 5
(a) Immediately prepare and submit a waiver application to the federal Centers 6
for Medicare and Medicaid Services seeking authorization to condition the 7
eligibility of applicable in dividuals, as defined in subsection (5) of this 8
section, to enroll or continue to be enrolled in the Medicaid program on 9
demonstrated community engagement, as defined in subsection (5) of this 10
section; and 11
(b) For applicable individuals, as defined in subs ection (5) of this section, and 12
in accordance with subsection (1)(b) and (c) of this section, condition 13
eligibility for enrollment or continued enrollment in the Medicaid program 14
on demonstrated community engagement, as defined in subsection (5) of 15
this section, if authorized to do so by the federal Centers for Medicare and 16
Medicaid Services. 17
(5) As used in subsection (4) of this section [this section, "able -bodied adult without 18
dependents" means an individual who is]: 19
(a) "Applicable individual" means an in dividual who is: [Over eighteen (18) 20
years of age but under sixty (60) years of age;] 21
1. At least nineteen (19) years of age but less than sixty -five (65) years of 22
age; 23
2. Eligible for enrollment or currently enrolled in the Medicaid program 24
under 42 U.S.C. sec. 1396a(a)(10)(A)(i)(VIII) or a waiver that 25
provides coverage that is equivalent to minimum essential coverage as 26
described in Section 5000A(f)(1)(A) of the Internal Revenue Code of 27
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1986; and 1
3. Not: 2
a. Currently, or was not previously, placed in the f oster care system 3
if the individual is under twenty-six (26) years of age; 4
b. Eligible for coverage under the Indian Health Service; 5
c. A parent, guardian, caretaker relative, or family caregiver, as 6
defined in the RAISE Family Caregivers Act, Pub. L. No. 115-7
119, of a dependent child thirteen (13) years of age or under or a 8
disabled individual; 9
d. A disabled veteran with a disability rated as total under 38 U.S.C. 10
sec. 1155; 11
e. Medically frail or otherwise has special medical needs, including 12
an individual: 13
i. Who is blind or disabled; 14
ii. With a substance use disorder; 15
iii. With a disabling mental condition; 16
iv. With a physical, intellectual, or developmental disability 17
that significantly impairs his or her ability to perform one 18
(1) or more activities of daily living; or 19
v. With a serious or complex medical condition; 20
f. An individual subject to work or community engagement 21
requirements imposed under the Supplemental Nutrition 22
Assistance Program or Temporary Assistance for Needy 23
Families, if the individual is in compliance with such 24
requirements; 25
g. An individual participating in a drug addiction or alcohol 26
addiction recovery program recognized by the secretary through 27
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the promulgation of administrative regulations in accordance 1
with KRS Chapter 13A; 2
h. An inmate at a public institution; 3
i. Pregnant or eligible for coverage under KRS 205.592; or 4
j. An individual experiencing a short -term hardship as defined by 5
the secretary through the promulgation of administrative 6
regulations in accordance with KRS Chapter 13A; and 7
(b) "Demonstrated community engagement" means satisfying one (1) or more 8
of the following conditions on a monthly basis: 9
1. Working, as defined in 7 C.F.R. sec. 273.24, not less than eighty (80) 10
hours; 11
2. Completing not less than eighty (80) hours of community service; 12
3. Participating in a work program, as defined in 7 C.F.R. sec. 273.24, 13
for not less than eighty (80) hours; 14
4. Participating at least half-time in an education program recognized by 15
the secretary through the promulgation of admi nistrative regulations 16
in accordance with KRS Chapter 13A; 17
5. Engaging in any combination of activities described in subparagraphs 18
1., 2., 3., and 4. of this paragraph for a total of not less than eighty 19
(80) hours; 20
6. Having a verifiable monthly income th at is not less than applicable 21
state minimum wage established in KRS 337.275 multiplied by eighty 22
(80) hours; or 23
7. Having a verifiable average monthly income over the previous six (6) 24
months that is not less than applicable state minimum wage 25
established in KRS 337.275 multiplied by eighty (80) hours if the 26
individual is a seasonal worker as described in Section 45R(d)(5)(B) of 27
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the Internal Revenue Code of 1986[ 1
(b) Physically and mentally able to work as determined by the cabinet; and 2
(c) Not primarily re sponsible for the care of a dependent child under the age of 3
eighteen (18) or a dependent disabled adult relative]. 4
Section 2. KRS 205.6312 is amended to read as follows: 5
(1) The Department for Medicaid Services and each managed care organization 6
contracted by the department to provide Medicaid services pursuant to this 7
chapter shall establish cost -sharing requirements for Medicaid enrollees in 8
accordance with this section [Notwithstanding any state law to the contrary, th e 9
cabinet or a managed care organization contracted by the cabinet to provide 10
Medicaid services pursuant to this chapter shall not institute copayments, cost 11
sharing, or similar charges to be paid by any medical assistance recipients, their 12
spouses, or par ents, for any assistance provided pursuant to this chapter, federal 13
law, or any federal Medicaid waiver]. 14
(2) Unless otherwise required under federal law, including 42 U.S.C. sec. 1396o(k), 15
cost-sharing requirements established under this section shall onl y apply to 16
Medicaid enrolled individuals: 17
(a) With a family income that exceeds one hundred percent (100%) of the 18
federal poverty line; and 19
(b) Who are enrolled in the Medicaid program under 42 U.S.C. sec. 20
1396a(a)(10)(A)(i)(VIII). 21
(3) In accordance with 4 2 U.S.C. sec. 1396o(k)(2)(B)(i), the following services shall 22
not be subject to cost -sharing requirements established under this section unless 23
otherwise required by federal law: 24
(a) Any care, item, or service described in 42 U.S.C. sec. 1396o(a)(2)(B) et seq.; 25
(b) Primary care services; 26
(c) Mental health care services; 27
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(d) Substance use disorder services; 1
(e) Any services provided by a: 2
1. Federally-qualified health center, as defined in 42 U.S.C. sec. 3
1396d(l)(2); 4
2. Certified community behavioral health clinic, as defined in 42 U.S.C. 5
sec. 1396d(jj)(2); or 6
3. Rural health clinic, as defined in 42 U.S.C. sec. 1396d(l)(1); and 7
(f) Any other service exempted from cost -sharing requirements under federal 8
law. 9
(4) (a) Except as provided in paragraph (b) of this subsection and subsections (3) 10
and (5) of this section, beginning October 1, 2028, for care or an item or 11
service furnished to a Medicaid enrolled individual described in subsection 12
(2) of this section, the cost -sharing requirement established under this 13
subsection shall be in the form of a copayment requirement equal to five 14
dollars ($5). 15
(b) The cost -sharing requirements establi shed under this subsection for any 16
prescription drugs shall be in the form of a copayment requirement equal to 17
one dollar ($1). 18
(5) The total aggregate amount of cost sharing imposed under this section for all 19
individuals in a family shall not exceed five percent (5%) of the family's income 20
on a monthly or quarterly basis, as determined by the secretary. 21
Section 3. KRS 205.556 is amended to read as follows: 22
(1) As used in this section: 23
(a) "Breast pump kit" means a collec tion of tubing, valves, flanges, bottles, and 24
other parts required to extract human milk using a breast pump; 25
(b) "In-home program" means a program offered by a health care facility or 26
health care professional for the treatment of substance use disorder wh ich the 27
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insured accesses through telehealth or digital health service; 1
(c) "Lactation consultation" means the clinical application of scientific principles 2
and a multidisciplinary body of evidence for evaluation, problem 3
identification, treatment, education, and consultation to families regarding the 4
course of lactation and feeding by a qualified clinical lactation care 5
practitioner, including but not be limited to: 6
1. Clinical maternal, child, and feeding history and assessment related to 7
breastfeeding and human lactation through the systematic collection of 8
subjective and objective information; 9
2. Analysis of data; 10
3. Development of a lactation management and child feeding plan with 11
demonstration and instruction to parents; 12
4. Provision of lactation and feeding education; 13
5. The recommendation and use of assistive devices; 14
6. Communication to the primary health care practitioner or practitioners 15
and referral to other health care practitioners, as needed; 16
7. Appropriate follow-up with evaluation of outcomes; and 17
8. Documentation of the encounter in a patient record; 18
(d) "Qualified clinical lactation care practitioner" means a licensed health care 19
practitioner wherein lactation consultation is within their legal scope of 20
practice; and 21
(e) "Telehealth" or "digital health" has the same meaning as in KRS 211.332. 22
(2) The Department for Medicaid Services and any managed care organization with 23
which the department contracts for the delivery of Medicaid services shall provide 24
coverage: 25
(a) For lactation consultation; 26
(b) For breastfeeding equipment; 27
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(c) To pregnant and postpartum women for an in-home program; and 1
(d) For telehealth or digital health services that are related to maternity care 2
associated with pregnancy, childbirth, and postpartum care. 3
(3) The coverage required by this section shall: 4
(a) Not be subject to: 5
1. Any cost-sharing requirements, including but not limited to copayments, 6
unless otherwise required under federal law; or 7
2. Utilization management requirements, including but not limited to prior 8
authorization, prescription, or referral, except as permitted in paragraph 9
(d) of this subsection; 10
(b) Be provided in conjunction with each birth for the duration of breastfeeding, 11
as defined by the beneficiary; 12
(c) For lactation consultation, include: 13
1. In-person, one-on-one consultation, including home visits, regardless of 14
location of service provision; 15
2. The delivery of consultation via telehealth, as defined in KRS 205.510, 16
if the beneficiary requests telehealth consultation in lieu of in -person, 17
one-on-one consultation; or 18
3. Group consultation, if the beneficiary requests group consultation in lieu 19
of in-person, one-on-one consultation; and 20
(d) For breastfeeding equipment, include: 21
1. Purchase of a single -user, double electric breast pump, or a manual 22
pump in lieu of a double electric breast pump, if requested by the 23
beneficiary; 24
2. Rental of a multi-user breast pump on the recommendation of a licensed 25
health care provider; and 26
3. Two (2) breast pump kits as well as appropriately sized brea st pump 27
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flanges and other lactation accessories recommended by a health care 1
provider. 2
(4) (a) The breastfeeding equipment described in subsection (3)(d) of this section 3
shall be furnished within forty -eight (48) hours of notification of need, if 4
requested after the birth of the child, or by the later of two (2) weeks before 5
the beneficiary's expected due date or seventy -two (72) hours after 6
notification of need, if requested prior to the birth of the child. 7
(b) If the department cannot ensure delivery of b reastfeeding equipment in 8
accordance with paragraph (a) of this subsection, an individual may purchase 9
equipment and the department or a managed care organization with whom the 10
department contracts for the delivery of Medicaid services shall reimburse the 11
individual for all out-of-pocket expenses incurred by the individual, including 12
any balance billing amounts. 13
Section 4. KRS 205.618 is amended to read as follows: 14
(1) Notwithstanding any provision of law to the contrary, the Department for Medicaid 15
Services or a managed care organization contracted to provide Medicaid services 16
shall, at a minimum, provide coverage for all United States Food and Drug 17
Administration-approved tobacco cessation medications, all forms of tobac co 18
cessation services recommended by the United States Preventive Services Task 19
Force, including but not limited to individual, group, and telephone counseling, and 20
any combination thereof. 21
(2) The following conditions shall not be imposed on any tobacco c essation services 22
provided pursuant to this section: 23
(a) Counseling requirements for medication; 24
(b) Limits on the duration of services, including but not limited to annual or 25
lifetime limits on the number of covered attempts to quit; or 26
(c) Copayments or other out-of-pocket cost sharing, including deductibles, unless 27
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otherwise required under federal law. 1
(3) Utilization management requirements, including prior authorization and step 2
therapy, shall not be imposed on any tobacco cessation services provided p ursuant 3
to this section, except in the following circumstances where prior authorization may 4
be required: 5
(a) For a treatment that exceeds the duration recommended by the most recently 6
published United States Public Health Service clinical practice guideli nes on 7
treating tobacco use and dependence; or 8
(b) For services associated with more than two (2) attempts to quit within a 9
twelve (12) month period. 10
(4) Nothing in this section shall be construed to prohibit the Department for Medicaid 11
Services or a manag ed care organization contracted to provide Medicaid services 12
from providing coverage for tobacco cessation services in addition to those 13
recommended or to deny coverage for services that are not recommended by the 14
United States Preventive Services Task Force. 15
SECTION 5. A NEW SECTION OF KRS CHAPTER 205 IS CREATED TO 16
READ AS FOLLOWS: 17
(1) Beginning January 1, 2027, the cabinet shall, in accordance with 42 U.S.C. sec. 18
1396a(e)(14)(L), conduct Medicaid eligibility redeterminations once every six (6) 19
months for individuals who are: 20
(a) Described in 42 U.S.C. sec. 1396a(e)(14)(L)(i)(I) and (II); and 21
(b) Not exempted under 42 U.S.C. sec. 1396a(e)(14)(L)(ii). 22
(2) When conducting eligibility determinations and redeterminations, including but 23
not limited to redeterminations required under subsection (1) of this section, the 24
cabinet shall: 25
(a) Access and review information from all available federal and state data 26
systems that may contain information related to eligibility for enrollment or 27
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continued enrollment in the Medicaid program, including but not limited to: 1
1. The Public Assistance Reporting Information System, or PARIS; 2
2. The Transformed Medicaid Statistical Information System, or T -3
MSIS; 4
3. The T-MSIS Analytic Files, or TAF; and 5
4. All data described in Section 7 of this Act; 6
(b) Except as provided in subsection (11) of Section 9 of this Act and to the 7
extent permitted under federal law, issue an initial finding of ineligibility 8
that may be appealed by the individual through the cabinet's established 9
appeals process if the cabinet finds or reviews inconsistent or contradictory 10
data from the v arious data sources the cabinet is required to review under 11
paragraph (a) of this subsection and any data source reflects that the 12
individual whose eligibility is being determined or redetermined is ineligible 13
to enroll in or continue to be enrolled in the Medicaid program; and 14
(c) Assess and make a determination regarding the individual's eligibility for 15
Medicaid-covered nonemergency medical transportation services. 16
SECTION 6. A NEW SECTION OF KRS CHAPTER 205 IS CREATED TO 17
READ AS FOLLOWS: 18
For the purpose of identifying and, when appropriate, disenrolling individuals from the 19
Kentucky Medicaid program who are concurrently enrolled, or suspected of being 20
concurrently enrolled , in one (1) or more other states' Medicaid programs or are 21
otherwise ineligible for enrollment in the Kentucky Medicaid program because they no 22
longer reside in Kentucky, to the extent permitted under federal law: 23
(1) The cabinet shall: 24
(a) On at least a quarterly basis, review the Public Assistance Reporting 25
Information System, or PARIS, match files submitted to the state by the 26
federal Administration for Children and Families; 27
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(b) Identify individuals enrolled in the Kentucky Medicaid program who may 1
be concurrently enrolled in one (1) or more other states' Medicaid 2
programs; 3
(c) Notify any individual suspected of being concurrently enrolled in the 4
Kentucky Medicaid program and one (1) or more other states' Medicaid 5
programs within thirty (30) days of ide ntification under paragraph (b) of 6
this subsection. Notifications made under this paragraph shall inform 7
individuals: 8
1. That they are required to submit proof of current residency in the 9
Commonwealth within thirty (30) days; 10
2. Of the process for submitti ng proof of current residency to the cabinet 11
and the documents required to be submitted to validate current 12
residency in the Commonwealth; and 13
3. That failure to submit proof of current residency in the 14
Commonwealth within thirty (30) days shall result in the individual 15
being disenrolled from the Medicaid managed care organization in 16
which the individual is enrolled or assigned; 17
(d) For individuals who fail to respond as required under paragraph (c) of this 18
subsection: 19
1. Disenroll the individual from the M edicaid managed care 20
organization in which the individual is enrolled or assigned and place 21
the individual in the Medicaid fee-for-service program; and 22
2. Make a second attempt to notify the individual within forty -five (45) 23
days from the date on which the notice required under paragraph (c) 24
of this subsection was made. Notifications made under this 25
subparagraph shall inform individuals: 26
a. That they must submit proof of current residency in the 27
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Commonwealth within thirty (30) days; 1
b. Of the process for submitting proof of current residency to the 2
cabinet and the documents required to be submitted to validate 3
current residency in the Commonwealth; and 4
c. That failure to submit proof of current residency in the 5
Commonwealth within thirty (30) days shall result in the 6
individual being disenrolled from the Kentucky Medicaid 7
program; 8
(e) Not make capitation payments to any managed care organization with 9
whom the cabinet contracts for the delivery of Medicaid services on behalf 10
of any individ ual disenrolled from managed care in accordance with 11
paragraphs (c) and (d) of this subsection; 12
(f) Upon receipt of a notification required under subsection (2)(b) of this 13
section, provide notice in accordance with paragraphs (c) and (d) of this 14
subsection to the individual identified by the managed care organization 15
and disenroll the individual as required under paragraphs (c) and (d) of this 16
subsection; and 17
(g) Establish administrative penalties for any managed care organization that 18
fails to comply with the requirements of subsection (2) of this section; 19
(2) Each managed care organization with whom the cabinet contracts for the 20
delivery of Medicaid services shall: 21
(a) On at least a monthly basis, make all reasonable efforts to identify any 22
individual who is: 23
1. Enrolled in the Kentucky Medicaid program; 24
2. Served by, enrolled with, or assigned to the managed care 25
organization; and 26
3. Covered by, insured by, or enrolled with the managed care 27
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organization, the managed care organization's parent company, or 1
any subsidiary of the managed care organization or its parent 2
company in another state, regardless of the type of coverage provided 3
in the other state; 4
(b) Promptly notify the cabinet of any individual identified in accordance with 5
paragraph (a) of this subsection; and 6
(c) On a monthly basis, report to the Department for Medicaid Services efforts 7
and activities undertaken to comply with paragraph (a) of this subsection; 8
and 9
(3) (a) The cabinet shall impose a penalty of one thousand dollars ($1,000) for 10
each violation of: 11
1. Subsection (2)(a) and (c) of this section with each month in which a 12
managed care organization fails to comply with subsection (2)(a) and 13
(c) of this section constituting a separate violation; and 14
2. Subsection (2)(b) of this section. 15
(b) Penalties collected under this subsection shall be deposited into the 16
Medicaid managed care organization compliance fund established in 17
Section 11 of this Act. 18
Section 7. KRS 205.178 is amended to read as follows: 19
(1) On at least a monthly basis [At a regularly scheduled interval] , each enrollment or 20
benefit tracking agency associated with the Medicaid program or the Supplemental 21
Nutrition Assistance Program of the cabinet shall receive and review information 22
from the Kent ucky Lottery Corporation and the Kentucky Horse Racing and 23
Gaming Corporation concerning individuals enrolled [as recipients ] in the 24
Medicaid program or the Supplemental Nutrition Assistance Program that may 25
indicate[indicates] a change in circumstances th at would[may] affect eligibility, 26
including but not limited to changes in income or resources. 27
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(2) On at least a monthly basis, each enrollment or benefit tracking agency associated 1
with the Medicaid program or the Supplemental Nutrition Assistance Program of 2
the cabinet shall receive and review information from the Vital Statistics Branch 3
concerning individuals enrolled in the Medicaid program or the Supplemental 4
Nutrition Assistance Program that may indicate [indicates] a change in 5
circumstances that would[may] affect eligibility. 6
(3) On at least a quarterly basis, each enrollment or benefit tracking agency associated 7
with the Medicaid program or the Supplemental Nutrition Assistance Program of 8
the cabinet shall receive and review information from the [ Kent ucky] Office of 9
Unemployment Insurance concerning individuals enrolled in the Medicaid program 10
or the Supplemental Nutrition Assistance Program that may indicate [indicates] a 11
change in circumstances that would[may] affect eligibility, including but not 12
limited to changes in employment or wages. 13
(4) On at least a quarterly basis, each enrollment or benefit tracking agency associated 14
with the Medicaid program or the Supplemental Nutrition Assistance Program of 15
the cabinet shall receive and review information , including information from the 16
Kentucky Transitional Assistance Program, concerning individuals enrolled in the 17
Medicaid program or the Supplemental Nutrition Assistance Program that may 18
indicate[indicates] a change in circumstances that would[may] affect eligibility, 19
including but not limited to potential changes in residency as identified by out -of-20
state electronic benefit transfer transactions. 21
(5) On at least a quarterly basis, each enrollment and benefit tracking agency 22
associated with the Medicaid pr ogram shall receive and review information from 23
the Kentucky Transportation Cabinet, including vehicle registration information, 24
concerning individuals enrolled in the Medicaid program that may indicate a 25
change in circumstances that would affect eligibili ty for Medicaid -covered 26
nonemergency medical transportation services. 27
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(6) On at least an annual basis, each enrollment or benefit tracking agency 1
associated with the Medicaid program shall receive and review information from 2
the Department of Revenue conce rning individuals enrolled in the Medicaid 3
program that may indicate a change in circumstances that would affect eligibility 4
for enrollment in the Medicaid program, including but not limited to changes in 5
adjusted gross income or family composition. 6
(7) On at least a monthly basis, each enrollment or benefit tracking agency 7
associated with the Medicaid program shall receive and review information from 8
the Department of Corrections concerning individuals enrolled in the Medicaid 9
program that may indicate a c hange in circumstances that would affect eligibility 10
for enrollment in the Medicaid program. 11
(8) At a regularly scheduled interval, each enrollment or benefit tracking agency 12
associated with the Medicaid program shall receive and review information 13
related to child support payments received by individuals enrolled in the Medicaid 14
program that may indicate a change in circumstances that would affect eligibility 15
for enrollment in the Medicaid program. 16
(9) On at least a quarterly basis, each enrollment and benefit tracking agency 17
associated with the Medicaid program shall review information from the National 18
Change of Address database, or NCOALink, concerning individuals enrolled in 19
the Medicaid program that may indicate a change in circumstances that would 20
affect eligibility for enrollment in the Medicaid program. 21
(10) The Department for Medicaid Services shall, as permitted under federal law: 22
(a) Enter into a data exchange agreement with the Social Security 23
Administration to receive the full file of death information on at least a 24
quarterly basis; and 25
(b) Upon receipt of the full file of death information and any update to the file, 26
disenroll from the Medicaid program any individual whose death is reported 27
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in the full file of death information. 1
(11)[(5)] Notwithstanding any other provision of law to the contrary: 2
(a) The cabinet and each enrollment or benefit tracking agency associated with 3
the Medicaid program or the Supplemental Nutrition Assistance Program [ of 4
the cabinet] shall enter into a memorandum of understanding with any 5
department, agency, or division for information detailed in this section; and 6
(b) Any department, agency, or division for information detailed in this section, 7
including but not limi ted to the Kentucky Lottery Corporation, the Kentucky 8
Horse Racing and Gaming Corporation, the Vital Statistics Branch, the 9
Office of Unemployment Insurance, [and ] the Department for Community 10
Based Services, the Kentucky Transportation Cabinet, the Depart ment of 11
Revenue, and the Department of Corrections, shall enter into any necessary 12
memoranda of understanding with the cabinet or the enrollment or benefit 13
tracking agency associated with the Medicaid program or the Supplemental 14
Nutrition Assistance Program requesting an agreement pursuant to paragraph 15
(a) of this subsection. 16
(12)[(6)] The cabinet and each enrollment or benefit tracking agenc y associated with 17
the Medicaid program or the Supplemental Nutrition Assistance Program [ of the 18
cabinet] may contract in accordance with KRS Chapter 45A with one (1) or more 19
independent vendors to provide additional data or information that may indicate a 20
change in circumstances that would[may] affect eligibility. 21
(13)[(7)] The cabinet and each enrollment or benefit tracking agency associated with 22
the Medicaid program or the Supplemental Nutrition Assistance Program [of the 23
cabinet ]shall explore joining any multistate cooperative to identify individuals who 24
are also enrolled in public assistance programs outside of this state. 25
(14)[(8)] If the cabinet or an enrollment or benefit tracking agency associated with the 26
Medicaid program or the Supplemental Nutrit ion Assistance Program [of the 27
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cabinet ] receives information concerning an individual enrolled in the Medicaid 1
program or the Supplemental Nutrition Assistance Program that indicates a change 2
in circumstances that would[may] affect eligibility, the cabinet or the enrollment or 3
benefit tracking agency or other appropriate agency shall: 4
(a) For individuals enrolled in the Supplemental Nutrition Assistance Program, 5
review the individual's case; and 6
(b) For individuals enrolled in the Medicaid program, promptly initiate a full 7
and complete eligibility redetermination for the individual. Any eligibility 8
redetermination conducted under this paragraph shall be in addition to 9
semiannual eligibility redeterminations required under Section 5 of this Act 10
and 42 U.S.C. sec. 1396a(e)(14)(L)(i). 11
(15)[(9)] (a) Unless expressly required by federal law or as permitted by this 12
subsection, the cabinet shall not seek, apply for, accept, or renew any waiver 13
of work requirements established by the Supplemental Nutrition Assistance 14
Program under 7 U.S.C. sec. 2015(o) without first obtaining specific 15
authorization from the General Assembly to do so. The cabinet may, without 16
first obtaining specific authorization from the General Assembly, request: 17
1. A waiver of Supplemental Nutritio n Assistance Program work 18
requirements for a county in which the unemployment rate is equal to or 19
greater than ten percent (10%); 20
2. A waiver of Supplemental Nutrition Assistance Program work 21
requirements in a county in which the cabinet determines that ot her 22
economic conditions are severe enough to necessitate a waiver; or 23
3. A statewide waiver of Supplemental Nutrition Assistance Program work 24
requirements if the state's unemployment rate is equal to or greater than 25
ten percent (10%). 26
(b) The cabinet shall not exercise the state's option under 7 U.S.C. sec. 27
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2015(o)(6). 1
(c) The cabinet may assign individuals who are subject to work requirements 2
under 7 U.S.C. sec. 2015(d)(1) to an employment and training program as 3
defined in 7 U.S.C. sec. 2015(d)(4). 4
(16)[(10)] The cabinet shall, in accordance with KRS Chapter 13A, promulgate [all rules 5
and ] administrative regulations necessary for the purposes of carrying out this 6
section. 7
(17)[(11)] Upon request from the Legislative Research Commission, the cabinet [for 8
Health and Family Services ] shall submit a report relating to the number of 9
individuals discovered utilizing services inappropriately, the number of individuals 10
who were removed from one (1) or more public assistance programs as a result of a 11
review under[pursuant] to this section, and the amount of public funds preserved in 12
total and by public assistance program and aggregated by prior years. 13
Section 8. KRS 205.5375 is amended to read as follows: 14
(1) As used in this section: 15
(a) "Department" means the Department for Medicaid Services; 16
(b) "Period of presumptive eligibility" has the same meaning as in 42 C.F.R. sec. 17
435.1101; and 18
(c) "Qualified hospital" has the same meaning as in 42 C.F.R. 435.1110(b). 19
(2) If a qualified hospital determines that an individual meets the criteria for 20
presumptive eligibility using information provided and attested to by the individual, 21
the hospital shall: 22
(a) Notify the department of the determination within five (5) business d ays from 23
the date of determination in a form prescribed by the department; 24
(b) Provide a written eligibility notice to the individual. The written eligibility 25
notice shall, at a minimum, include the following information in plain 26
language and large print: 27
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1. The beginning and end dates of the period of presumptive eligibility; 1
2. Notification that the individual is required to make an application for 2
Medicaid benefits through the individual's local Department for 3
Community Based Services office; 4
3. The location of the individual's local Department for Community Based 5
Services office; 6
4. Notification that if the individual does not file a full Medicaid 7
application before the last day of the following month, the period of 8
presumptive eligibility coverage will end on that day; and 9
5. Notification that if the individual does file a full Medicaid application 10
before the last day of the following month, presumptive eligibility 11
coverage will continue until an eligibility determination is made on the 12
application by the department; 13
(c) Issue a presumptive eligibility identification card or document to the 14
presumed eligible individual; 15
(d) Maintain a record of the presumptive eligibility screening for each 16
application; and 17
(e) Assist presumptively eligible individuals in completing and submitting a full 18
Medicaid application prior to the end of the period of presumptive 19
eligibility[and understanding any documentation requirements]. 20
(3) If a qualified hospital determines that an individual does not meet the criteria for 21
presumptive eligibility using information provided and attested to by the individual, 22
the hospital shall provide the individual with written notification of: 23
(a) The reason for the determination; 24
(b) Notification that the individual may file a full Medicaid a pplication through 25
the individual's local Department for Community Based Services office if the 26
individual wishes to have a formal determination of eligibility made by the 27
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department; and 1
(c) The location of the individual's local Department for Community Based 2
Services office. 3
(4) Notwithstanding any other provision of law to the contrary and to the extent 4
permitted under federal law, a pregnant individual shall be limited to one (1) period 5
of presumptive eligibility per pregnancy. 6
(5) (a) The department shall provide training on all applicable state and federal laws 7
related to presumptive eligibility to all qualified hospitals. 8
(b) Prior to conducting presumptive eligibility screenings and determinations, a 9
qualified hospital's staff, contractor, or vendor responsible for presumptive 10
eligibility screenings and determinations shall be required to complete 11
presumptive eligibility training provided by the department. 12
(6) If a qualified hospital uses a contractor or other vendor for the purpose of 13
conducting presumptive eligibility screenings and determinations, the hospital shall 14
be responsible for monitoring the contractor's or vendor's compliance with all 15
applicable state and federal laws related to presumptive eligibility. 16
(7) [Within ninety (90) days after July 14, 2022, ] The department shall promulgate 17
administrative regulations in accordance with KRS Chapter 13A that are necessary 18
to administer this section. Administrative regulations promulgated pursuant to this 19
subsection shall include but not be limited to a thorough p resumptive eligibility 20
application form to be used by qualified hospitals when making presumptive 21
eligibility determinations using information provided and attested to by an 22
individual. 23
Section 9. KRS 205.200 is amended to read as follows: 24
(1) A needy aged person, a needy blind person, a needy child, a needy permanently and 25
totally disabled person, or a person with whom a needy child lives shall be eligible 26
to receive a public assistance grant only if he or she has made a proper application 27
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or an application has been made on his or her behalf in the manner and form 1
prescribed by administrative regulation. No individual shall be eligible to receive 2
public assistance under more than one (1) category of public assistance for the same 3
period of time. 4
(2) The secretary shall, by administrative regulations, prescribe the conditions of 5
eligibility for public assistance in conformity with the public assistance titles of the 6
Social Security Act, its amendments, and other federal act s and regulations. The 7
secretary shall also promulgate administrative regulations to allow for between a 8
forty percent (40%) and a forty -five percent (45%) ratable reduction in the method 9
of calculating eligibility and benefits for public assistance under Title IV-A of the 10
Federal Social Security Act. In no instance shall grants to families with no income 11
be less than the appropriate grant maximum used for public assistance under Title 12
IV-A of the Federal Social Security Act. As used in this section, "ratab le reduction" 13
means the percentage reduction applied to the deficit between the family's 14
countable income and the standard of need for the appropriate family size. 15
(3) The secretary may by administrative regulation prescribe as a condition of 16
eligibility t hat a needy child regularly attend school, and may further by 17
administrative regulation prescribe the degree of relationship of the person or 18
persons in whose home such needy child must reside. 19
(4) The secretary may by administrative regulation prescribe c onditions for bringing 20
paternity proceedings or actions for support in cases of out of wedlock birth or 21
nonsupport by a parent in the public assistance under Title IV -A of the Federal 22
Social Security Act program. 23
(5) Public assistance shall not be payable to or in behalf of any individual who has 24
taken any legal action in his or her own behalf or in the behalf of others with the 25
intent and purpose of creating eligibility for the assistance. 26
(6) The cabinet shall prompt ly notify the appropriate law enforcement officials of the 27
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furnishing of public assistance under Title IV -A of the Federal Social Security Act 1
in respect to a child who has been deserted or abandoned by a parent. 2
(7) No person shall be eligible for public assistance payments if, after having been 3
determined to be potentially responsible, and afforded notice and opportunity for 4
hearing, he or she refuses without good cause: 5
(a) To register for employment with the state employment service, 6
(b) To accept suitable training, or 7
(c) To accept suitable employment. 8
The secretary may prescribe by administrative regulation, subject to the provisions 9
of KRS Chapter 13A, standards of suitability for training and employment. 10
(8) To the extent permitted by federal law, s cholarships, grants, or other types of 11
financial assistance for education shall not be considered as income for the purpose 12
of determining eligibility for public assistance. 13
(9) To the extent permitted by federal law, any money received because of a settle ment 14
or judgment in a lawsuit brought against a manufacturer or distributor of "Agent 15
Orange" for damages resulting from exposure to "Agent Orange" by a member or 16
veteran of the Armed Forces of the United States or any dependent of such person 17
who served i n Vietnam shall not be considered as income for the purpose of 18
determining eligibility or continuing eligibility for public assistance and shall not be 19
subject to a lien or be available for repayment to the Commonwealth for public 20
assistance received by the recipient. 21
(10) (a) For the purpose of determining eligibility for medical assistance under Title 22
XIX of the Social Security Act and compliance with 42 U.S.C. sec. 23
1396a(xx) and Section 1 of this Act, unless otherwise required by federal law, 24
the cabinet shall only accept self -attestation of income, residency, age, 25
household composition, caretaker or relative status, or receipt of other 26
coverage as verification of last resort prior to enrollment, and the cabinet shall 27
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not request federal authorization or approval to waive or decline to 1
periodically check any available income -related data source to verify 2
eligibility. 3
(b) This subsection shall not apply to any individual who is a resident of an 4
assisted living community as defined in KRS 194A.700 or to a lo ng-term care 5
facility as defined in KRS 216A.010 or hospital licensed under KRS Chapter 6
216B that is using self-attestation to determine presumptive eligibility. 7
(c) If an individual for medical assistance under Title XIX of the Social Security 8
Act willing ly and knowingly self -attests to falsified information related to 9
income, residency, age, household composition, caretaker or relative status, or 10
receipt of other coverage, the cabinet may fine the individual not more than 11
five hundred dollars ($500) per offense. 12
(11) When determining whether an applicant for services or assistance provided under 13
this chapter meets the applicable income eligibility guidelines, the cabinet shall use 14
the most recent income verification data available and consider fluctuating 15
employment income data. 16
(12) If in the normal course of operations, the cabinet finds that an individual has 17
trafficked, sold, distributed, given, or otherwise transferred an electronic benefit 18
transfer card issued by the department for money, service, or other valuable 19
consideration, the cabinet, to the extent permitted under state and federal law: 20
(a) Shall through any means practical, including but not limited to garnishment of 21
future cash assistance benefits, seek recoupment from the individual of any 22
cash benefits trafficked, sold, distributed, given, or otherwise transferred; and 23
(b) May: 24
1. Upon the first violation, deem the individual ineligible for all public 25
assistance programs administered by the cabinet under this chapter for a 26
period of not more than six (6) months; 27
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2. Upon the second violation, deem the individual ineligible for all public 1
assistance programs administered by the cabinet under this chapter for a 2
period of not more than twelve (12) months; and 3
3. Upon the third violation, deem the individual ineligible for all public 4
assistance programs administered by the cabinet under this chapter for a 5
period of not more than five (5) years. 6
(13) (a) Notwithstanding any other provision of Kentucky law, the following shall be 7
disregarded for the purposes of determining an individual's eligibility for a 8
means-tested public assistance program, and the amount of assistance or 9
benefits the individual is eligible to receive under the program: 10
1. Any amount in an ABLE account; 11
2. Any contributions to an ABLE account; and 12
3. Any distribution from an ABLE account for qualified disability 13
expenses. 14
(b) As used in[For purposes of] this subsection: 15
1. "ABLE account" means an account established within any state having a 16
qualified ABLE program as provided in 2 6 U.S.C. sec. 529A, as 17
amended; 18
2. "Kentucky law" includes: 19
a. All provisions of the Kentucky Revised Statutes: 20
b. Any contract to provide Medicaid managed care established 21
pursuant to this chapter; 22
c. Any agreement to operate a Medicaid program established 23
pursuant to this chapter; and 24
d. Any administrative regulation promulgated pursuant to this 25
chapter; and 26
3. "Qualified disability expenses" means expenses described in 26 U.S.C. 27
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sec. 529A of a person who is the beneficiary of an ABLE account. 1
(14) (a) Residency shall not be established for an individual if the individual relocates 2
to Kentucky with the sole intention of establishing eligibility to receive 3
medical services, including substance use disorder treatment services under 4
this chapter. 5
(b) An individual may rebut the sole intention of paragraph (a) of this subsection 6
by showing proof of residency. Proof of resi dency shall include but not be 7
limited to the possession of a valid Kentucky operator's license or a copy of a 8
deed or property tax bill, utility agreement or bill, or rental housing 9
agreement. 10
SECTION 10. A NEW SECTION OF KRS CHAPTER 205 IS CREATED TO 11
READ AS FOLLOWS: 12
Any contract entered into, renewed, or extended on or after the effective date of this 13
Act by the cabinet, or any subdivision thereof, and any managed care organization for 14
the delivery of Medicaid services shall include the following provisions: 15
(1) The managed care organization shall be prohibited from: 16
(a) Contacting or providing any incentive for Medicaid providers to resubmit 17
claims after an initial submission for the purpose of increasing the 18
managed care organization's risk score; 19
(b) Contracting with a vendor or other subcontractor for the purpose of 20
engaging in activities the managed care organization is prohibited from 21
engaging in under paragraph (a) of this subsection; 22
(c) Penalizing a primary care provider for the primary care provider's inability 23
to make contact with a Medicaid enrollee that has been assigned to the 24
primary care provider's roster if the primary care provider has made a 25
good-faith effort, as defined by the Department for Medicaid S ervices in its 26
contract with a managed care organization, to contact the enrollee; 27
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(d) Advertising or otherwise marketing the Medicaid program except to indicate 1
the managed care organization's participation in the Medicaid program; 2
and 3
(e) 1. For the purp oses of assessing, evaluating, or determining network 4
adequacy, counting or otherwise including in any analysis of network 5
adequacy an inactive Medicaid provider. 6
2. As used in this paragraph, "inactive Medicaid provider" means an 7
enrolled Medicaid provide r who has submitted fewer than one (1) 8
encounter or claim for payment for Medicaid covered services to a 9
given managed care organization within the pervious twelve (12) 10
months; 11
(2) The managed care organization shall be required to: 12
(a) Notify the Departme nt for Medicaid Services and the Social Security 13
Administration in the appropriate county within five (5) business days of 14
receiving notice from any source of the death of a Medicaid enrollee served 15
by the managed care organization; 16
(b) Collaborate with th e Department for Medicaid Services to implement and 17
execute a value -based payment model that aligns incentives for enrollees, 18
providers, managed care organizations, and the Commonwealth to improve 19
quality and health care outcomes. The value -based payment model required 20
under this subsection shall include a two percent (2%) withhold from each 21
managed care organization's capitation amount that can be earned back in 22
full or in part by the managed care organization through the achievement 23
of designated value-based measures that shall include but not be limited to: 24
1. Hospital readmission rates; 25
2. Cancer screening rates; 26
3. Child and adolescent well care visits; 27
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4. Prenatal and postpartum care; 1
5. Emergency department utilization rates; 2
6. Behavioral health treatment and counseling services; and 3
7. Recovery services; and 4
(c) Comply with: 5
1. This section and Sections 3, 12, 13, and subsection (2) of Section 6 of 6
this Act; 7
2. All terms, conditions, requirements , performance standards, and 8
obligations created under or included in the contract between the 9
managed care organization and the cabinet for the delivery of 10
Medicaid services; 11
3. KRS 304.17A-708; and 12
4. All sections of Subtitle 17A of KRS Chapter 304 liste d in KRS 13
205.522; 14
(3) (a) If the Department for Medicaid Services receives mail returned as 15
undeliverable following an attempt to contact a Medicaid beneficiary by 16
first-class mail, the department shall make a good -faith effort to obtain the 17
beneficiary's current and correct address. The good -faith effort shall 18
include: 19
1. First, requesting the beneficiary's current and correct address from 20
his or her managed care organization; 21
2. Accessing and reviewing all available state and federal data sources, 22
including but not limited to the National Change of Address database, 23
from which the department might obtain the beneficiary's current and 24
correct address; and 25
3. Attempting to obtain the beneficiary's current and correct address 26
directly from the beneficiary by attempting to contact him or her 27
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through at least two (2) of the following means of communication: 1
a. Telephone; 2
b. Text message; and 3
c. Email message. 4
(b) 1. The good-faith effort required under paragraph (a) of this subsection 5
shall continue for at least thirty (30) days after the date on which the 6
department first requested the beneficiary's current and correct 7
address from his or her managed care organization. 8
2. If the department is able to obtain the beneficiary's current and 9
correct address, the depa rtment shall resend any mail that was 10
returned to the department as undeliverable. 11
3. If the department is not able to obtain the beneficiary's current and 12
correct address within thirty (30) days after the date on which the 13
department first requested the b eneficiary's current and correct 14
address from his or her managed care organization, the department 15
shall, to the extent permitted under federal law, disenroll the 16
individual from the Medicaid program pending any appeal that may 17
be required or guaranteed under federal law; 18
(4) The Department for Medicaid Services shall, in all instances, exercise its rights 19
under a contract with a Medicaid managed care organization to impose all 20
remedies available to the department under the terms of the contract, at law, or 21
equity if the department determines that the managed care organization or a 22
subcontractor acting on behalf of the managed care organization has: 23
(a) Violated any provision of the contract between the department and the 24
managed care organization; or 25
(b) Failed to fully comply with any applicable state or federal law or regulation, 26
compliance with which is mandated expressly or implicitly by the contract; 27
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and 1
(5) (a) Penalties for violations of state and federal law related to the Medicaid 2
program, including but not limited to this section, and any other contract 3
requirements or prohibitions imposed upon the managed care organization 4
by the cabinet, including but not limited to: 5
1. The penalty for a violation of subsection (1)(a) or (b) of this section 6
shall be at least five hundred dollars ($500) for each claim a managed 7
care organization requests or incentivizes a provider to resubmit; 8
2. The penalty for a violation of subsection (1)(c) of this section shall be 9
at least one thousand dollars ($1,000) per violation; 10
3. The penalty for a violation of subsection (1)(d) of this section shall be 11
at least five thousand dollars ($5,000) per violation; 12
4. The penalty for a violation of subsection (1)(e) of this section shall be 13
at least ten thousand dollars ($10,000) for each i nactive provider 14
included in an analysis of network adequacy; and 15
5. The penalty for a violation of subsection (2)(a) of this section shall be 16
at least one thousand dollars ($1,000) per violation. 17
(b) All penalties and fines imposed or assessed against a Medicaid managed 18
care organization by the Cabinet for Health and Family Services, including 19
but not limited to those penalties established in paragraph (a) of this 20
subsection, shall be deposited into the Medicaid managed care organization 21
compliance fund established in Section 11 of this Act. 22
SECTION 11. A NEW SECTION OF KRS CHAPTER 205 IS CREATED TO 23
READ AS FOLLOWS: 24
(1) (a) There is hereby established in the State Treasury a restricted fund to be 25
known as the Medicaid managed care organization compliance fund. 26
(b) The fund shall consist of all penalties or fines imposed by the cabinet on a 27
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managed care organization for violations of Section 10 of this Act, any 1
other contract violation, or any violation of state or federal law related to 2
the Medicaid program, regardless of the manner in which the penalty of 3
fine is paid by a managed care organization, including but not limited to 4
reductions in future capitation payments or any monies withheld by the 5
Department for Medicaid Services for payment of penalties or fines. 6
(c) The fund shall be administered by the cabinet. 7
(d) Notwithstanding KRS 45.229, fund amounts not appropriated at the close of 8
a fiscal year shall not lapse but shall be carried forward into the next fiscal 9
year. 10
(e) Any interest earnings of the fund shall become a part of the fund and shall 11
not lapse. 12
(f) Notwithstanding KRS 48.630, expenditures shall not be made from this 13
fund unless expressly appropriated by the General Assembly. 14
(g) It is the intent of the G eneral Assembly that monies in the fund shall 15
provide financial support for future Medicaid reimbursement rate increases 16
upon appropriation by the General Assembly. 17
(2) The cabinet shall submit specific recommendations for the use of monies in the 18
Medicaid managed care organization compliance fund to increase certain 19
Medicaid reimbursement rates to the Legislative Research Commission for 20
referral to the Interim Joint Committees on Appropriations and Revenue and 21
Health Services and the Medicaid Oversight and Advisory Board established in 22
KRS 7A.273 by November 1, 2027, and November 1 of each following odd -23
numbered year. 24
Section 12. KRS 205.533 is amended to read as follows: 25
(1) [By January 1, 2019, ] A managed care organizat ion shall maintain[establish] an 26
interactive website[Web site] , operated by the managed care organization, that 27
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allows providers to file grievances, appeals, and supporting documentation 1
electronically in an encrypted format that complies with federal law and that allows 2
a provider to review the current status of a matter relating to an appeal or a 3
grievance filed concerning a submitted claim. 4
(2) Each managed care organization's website established in accordance with 5
subsection (1) of this section shall in clude, in a highly visible and easily 6
accessible manner, the following: 7
(a) The name, individual email address, and individual telephone number for 8
each of the managed care organization's provider relations representatives 9
for: 10
1. Behavioral health; 11
2. Physical health; and 12
3. Provider contract changes; and 13
(b) A detailed explanation, written in plain and simple to understand language, 14
of the managed care organization's process for: 15
1. Internal appeals; and 16
2. Providers to request an external, independent third-party review. 17
(3) Information required to be accessible on a managed care organization's website 18
pursuant to subsection (2) of this section shall be kept current and updated within 19
thirty (30) days of any change to the information. 20
Section 13. KRS 205.534 is amended to read as follows: 21
(1) A Medicaid managed care organization with whom the department contracts for 22
the delivery of Medicaid services shall: 23
(a) Provide: 24
1. A toll-free telephone line for providers to contact the insurer for claims 25
resolution for forty (40) hours a week during normal business hours in 26
this state; 27
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2. A toll -free telephone line for providers to submit requests for 1
authorizations of covered servi ces during normal business hours and 2
extended hours in this state on Monday and Friday through 6 p.m., 3
including federal holidays; 4
3. With regard to any adverse payment or coverage determination, copies 5
of all documents, records, and other information rele vant to a 6
determination, including medical necessity criteria and any processes, 7
strategies, or evidentiary standards relied upon, if requested by the 8
provider. Documents, records, and other information required to be 9
provided under this paragraph shall be provided at no cost to the 10
provider; and 11
4. For any adverse payment or coverage determination, a written reply in 12
sufficient detail to inform the provider of all reasons for the 13
determination. The written reply shall include information about the 14
provider's right to request and receive at no cost to the provider 15
documents, records, and other information under subparagraph 3. of this 16
paragraph; 17
(b) Afford each participating provider the opportunity for an in -person meeting 18
with a representative of the managed care organization on: 19
1. Any clean claim that remains unpaid in violation of KRS 304.17A -700 20
to 304.17A-730; and 21
2. Any claim that remains unpaid for forty -five (45) days or more after the 22
date the claim is received by the managed care organization and that 23
individually or in the aggregate exceeds two thousand five hundred 24
dollars ($2,500); 25
(c) Reprocess claims that are incorrectly paid or denied in error, in compliance 26
with KRS 304.17A-708. The reprocessing shall not require a provider to rebill 27
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or res ubmit claims to obtain correct payment. A[ No] claim shall not be 1
denied for timely filing if the initial claim was timely submitted;[ and] 2
(d) Establish processes for internal appeals, including provisions for: 3
1. Allowing a provider to file any grievance or appeal related to the 4
reduction or denial of the claim within one hundred twenty (120) [sixty 5
(60)] days of confirmed receipt of a notification from the managed care 6
organization that payment for a submitted claim has been reduced or 7
denied;[ and] 8
2. a. Ensuring the timely consideration and disposition of any grievance 9
or any appeal within thirty (30) days from the date the grievance or 10
appeal is filed with the managed care organization by a provider 11
under this paragraph. 12
b. Failure of the managed care organization to comply with 13
subdivision a. of this subparagraph shall result in a fine or 14
penalty as provided in subsection (6) of this section; and 15
3. Ensuring that, following the resolution of an appeal that results in a 16
determination that a monetary amount is owed to a provider, payment 17
is made in full to the provider within thirty (30) days from the date on 18
which the appeal was resolved; and 19
(e) With regard to provider audits: 20
1. Allow at least thirty (30) calendar days for a provider to provide or 21
grant access to the requested records; 22
2. Complete an audit within one hundred eighty (18) calendar days for 23
the data on whic h the audit was initiated by the managed care 24
organization unless the provider subject to the audit fails to provide or 25
grant access to requested records in a timely manner; 26
3. Only recoup denied payments or issue a demand for payment from a 27
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provider upon the final disposition of the audit, including the appeals 1
process established in KRS 205.646; and 2
4. Base recoupment of claims on the actual overpayment or 3
underpayment of claims unless the provider agrees to a settlement to 4
the contrary. 5
(2) (a) As used in[For the purposes of] this subsection: 6
1. "Timely" means that an authorization or preauthorization request shall 7
be approved: 8
a. For an expedited authorization request, within twenty-four 9
(24)[seventy-two (72)] hours after receipt of the request. The 10
timeframe for an expedited authorization request may be extended 11
by up to fourteen (14) days if: 12
i. The enrollee requests an extension; or 13
ii. The Medicaid managed care organization justifies to the 14
department a need for additional information and how the 15
extension is in the enrollee's interest; and 16
b. For a standard authorization request, within five (5) calendar [two 17
(2) business] days. The tim eframe for a standard authorization 18
request may be extended by up to fourteen (14) additional days if: 19
i. The provider or enrollee requests an extension; or 20
ii. The Medicaid managed care organization justifies to the 21
department a need for additional infor mation and how the 22
extension is in the enrollee's interest; and 23
2. a. "Expedited authorization request" means a request for 24
authorization or preauthorization where the provider determines 25
that following the standard [ a] timeframe could seriously 26
jeopardize an enrollee's life or health, or ability to attain, maintain, 27
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or regain maximum function.[; and] 1
b. A request for authorization or preauthorization for treatment of an 2
enrollee with a diagnosis of substance use disorder shall be 3
considered an expedited au thorization request by the provider and 4
the managed care organization. 5
(b) A decision by a managed care organization on an authorization or 6
preauthorization request for physical, behavioral, or other medically necessary 7
services shall be made in a timely a nd consistent manner so that Medicaid 8
members with comparable medical needs receive a comparable, consistent 9
level, amount, and duration of services as supported by the member's medical 10
condition, records, and previous affirmative coverage decisions. 11
(3) (a) Each managed care organization shall report on a monthly basis to the 12
department: 13
1. The number and dollar value of claims received that were denied, 14
suspended, or approved for payment; 15
2. The number of requests for authorization of services and the num ber of 16
such requests that were approved and denied; 17
3. The number of internal appeals and grievances filed by members and by 18
providers and the type of service related to the grievance or appeal, the 19
total dollar amount of all denials being appealed, the t ime of 20
resolution, the number of internal appeals and grievances where the 21
initial denial was overturned and the type of service and dollar amount 22
associated with the overturned denials;[ and] 23
4. For each internal appeal or grievance not resolved within si xty (60) 24
calendar days, the name of the provider who filed the unresolved 25
internal appeal or grievance, the dollar amount of the claim that was 26
denied if a denial is being appealed, the reason for the delay in 27
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resolving the internal appeal or grievance, th e current status of the 1
internal appeal or grievance, and the outcome determination if 2
rendered prior to the filing of the report; and 3
5. Any other information required by the department. 4
(b) The data required in paragraph (a) of this subsection shall be s eparately 5
reported by provider category, as prescribed by the department, and shall at a 6
minimum include inpatient acute care hospital services, inpatient psychiatric 7
hospital services, outpatient hospital services, residential behavioral health 8
services, and outpatient behavioral health services. 9
(4) On a monthly basis, the department shall transmit to the Department of Insurance a 10
report of each corrective action plan, fine, or sanction assessed against a Medicaid 11
managed care organization for violation o f a Medicaid managed care organization's 12
contract relating to prompt payment of claims. The Department of Insurance shall 13
then make a determination of whether the contract violation was also a violation of 14
KRS 304.17A-700 to 304.17A-730. 15
(5) By December 15 of each year, the department shall submit to the Legislative 16
Research Commission for referral to the Interim Joint Committee on Health 17
Services, the Legislative Oversight and Investigations Committee, and the 18
Medicaid Oversight and Advisory Board a report containing the following 19
information for the previous state fiscal year and reported separately for each 20
managed care organization with whom the department has contracted for the 21
delivery of Medicaid services: 22
(a) The number and dollar value of all claims that were received by the 23
managed care organization and the number and dollar value of those 24
claims that were approved for payment, denied, or suspended; 25
(b) The number of requests for authorization of services received and the 26
number of those requests that were approved or denied; 27
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(c) The number of internal appeals and grievances filed by Medicaid enrollees 1
and by providers, the types of services to which the internal appeals and 2
grievances relate, the total dollar amount of denials that were appealed, th e 3
average length of time to resolution, the number of internal appeals and 4
grievances where the initial denial was overturned, and the types of services 5
and dollar amount of overturned denials; and 6
(d) The number of internal appeals and grievances not reso lved within sixty 7
(60) calendar days, the ten (10) most common reasons given for delays, the 8
total dollar amount when a denial is being appealed, and the number of 9
final determinations made in favor of a provider. 10
(6) Any Medicaid managed care organization that fails to comply with subsection 11
(1)(d)2. of this section or KRS 205.522, 205.532 to 205.536, or[and] 304.17A-515 12
may be subject to fines, penalties, and sanctions, up to and including termination, as 13
established under its Medicaid managed care contract with the department. 14
(7) The department may promulgate administrative regulations in accordance with 15
KRS Chapter 13A to implement and enforce this section. 16
SECTION 14. A NEW SECTION OF KRS CHAPTER 205 IS CREATED TO 17
READ AS FOLLOWS: 18
(1) The provision of nonemergency medical transportation services to eligible 19
Medicaid enrolled beneficiaries in the Commonwealth shall comply with 42 20
U.S.C. sec. 1396a(a)(87), 42 C.F.R. sec. 431.53, 42 C.F.R. sec. 440.170, any other 21
relevant federal law or regulation, and this section, except that this section shall 22
not apply to any nonemergency medical transportation services, including 23
transportation via stretcher, covered by a Medicaid managed care organization. 24
(2) A nonemergency medical transportation service program administered under this 25
section and relevant federal law shall: 26
(a) Be administered under a regional brokerage delivery model; 27
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(b) 1. Utilize a capitated payment model. 1
2. Capitation payments made to regional brokers shall be: 2
a. Actuarially sound; 3
b. Set by an actuary contracted by the Departm ent for Medicaid 4
Services; 5
c. Calculated based only on the number of nonemergency medical 6
transportation service eligible Medicaid enrollees, as determined 7
by the Department for Medicaid Services in accordance with 8
subsection (2)(c) of Section 5 of this Ac t, within a given region 9
and shall not be based on the total number of Medicaid 10
enrollees; and 11
d. Calculated separately for each region with consideration given to 12
each region's average trip time, average trip distance or average 13
mileage per trip, and othe r region-specific factors, including but 14
not limited to geography, terrain, and population density; and 15
(c) Require regional brokers to: 16
1. Achieve an annual medical loss ratio for each state fiscal year as 17
required under subsection (3) of this section; 18
2. Provide a remittance to the state of any excess capitation payments for 19
any state fiscal year in which the regional broker fails to achieve an 20
annual medical loss ratio as required under subsection (3) of this 21
section; 22
3. a. Ensure that all vehicles used to provide Medicaid -covered 23
nonemergency medical transportation services are equipped with 24
a global positioning system device that enables the broker to 25
determine the precise location of the vehicle at all times when the 26
vehicle is being operated to provid e nonemergency medical 27
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transportation services. 1
b. Any cost that may be associated with the requirement to equip 2
vehicles used to provide Medicaid -covered nonemergency 3
medical transportation services with a global positioning system 4
device shall be borne b y the regional broker and not the 5
Department for Medicaid Services or any other state agency; and 6
4. Collaborate with the Department for Medicaid Services, or another 7
agency in state government or a private entity with which the 8
department has contracted f or the administration of a nonemergency 9
medical transportation service program, to implement and execute a 10
performance-based payment model that aligns incentives for Medicaid 11
enrollees, drivers, regional brokers, and the Commonwealth to 12
improve quality, re liability, and cost -effectiveness in the 13
nonemergency medical transportation service program. The 14
performance-based payment model required under this subparagraph 15
shall include a two percent (2%) withhold from each regional broker's 16
capitation amount that can be earned back in full or in part by the 17
regional transportation broker through achievement of designated 18
performance-based measures which shall: 19
a. Be developed in a manner that reflects the unique circumstances 20
of each region; and 21
b. Include but not be limited to: 22
i. Utilization rates; 23
ii. The number of nonemergency medical transportation 24
service trips completed; 25
iii. The number of nonemergency medical transportation 26
service trips canceled or rescheduled; 27
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iv. The number of delayed nonemergency medical 1
transportation service trips; 2
v. Average trip time; 3
vi. Average miles per trip; 4
vii. The amount of time required to schedule a nonemergency 5
medical transportation service; and 6
viii. Rider satisfaction. 7
(3) (a) For the state fiscal year beginning July 1, 2026, regional brokers shall be 8
required to achieve a medical loss ratio of at least eighty-five percent (85%). 9
(b) For the state fiscal year beginning July 1, 2027, regional brokers shall be 10
required to achieve a medical loss ratio of at least eighty -seven percent 11
(87%). 12
(c) For the state fiscal year beginning July 1, 2028, regional brokers shall be 13
required to achieve a medical loss ratio of at least eighty -nine percent 14
(89%). 15
(d) For the state fiscal year beginning July 1, 2029, and each state fiscal year 16
thereafter, regional brokers shall be required to achieve a medical loss ratio 17
of at least ninety percent (90%). 18
(4) Utilization rates for nonemergency medical transportation services, including 19
when calculated by an actuary under subsection (2) of this section, shall consider 20
only nonemergency medical transportation service eligible Medic aid enrollees, as 21
determined by the Department for Medicaid Services in accordance with 22
subsection (2)(c) of Section 5 of this Act, within a given region and shall not be 23
based on the total number of Medicaid enrollees. 24
(5) (a) A skilled nursing facility o r hospital shall be permitted to provide 25
nonemergency medical transportation services for residents of the skilled 26
nursing facility or patients of the hospital if the transportation service would 27
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be considered a Medicaid -covered service if provided by a dr iver contracted 1
by a nonemergency medical transportation service regional broker. 2
(b) A skilled nursing facility or hospital that provides nonemergency medical 3
transportation services under this subsection shall be eligible for 4
reimbursement by the locally contracted nonemergency medical 5
transportation service regional broker at the same mileage rate as would be 6
paid to a driver contracted by the regional broker for the same service. 7
(c) This subsection shall not establish or impose upon a skilled nursing f acility 8
or hospital any duty or responsibility to provide nonemergency 9
transportation services to an individual who is not a resident of the facility 10
or patient of the hospital. 11
(6) When submitting data or reports to the Department for Medicaid Services or any 12
other agency of state government with responsibility for oversight or 13
administration of the nonemergency medical transportation services, the chief 14
executive officer, chief financial officer, president, executive director, or another 15
officer of a regional broker shall attest, to the best of his or her knowledge, to the 16
truthfulness, accuracy, and completeness of all data or reports at the time of 17
submission. 18
(7) Beginning in 2027, the Department for Medicaid Services shall conduct an 19
annual review of t he nonemergency medical transportation service program and 20
submit a report to the Legislative Research Commission for referral to the 21
Interim Joint Committees on Health Services and Appropriations and Revenue 22
and the Medicaid Oversight and Advisory Board b y July 1 of each year. The 23
review and report required by this subsection shall, at a minimum, include 24
information and recommendations for the following: 25
(a) Utilization rates; 26
(b) The number of nonemergency medical transportation service trips 27
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completed; 1
(c) The number of nonemergency medical transportation service trips cancelled 2
or rescheduled, including the reason for cancellation or rescheduling; 3
(d) The number of delayed nonemergency medical transportation service trips; 4
(e) Average trip time; 5
(f) Average miles per trip; 6
(g) The amount of time required to schedule a nonemergency medical 7
transportation service; 8
(h) Rider satisfaction; and 9
(i) The performance -based payment model required under subsection (5) of 10
this section. 11
SECTION 15. A NEW SECTION OF KRS CHAPTER 205 IS CREATED TO 12
READ AS FOLLOWS: 13
(1) As used in this section and Section 25 of this Act: 14
(a) "Department": 15
1. Means the Department for Medicaid Services; and 16
2. Includes any other agency of state government or nongovernmental 17
entity contracted by the department to administer any aspect of a 18
waiver program; 19
(b) "Waiver program" means a 1915(c) home and community -based waiver 20
program approved by the federal Centers for Medicare and Medicaid 21
Services and administered by the department or any other subdivision of the 22
cabinet; and 23
(c) "Waiver program application" means any waiver program application, 24
including a waiver waitlist application or application to begin receiv ing 25
waiver program services. 26
(2) (a) The department shall require any individual applying for waiver program 27
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services, including any individuals applying for or requesting placement on 1
a waiver waitlist, to submit a completed waiver program application tha t 2
includes a provider's recommendation for waiver program services and 3
provider attestation to the primary diagnosis for which the individual is 4
seeking waiver program services. 5
(b) Except as provided in paragraph (c) of this subsection, the department sha ll 6
not place any individual on a waiver waitlist or approve any individual to 7
receive waiver program services if the individual has not completed and 8
submitted a waiver program application that includes a provider's 9
recommendation for waiver program services and provider attestation to the 10
primary diagnosis for which the individual is seeking waiver program 11
services. 12
(c) An individual who was placed on a waiver waitlist on or before the effective 13
date of this Act shall be allowed twelve (12) months from the effective date 14
of this Act to submit a waiver program application that includes a provider's 15
recommendation for waiver program services and provider attestation to the 16
primary diagnosis for which the individual is seeking waiver program 17
services. Any indi vidual who was placed on a waiver waitlist on or before 18
the effective date of this Act who fails to comply with the requirements of 19
this paragraph shall be removed from the waiver waitlist. 20
(d) As used in this subsection, "provider" means a physician or ph ysician 21
assistant licensed under KRS Chapter 311, an advanced practice registered 22
nurse licensed under KRS Chapter 314, or a licensed psychologist licensed 23
under KRS Chapter 319. 24
(3) By July 1, 2026, the department shall identify, designate, and require th e use of a 25
waiver-specific level of care assessment tool for each waiver program operated by 26
the department. The level of care assessment tools designated under this 27
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subsection shall: 1
(a) Be nationally recognized; 2
(b) At a minimum, recommend the frequency, duration, and intensity of 3
services needed by the individual; and 4
(c) Be age-appropriate relative to the population served by the waiver program 5
for which it is designated. 6
(4) All level of care assessments, including annual level of care reevaluations, s hall 7
utilize the waiver-specific level of care assessment tools designated in accordance 8
with subsection (3) of this section. 9
(5) Notwithstanding subsections (3) and (4) of this section, an individual who is 10
eighteen (18) years of age or younger and curren tly receiving waiver services on 11
the effective date of this Act shall not be reassessed using the level of care 12
assessment tools designated under subsection (3) of this section and shall 13
continue to be reassessed as required under state and federal law usi ng the 14
assessment tool in effect on the effective date of this Act until he or she reaches 15
eighteen (18) years of age. 16
(6) The department shall undertake efforts to encourage waiver service providers to 17
develop innovative programs that increase the quality and value of care while 18
reducing costs of the waiver programs. 19
(7) (a) Except as provided in paragraphs (b) and (c) of this subsection and to the 20
extent permitted under federal law, in order to be eligible for enrollment in 21
a waiver program an individual shall be a citizen of the United States or a 22
qualified alien as defined in 8 U.S.C. sec. 1641 and have been a resident of 23
the Commonwealth for at least one (1) year prior to enrollment. 24
(b) Notwithstanding paragraph (a) of this subsection, an individual wh o has 25
been a resident of the Commonwealth for less than one (1) year may be 26
enrolled in a waiver program for which there is no waitlist. 27
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(c) This subsection shall not apply to: 1
1. Individuals enrolled in a waiver program prior to the effective date of 2
this Act; or 3
2. Members of the United States Armed Forces, their spouses or 4
dependents, or veterans. 5
(8) (a) The cabinet shall reserve capacity in each waiver program to ensure 6
availability of waiver slots for individuals determined to have an emergency 7
need status and shall develop waitlist management policies for individuals 8
seeking emergency placement in a waiver program, including but not 9
limited to, by January 1, 2027, for each waiver program, development of 10
waiver-specific emergency need allocation criter ia for any waiver program 11
for which such criteria do not already exist on the effective date of this Act. 12
(b) Allocation criteria developed pursuant to this subsection for the home and 13
community based waiver, or HCB waiver, shall prioritize the allocation of 14
reserve capacity waiver slots to individuals determined through assessment 15
to be in need of skilled nursing services through a waiver program. 16
(9) (a) For the purposes of identifying and eliminating waste, fraud, and abuse in 17
the 1915(c) waiver programs , any person who knows or has reasonable 18
cause to believe that a violation of waiver program policy or law, including 19
but not limited to this section, this chapter, any administrative regulation 20
promulgated under this chapter, waiver program documents appr oved by 21
the federal Centers for Medicare and Medicaid Services, federal Medicaid -22
related statutes or regulations, or contracts entered into by any agency of 23
state government for administration of the waiver programs, has been or is 24
being committed by any p erson, corporation, or entity, shall report or cause 25
to be reported to the Office of Medicaid Fraud and Abuse Control in the 26
Office of the Attorney General, or the Medicaid Fraud and Abuse hotline as 27
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required under KRS 205.8465. 1
(b) This subsection and KRS 205.8465 shall apply to area development districts, 2
or any other agency of state government, quasi -governmental agency, or 3
private entity tasked with administering or overseeing a patient directed 4
services program under which waiver participants are permi tted to directly 5
employ caregiving staff. Any person who knows or has reasonable cause to 6
believe that any fraudulent activity in the hiring, employment, or 7
compensation of patient directed services staff has occurred or is ongoing 8
shall report or cause to be reported to the Office of Medicaid Fraud and 9
Abuse Control. 10
(10) On a quarterly basis beginning July 1, 2026, the cabinet shall prepare and submit 11
a report to the Legislative Research Commission for referral to the Interim Joint 12
Committees on Appropria tions and Revenue and Families and Children and the 13
Medicaid Oversight and Advisory Board on waiver program expenditures and 14
waiver service utilization rates for the quarter immediately preceding the most 15
recent quarter. 16
SECTION 16. A NEW SECTION OF KRS 7A.270 TO 7A.290 IS CREATED 17
TO READ AS FOLLOWS: 18
(1) The General Assembly finds and declares that: 19
(a) The ability to conduct thorough and systematic evaluations of state agencies 20
and their various departments, divisions, and programs is necessary to 21
ensure that the General Assembly has access to factual information 22
necessary to discharge its legislative duties; 23
(b) Chief among the General Assembly's legislative duties is the responsibility 24
to engage in meaningful legislative oversight of state agencies and their 25
various departments, divisions, and programs, including but not limited to 26
the Cabinet for Healt h and Family Services, the Department for Medicaid 27
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Services, and the Medicaid program; 1
(c) The General Assembly's legislative duties also include the responsibility to 2
engage in effective, data -driven, and evidence -based policy making and the 3
appropriation of funds to provide for the effective and efficient 4
administration of the Medicaid program in a manner that is transparent, 5
responsive to the health care needs of the Commonwealth's most vulnerable 6
citizens, and representative of responsible stewardship of taxpayer dollars; 7
(d) The duty to engage in effective, data -driven, and evidence -based policy 8
making and the appropriation of funds related to the Medicaid program and 9
meaningful legislative oversight is only possible when the General Assembly 10
has immedi ate and unobstructed access to current and timely data, 11
evidence, records, and information that may be in the possession of or 12
housed within the cabinet and its various departments and divisions; 13
(e) Existing policies and procedures for the acquisition of current and timely 14
data, evidence, records, and information by the General Assembly from the 15
cabinet and its various departments and divisions is unnecessarily 16
bureaucratic and burdensome in nature and frequently results in untimely 17
delays that hinder the General Assembly's ability to discharge its legislative 18
duties; and 19
(f) Providing the General Assembly with continuous and ongoing access to 20
data, evidence, records, and information pertaining to the Medicaid 21
program and the administration thereof is criti cal to ensuring that the 22
General Assembly is able to conduct the thorough and systematic 23
evaluations that are a necessary precursor to the body's effective and 24
meaningful discharge of its oversight, policy -making, and appropriation 25
duties. 26
(2) (a) No later than fourteen (14) calendar days after the effective date of this Act, 27
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the cabinet shall provide the Commission with a comprehensive and 1
exhaustive list of all databases, datasets, electronic records, and files 2
pertaining to the Medicaid program or any as pect thereof that are 3
maintained by or in the possession of the cabinet or any of its various 4
departments and divisions. 5
(b) No later than thirty (30) calendar days after the effective date of this Act, 6
the director of the Commission shall provide the cabi net with a list of 7
databases, datasets, electronic records, and files determined by the director 8
to be necessary for the meaningful and effective discharge of legislative 9
duties, including oversight, policy making, and the appropriation of funds to 10
provide for the administration of the Medicaid program by the General 11
Assembly. 12
(c) No later than July 1, 2026, the cabinet shall provide the General Assembly 13
with continuous and ongoing access to all databases, datasets, electronic 14
records, and files determined by the director of the Commission to be 15
necessary for the meaningful and effective discharge of legislative duties, 16
including oversight, policy making, and the appropriation of funds to 17
provide for the administration of the Medicaid program by the General 18
Assembly. 19
(3) In providing the continuous and ongoing access required under subsection (2) of 20
this section, the cabinet shall: 21
(a) Ensure that the director of the Commission and any nonpartisan employee 22
thereof designated by the director have electronic, m achine-readable, read-23
only, on -demand access at their regular workstations to all databases, 24
datasets, electronic records, and files determined by the director of the 25
Commission to be necessary for the meaningful and effective discharge of 26
legislative duties by the General Assembly; 27
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(b) Consult with the director of the Commission and the Kentucky Office of 1
Information Technology on the manner and method by which access is 2
provided; and 3
(c) Provide training on methods to access the databases, datasets, elect ronic 4
records, and files in a secure manner to the director of the Commission and 5
any nonpartisan employee thereof designated by the director. 6
(4) The Commission and the cabinet may enter into a memorandum of 7
understanding governing the Commission's access to the shared databases, 8
datasets, electronic records, and files. Any memorandum of understanding that 9
may be entered into under this subsection: 10
(a) Shall not preclude or prohibit the Commission from providing information 11
shared with the Commission under this section to any vendor or entity with 12
which the Commission may contract for the purpose of analyzing, 13
reviewing, studying, investigating, or evaluating the Medicaid program or 14
any aspect thereof, including but not limited to any vendor with which the 15
Commission may contract pursuant to Section 20 of this Act; 16
(b) May include requirements for otherwise ensuring and maintaining the 17
confidentiality and security of all databases, datasets, electronic records, 18
and files shared with the Commission under this section, including but not 19
limited to requirements that may be necessary to comply with the Health 20
Insurance Portability and Accountability Act of 1996, Pub. L. No. 104 -191; 21
and 22
(c) Shall be no more restrictive than any other current memorandum of 23
understanding between the cabinet and any other entity governing access to 24
data shared with the Commission under this section. 25
(5) The list of databases, datasets, electronic records, and files submitted by the 26
director of the Commission pursuant to subsection (2 )(b) of this section may be 27
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amended by the director of the Commission as the needs of the General Assembly 1
change. When the cabinet is notified of such an amendment, the cabinet shall 2
ensure that the Commission is provided with access to any newly requeste d 3
databases, datasets, electronic records, or files within thirty (30) calendar days. 4
(6) (a) In addition to the data -sharing requirements established in subsections (2), 5
(3), (4), and (5) of this section, the cabinet shall provide the Commission 6
with a copy of: 7
1. Any external audit report related to the Medicaid program prepared by 8
any external federal or state entity, including but not limited to the 9
federal Centers for Medicare and Medicaid Services, the United States 10
Department of Health and Human Serv ices Office of the Inspector 11
General, or the Auditor of Public Accounts; 12
2. Any report required under 42 C.F.R. sec. 433, or 42 C.F.R. sec. 438 13
Subpart B or E; 14
3. Any report or data that may be submitted to the cabinet by any vendor 15
or entity with which th e cabinet has contracted for administration, 16
examination, study, or review of any aspect of the Medicaid program, 17
including but not limited to: 18
a. Medicaid managed care capitation rate certifications; 19
b. Nonemergency medical transportation rate certifications; and 20
c. Any medical loss ratio reports that require approval by the 21
federal Centers for Medicare and Medicaid Services; and 22
4. Any other report or action that requires approval by the federal 23
Centers for Medicare and Medicaid Services. 24
(b) All reports required to be provided to the Commission under this subsection 25
shall be provided within thirty (30) calendar days of the date on w hich the 26
report is completed or delivered to the cabinet. 27
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SECTION 17. A NEW SECTION OF KRS 7A.270 TO 7A.290 IS CREATED 1
TO READ AS FOLLOWS: 2
(1) In order to facilitate the board's ongoing efforts to continuously improve health 3
outcomes in a cost -efficient and effective manner, the Commission shall 4
collaborate with the University of Kentucky and the University of Louisville to 5
design and develop a w eb-based healthcare transparency dashboard that tracks, 6
at a minimum: 7
(a) Leading health indicators; 8
(b) Performance indicators for Medicaid managed care organizations; 9
(c) Performance indicators for Medicaid-participating providers; and 10
(d) Performance indicators for the department. 11
(2) Performance indicators for Medicaid managed care organizations shall include 12
but not be limited to: 13
(a) Follow-up after emergency department visits; 14
(b) Cancer screenings; 15
(c) Child and adolescent well-care visits; 16
(d) Postpartum care; 17
(e) Diabetes care and management; and 18
(f) Hypertension care and management. 19
(3) The healthcare transparency dashboard shall be: 20
(a) Overseen by a subcommittee of the board established in accordance 21
subsection (4) of Section 19 of this Act; and 22
(b) Maintained and operated by the Commission. 23
Section 18. KRS 7A.283 is amended to read as follows: 24
The board, consistent with its purpose as established in KRS 7A.273, shall have the 25
authority to: 26
(1) Require any of t he following entities to provide any and all information necessary 27
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to carry out the board's duties, including any contracts entered into by the 1
department, the cabinet, or any other state agency related to the administration of 2
any aspect of the Medicaid p rogram or the delivery of Medicaid benefits or 3
services: 4
(a) The cabinet; 5
(b) The department; 6
(c) Any other state agency; 7
(d) Any Medicaid managed care organization with whom the department has 8
contracted for the delivery of Medicaid services; 9
(e) The state pharmacy benefit manager contracted by the department pursuant to 10
KRS 205.5512; and 11
(f) Any other entity contracted by a sta te agency to administer or assist in 12
administering any aspect of the Medicaid program or the delivery of Medicaid 13
benefits or services; 14
(2) Establish a uniform format for reports and data submitted to the board and the 15
frequency, which may be monthly, quarterly, semiannually, annually, or biannually, 16
and the due date for the reports and data; 17
(3) Conduct public hearings in furtherance of its general duties, at which it may request 18
the appearance of officials of any state agency and solicit the testimony of 19
interested groups and the general public; 20
(4) Establish any advisory committees or subcommittees of the board that the board 21
deems necessary to carry out its duties and upon approval of the Commission: 22
(a) Include in the membership of an advisory committee or subcommittee 23
individuals who are not members of the board; and 24
(b) Appoint as co -chairs of an advisory committee or subcommittee individuals 25
who are not members of the General Assembly; 26
(5) Recommend that the Auditor of Public Accounts perform a financ ial or special 27
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audit of the Medicaid program or any aspect thereof; and 1
(6) Subject to selection and approval by the [Legislative Research ]Commission, utilize 2
the services of consultants, analysts, actuaries, legal counsel, and auditors to render 3
professional, managerial, and technical assistance, as needed. 4
Section 19. KRS 7A.286 is amended to read as follows: 5
(1) The board, consistent with its purpose as established in KRS 7A.273, shall: 6
(a) On an ongoing basis, conduc t an impartial review of all state laws and 7
regulations governing the Medicaid program and recommend to the General 8
Assembly any changes it finds desirable with respect to program 9
administration, including delivery system models, program financing, benefits 10
and coverage policies, reimbursement rates, payment methodologies, provider 11
participation, or any other aspect of the program; 12
(b) On an ongoing basis, review any change or proposed change in federal laws 13
and regulations governing the Medicaid program an d report to the Legislative 14
Research Commission on the probable costs, possible budgetary implications, 15
potential effect on healthcare outcomes, and the overall desirability of any 16
change or proposed change in federal laws or regulations governing the 17
Medicaid program; 18
(c) At the request of the Speaker of the House of Representatives or the President 19
of the Senate, evaluate proposed changes to state laws affecting the Medicaid 20
program and report to the Speaker or the President on the probable costs, 21
possible budgetary implications, potential effect on healthcare outcomes, and 22
overall desirability as a matter of public policy; 23
(d) At the request of the [Legislative Research ] Commission, research issues 24
related to the Medicaid program; 25
(e) Beginning in 2027[2026] and at least once every five (5) years thereafter, 26
cause: 27
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1. A review to be made of the administrative expenses and operational cost 1
of the Medicaid program. The review shall include but not be limited to 2
evaluating the level and growth of administrati ve costs, the potential for 3
legislative changes to reduce administrative costs, and administrative 4
changes the department may make to reduce administrative costs or 5
staffing needs. At the discretion of the [Legislative Research 6
]Commission, the review may be conducted by a consultant retained by 7
the board; 8
2. A program evaluation to be conducted of the Medicaid program. In 9
any instance in which a program evaluation indicates inadequate 10
operating or administrative system controls or procedures, 11
inaccuracies, inefficiencies, waste, extravagance, unauthorized or 12
unintended activities, or other deficiencies, the board shall report its 13
findings to the Commission. The program evaluation shall be 14
performed by a consultant retained by the board; and 15
3. An actuarial analysis to be performed of the Medicaid program, to 16
evaluate the sufficiency and appropriateness of Medicaid 17
reimbursement rates established by the department and those paid by 18
any managed care organization contracted by the department for the 19
delivery of Medicaid services. The actuarial analysis shall be 20
performed by an actuary retained by the board; 21
(f) [Beginning in 2027 and at least once every five (5) years thereafter, cause a 22
program evaluation to be conducted of the Medicaid program. In any instance 23
in which a program evaluation indicates inadequate operating or 24
administrative system controls or procedures, inaccuracies, inefficiencies, 25
waste, extravagance, unauthorized or unintended activities, or other 26
deficiencies, the board shall report its findi ngs to the Legislative Research 27
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Commission. The program evaluation shall be performed by a consultant 1
retained by the board; 2
(g) Beginning in 2028 and at least once every five (5) years thereafter, cause an 3
actuarial analysis to be performed of the Medicai d program, to evaluate the 4
sufficiency and appropriateness of Medicaid reimbursement rates established 5
by the department and those paid by any managed care organization 6
contracted by the department for the delivery of Medicaid services. The 7
actuarial analysis shall be performed by an actuary retained by the board; 8
(h) ]Beginning in 2029 and at least once every five (5) years thereafter, cause the 9
overall health of the Medicaid population to be assessed. The assessment shall 10
include but not be limited to a r eview of health outcomes, healthcare 11
disparities among program beneficiaries and as compared to the general 12
population, and the effect of the overall health of the Medicaid population on 13
program expenses. The assessment shall be performed by a consultant 14
retained by the board; and 15
(g)[(i)] Beginning in 2026 and annually thereafter, publish a report covering the 16
board's evaluations and recommendations with respect to the Medicaid 17
program. The report shall be submitted to the [Legislative Research 18
]Commission no later than December 1 of each year, and shall include at a 19
minimum a summary of the board's current evaluation of the program and any 20
legislative recommendations made by the board. 21
(2) The board, consistent with its purpose as established in KRS 7A.273, may: 22
(a) Review all new or amended administrative regulations related to the Medicaid 23
program and provide comments to the Administrative Regulation Review 24
Subcommittee established in KRS 13A.020; 25
(b) Make recommendations to the General Assembly, the Governor, the secretary 26
of the cabinet, and the commissioner of the department regarding program 27
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administration, including benefits and coverage policies, access to services 1
and provider network adequacy, h ealthcare outcomes and disparities, 2
reimbursement rates, payment methodologies, delivery system models, 3
funding, and administrative regulations. Recommendations made pursuant to 4
this section shall be nonbinding and shall not have the force of law; and 5
(c) On or before December 1 of each calendar year, adopt an annual research 6
agenda. The annual research agenda may include studies, research, and 7
investigations considered by the board to be significant. Board staff shall 8
prepare a list of study and research t opics related to the Medicaid program for 9
consideration by the board in the adoption of the annual research agenda. An 10
annual research agenda adopted by the board may be amended by the 11
[Legislative Research ] Commission to include any studies or reports 12
mandated by the General Assembly during the next succeeding regular 13
session. 14
(3) At the discretion of the [Legislative Research ] Commission, studies and research 15
projects included in an annual research agenda adopted by the board pursuant to 16
subsection (2)(c) of this section may be conducted by outside consultants, analysts, 17
or researchers to ensure the timely completion of the research agenda. 18
Section 20. KRS 205.5372 is amended to read as follows: 19
(1) Notwithstanding any p rovision of law to the contrary, including but not limited to 20
KRS 205.460 and 205.520, the cabinet shall not:[, ] 21
(a) Unless required by federal law, exercise the state's option to develop a basic 22
health program as permitted under 42 U.S.C. sec. 18051;[ or ] 23
(b) Make any change related to eligibility, coverage, or benefits in the Medicaid 24
program, including by pursuing or applying for a waiver of federal Medicaid 25
law under Title 42 of the United States Code, seeking to amend or renew an 26
existing waiver granted under Title 42 of the United States Code, or pursuing 27
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a state plan amendment, without first obtaining specific authorization from the 1
General Assembly to do so; or 2
(c) Provide any Medicaid benefit or expend general fund moneys on any 3
Medicaid benefit n ot expressly authorized by the General Assembly or 4
required under federal law. 5
(2) If the cabinet seeks authorization from the General Assembly to establish a basic 6
health program, apply for a waiver under Title 42 of the United States Code, amend 7
an existing waiver granted under Title 42 of the United States Code, submit a state 8
plan amendment, or make any other change to eligibility, coverage, or benefits in 9
the Medicaid program, the cabinet shall submit a detailed assessment of the 10
potential fiscal impac t of the change for which it is seeking authorization to the 11
Legislative Research Commission for referral to the Medicaid Oversight and 12
Advisory Board, the Interim Joint Committee on Appropriations and Revenue, the 13
Interim Joint Committee on Families and C hildren, the Interim Joint Committee on 14
Health Services, and the Office of Budget Review. The fiscal impact assessment 15
required by this subsection shall include a review of any anticipated expenditures 16
related to the change and any projected savings that m ay be generated by the 17
change for at least two (2) consecutive state fiscal years. 18
(3) If the cabinet seeks authorization from the General Assembly to renew an existing 19
waiver granted under Title 42 of the United States Code, the cabinet shall be 20
required to submit a fiscal impact assessment as described in subsection (2) of this 21
section and an assessment of the efficacy and necessity of the existing waiver. The 22
assessments required by this subsection shall be submitted to the Legislative 23
Research Commission for referral to the Interim Joint Committee on Appropriations 24
and Revenue, the Interim Joint Committee on Families and Children, the Interim 25
Joint Committee on Health Services, and the Office of Budget Review at least 26
twelve (12) calendar months prior to the date on which the existing waiver is set to 27
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expire. 1
(4) (a) This section shall not be interpreted as limiting the General Assembly's ability 2
to direct the cabinet to make changes to the Medicaid program, including but 3
not limited to changes to existing waivers, eligibility, coverage, or benefits. 4
(b) Any act of the General Assembly directing the Cabinet for Health and Family 5
Services or the Department for Medicaid Services to make a change to the 6
Medicaid program shall constitute authorization for that change as required by 7
subsection (1) of this section. 8
(5) (a) This section shall not be interpreted as limiting the cabinet's ability to make 9
changes to the Medicaid program that it determines are necessary: 10
1. To comply with any requirements that may be imposed by federal law or 11
by the federal Centers for Medicare and Medicaid Services; 12
2. In response to a national emergency declaration issued by the President 13
of the United States; 14
3. In response to a federal disaster declaration issued by the President o f 15
the United States; or 16
4. In response to a state of emergency declared by the Governor of the 17
Commonwealth. 18
(b) If the cabinet determines that a change to the Medicaid program is necessary 19
to comply with requirements imposed by federal law, the cabinet shall, at least 20
ninety (90) days prior to implementing the necessary changes, submit an 21
assessment of the potential fiscal impact, as described in subsection (2) of this 22
section, of those changes to the Legislative Research Commission for referral 23
to the Med icaid Oversight and Advisory Board, the Interim Joint Committee 24
on Appropriations and Revenue, the Interim Joint Committee on Families and 25
Children, the Interim Joint Committee on Health Services, and the Office of 26
Budget Review. 27
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(c) If the cabinet determi nes that a change to the Medicaid program is necessary 1
to respond to a national emergency declaration or federal disaster declaration 2
issued by the President of the United States or a state of emergency declared 3
by the Governor of the Commonwealth, any suc h change shall be temporary 4
in nature and shall only be in effect for the duration of the emergency or 5
disaster declaration. 6
(6) Subsection (1) of this section shall not apply to: 7
(a) Reimbursement rates or the fee-for-service fee schedules; 8
(b) Medicaid d irected or supplemental payment programs initially approved by 9
the federal Centers for Medicare and Medicaid Services prior to March 27, 10
2025, including but not limited to: 11
1. Those payment programs established in KRS 205.5601 to 205.5603, 12
205.6405 to 205. 6408, 205.6411, and 205.6412, and 907 KAR 10:015 13
and 907 KAR 10:830; and 14
2. Any other payment program for a university hospital as defined in KRS 15
205.639; or 16
(c)[(b)] The Medicaid preferred drug list establish ed by the Department for 17
Medicaid Services as required under KRS 205.5514. 18
(7) As used in this section, the term "Medicaid program" includes the Kentucky 19
Medical Assistance Program established in KRS 205.510 to 205.5630 and the 20
Kentucky Children's Health Insurance Program established in KRS 205.6483. 21
SECTION 21. A NEW SECTION OF KRS CHAPTER 13A IS CREATED TO 22
READ AS FOLLOWS: 23
When the Cabinet for Health and Family Services, including any department or 24
division thereof, promulgates an administrative regulation related to the Medicaid 25
program that is e xpressly required by, or is in response to, an act of the General 26
Assembly, the promulgating agency shall: 27
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(1) At least thirty (30) days before filing the administrative regulation with the 1
regulations compiler, first submit the draft administrative regula tion, a detailed 2
implementation plan, and other documents required to be filed by this chapter to 3
the Medicaid Oversight and Advisory Board established in KRS 7A.273 for review 4
and comment; and 5
(2) Consider any comments or recommendations provided by the M edicaid Oversight 6
and Advisory Board before filing the administrative regulation. 7
SECTION 22. A NEW SECTION OF KRS CHAPTER 205 IS CREATED TO 8
READ AS FOLLOWS: 9
(1) Notwithstanding any provision of law to the contrary, the Department for 10
Medicaid Services shall: 11
(a) Extend all contracts with Medicaid managed care organizations in effect on 12
the effective date of this Act through December 31, 2028; and 13
(b) Not initiate a procurement process under KRS Chapter 45A for the delive ry 14
of Medicaid Services by one (1) or more managed care organizations prior 15
to January 1, 2028. 16
(2) This section shall expire and have no force or effect after March 15, 2029, unless 17
extended by an act of the General Assembly. 18
SECTION 23. A NEW SECTION OF KRS CHAPTER 205 IS CREATED TO 19
READ AS FOLLOWS: 20
Notwithstanding any provision of law to the contrary, the Kentucky Medicaid program, 21
including the Department for Medicaid Services and any managed care organization 22
with wh ich the department contracts for the delivery of Medicaid services, shall not 23
provide coverage for prescription drugs when prescribed primarily for weight loss. 24
SECTION 24. A NEW SECTION OF KRS CHAPTER 205 IS CREATED TO 25
READ AS FOLLOWS: 26
(1) The General Assembly finds and declares that: 27
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(a) Effective management of Medicaid -covered dental services is essential for 1
the overall health of Medicaid beneficiaries and that specialized 2
administration of dental services may improve programmatic efficiency, 3
oral health, and overall health outcomes in the Commonwealth; and 4
(b) It is the intent of the General Assembly to authorize the Department for 5
Medicaid Services to administer Medicaid -covered dental services under an 6
administrative services organization delivery model beginning January 1, 7
2029, and for the administrative service organization contracted in 8
accordance with this section to perform administrative functions necessary 9
to manage or process claims, prior authorization req uests, coordination of 10
care, network adequacy, and customer service related to Medicaid -covered 11
dental services. 12
(2) As used in this section: 13
(a) "Administrative service organization" or "ASO" means the entity 14
contracted by the department in accordance wit h subsection (3) of this 15
section to perform specified administrative functions related to the 16
administration of Medicaid -covered dental services without assuming a 17
financial or insurance risk; and 18
(b) "Department" means the Department for Medicaid Services. 19
(3) The department shall: 20
(a) Beginning July 1, 2028, employ a full -time Medicaid dental director who 21
shall: 22
1. Be licensed under KRS Chapter 313; 23
2. Report to the commissioner of the department; and 24
3. Be responsible for overseeing the administration o f Medicaid-covered 25
dental services; 26
(b) Consider any recommendations that may be made by the Medicaid 27
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Oversight and Advisory Board, or a subcommittee thereof, regarding the 1
transition of Medicaid -covered dental services from a managed care 2
delivery model to an ASO delivery model; 3
(c) In accordance with KRS Chapter 45A and subsection (5) of this section, 4
select and contract with a third -party ASO to administer Medicaid -covered 5
dental services. The contract entered into under this paragraph shall have 6
an effective date of January 1, 2029; 7
(d) Promulgate administrative regulations in accordance with KRS Chapter 8
13A to implement this section; 9
(e) Beginning January 1, 2029: 10
1. Transition all Medicaid beneficiaries from Medicaid managed care 11
organization coverage into ASO coverage for the administration of all 12
Medicaid-covered dental services; and 13
2. Establish a Dental Services Advisory Panel which shall: 14
a. Include the following members: 15
i. The Medicaid dental director employed pursuant to 16
paragraph (a) of this subsection; 17
ii. The members of Technical Advisory Committee on Dental 18
Care established in KRS 205.590; and 19
iii. A representative from the ASO contracted with pursuant to 20
paragraph (c) of this subsection; 21
b. Be attached to the department for administrative purposes; and 22
c. Provide ongoing consultation, recommendations, and guidance 23
to the department to continually improve administration and 24
delivery of Medicaid-covered dental services; and 25
(f) On January 1, 2029, begin utilizing an ASO delivery model for the 26
administration of all Medicaid-covered dental services. 27
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(4) (a) The ASO contracted with pursuant to this section shall operate on an 1
administrative-services-only basis. The ASO shall not assume any financial 2
or insurance risk for the cost of dental claims incurred by the 3
Commonwealth, and the Commonwealth shall remain fully financially 4
responsible for all Medicaid-covered dental claims. 5
(b) The duties and responsibilities of the ASO contracted with pursuant to this 6
section shall be limited to the following administrative services: 7
1. Assisting with and facilitating the transitioning of all Medicaid 8
beneficiaries from Medicaid managed care organization coverage into 9
ASO coverage for dental services; 10
2. Processing and paying Medicaid -covered dental services claims in 11
accordance with the department's established fee schedule and clinical 12
guidelines; 13
3. Employing utilization control strategies established by the department 14
and m anaging all prior authorization requests for Medicaid -covered 15
dental services; 16
4. Providing coordination of care with a Medicaid beneficiary's 17
Medicaid managed care organization; 18
5. Providing customer service and support to Medicaid beneficiaries and 19
Medicaid-participating dental providers; and 20
6. Any other administrative duties or responsibilities contractually 21
assigned to the ASO by the department. 22
(c) The ASO contracted with pursuant to this section shall not include in any 23
analysis of network adequacy a n inactive Medicaid provider as defined in 24
Section 10 of this Act; 25
(5) (a) Notwithstanding any provision of law to the contrary including subsection 26
(3)(c) of this section, the department shall not initiate a procurement 27
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process to contract with a third -party ASO to administer Medicaid -covered 1
dental services prior to January 1, 2028. 2
(b) Any contract entered into under this section shall be submitted to the 3
Government Contract Review Committee of the Legislative Research 4
Commission for comment and review. 5
(6) On an annual basis, the department, in collaboration with the Dental Services 6
Advisory Panel, shall: 7
(a) Evaluate the dental ASO's performance based on metrics, including but not 8
limited to the following: 9
1. Accuracy and timeliness of claims processing; 10
2. Efficiency of processing prior authorization requests; 11
3. Observed network adequacy improvements; 12
4. Availability of and access to services; and 13
5. Satisfaction ratings from participating dental service prov iders and 14
Medicaid beneficiaries; and 15
(b) Prepare and submit a report on the evaluation required under this 16
subsection to the Legislative Research Commission for referral to the 17
Interim Joint Committees on Appropriations and Revenue and Health 18
Services, an d the Medicaid Oversight and Advisory Board by August 1, 19
2029, and August 1 of each year thereafter. 20
Section 25. The following KRS sections are repealed: 21
205.515 Medicaid program delivery system. 22
311A.172 Provision of nonemergency medical transportation services to a resident by a 23
skilled nursing facility or hospital -- Conditions. 24
Section 26. (1) The Medicaid Oversight and Advisory Board is hereby 25
directed to establish a Waiv er Waitlist Management Subcommittee during the 2026 26
Legislative Interim. The Waiver Waitlist Management Subcommittee shall: 27
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(a) Review the current state of 1915(c) Home and Community Based Waiver 1
program waitlists; 2
(b) Consider strategies implemented by ot her states to manage demand for 3
1915(c) waiver services; 4
(c) Assess the potential of a tier priority system for assigning waiver slots based 5
on acuity of need to reduce the number of individuals on waiver waitlists; 6
(d) Receive testimony and reports from t he Cabinet for Health and Family 7
Services related to waiver waitlist management strategies required under subsection (2) 8
of this Section; 9
(e) Make recommendations for strategies that have the potential to reduce the 10
number of individuals on waiver waitlists. 11
(2) The Cabinet for Health and Family Services is hereby direct to prepare and 12
submit a report to the Medicaid Oversight and Advisory Board by October 1, 2026. The 13
report required under this subsection shall include: 14
(a) A review of potential strategie s for reducing the number of individuals 15
currently on the waiver waitlists; and 16
(b) A proposal for implementing a tiered priority system for assigning a priority 17
level for each waiver program applicant and assigning waiver slots on the basis of the 18
tiered priority system. 19
(3) The Waiver Waitlist Management Subcommittee of the Medicaid Oversight 20
and Advisory Board shall submit its findings and recommendations to the Legislative 21
Research Commission no later than December 1, 2026. 22
Section 27. If the Cabinet for Health and Family Services or the Department for 23
Medicaid Services determines that a state plan amendment, waiver, or any other form of 24
authorization or approval from any federal agency to implement Sections 1, 2, 3, 4 , 5, 6, 25
7, 8, 9, 10, 11, 13, 14, or 15 of this Act is necessary to prevent the loss of federal funds or 26
to comply with federal law, the cabinet or department: 27
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(1) Shall, within 90 days after the effective date of this section, request the 1
necessary federal authorization or approval to implement Sections 1, 2, 3, 4, 5, 6, 7, 8, 9, 2
10, 11, 13, 14, and 15 of this Act; and 3
(2) May only delay implementation of the provisions of Sections 1, 2, 3, 4, 5, 6, 4
7, 8, 9, 10, 11, 13, 14, and 15 of this Act for which fede ral authorization or approval was 5
deemed necessary until the federal authorization or approval is granted. 6
Section 28. Sections 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14, 15, and 27 of this Act 7
shall constitute the specific authorization required under KRS 205.5372(1). 8
Section 29. The Medicaid Oversight and Advisory Board, established in KRS 9
7A.273, is hereby directed to evaluate the Medicaid nonemergency medical 10
transportation, or NEMT , program during the 2026 Legislative Interim. As part of the 11
evaluation directed by this section the board shall: 12
(1) Review all current state and federal laws and regulations related to the 13
provision of Medicaid-covered NEMT services; 14
(2) Review the curr ent administrative structure of the NEMT program, including 15
but not limited to: 16
(a) All contracts or memoranda of understanding between the Cabinet for Health 17
and Family Services and third -party vendors or other state agencies for administration of 18
the program; 19
(b) The regional broker system; and 20
(c) The use of capitation payments to finance service delivery; 21
(3) Explore alternative administration and delivery mod els for NEMT services, 22
including administration and delivery models utilized by other states, to identify best 23
practices in the administration and delivery of NEMT services; 24
(4) Assess implementation of Section 14 of this Act; 25
(5) Identify strategies to: 26
(a) Reduce the overall cost of the NEMT program; 27
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(b) Improve transportation service accessibility, availability, and reliability; 1
(c) Improve customer satisfaction; and 2
(d) Enhance administrative efficiencies; and 3
(6) Submit a report of the board's findings and recommendations related to the 4
Medicaid NEMT program to the Legislative Research Commission not later than 5
December 31, 2026. 6
Section 30. Provisions of Section 26 and 29 of this Act to the contrary 7
notwithstanding, the Legislative Research Commission shall have the authority to 8
alternatively assign the issues identified therein to an interim joint committee or 9
subcommittee thereof, and to designate a study completion date. 10
Section 31. Sections 26, 29, and 30 of this Act shall have the same legal status 11
as a House Concurrent Resolution. 12
Section 32. (1) There is include d in the Medicaid Administration Budget 13
Unit in the 2026 -2028 State/Executive Branch Budget enacted in 2026 RS HB 500 14
sufficient funds to implement a community engagement pilot program for Medicaid 15
enrolled individuals who are subject to newly established federal demonstrated 16
community engagement requirements, and the Cabinet for Health and Family Services 17
shall distribute $5,000,000 in each fiscal year of the 2026 -2028 fiscal biennium to 18
Volunteers of America to support implementation and administration of the community 19
engagement pilot program described in this section. 20
(2) The community engagement pilot program shall: 21
(a) Be implemented by Volunteers of America, or its direct successor; 22
(b) Utilize a coordinated case management technology platform capable of 23
tracking eligibility, participation, exemptions, compliance, outcomes, and real -time 24
communication between partners; 25
(c) Be implemented through a proven community alliance model that operates at 26
the local, county, level and integrate workforce, educati on, health, faith-based, nonprofit, 27
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and social service partners; 1
(d) Provide individualized participant navigation, coaching, and support services 2
designed to promote sustained employment, education, training, or community 3
engagement; 4
(e) Collect data nece ssary to support future statewide implementation and meet 5
federal reporting requirements for demonstrated community engagement; and 6
(f) Begin providing services, no later than January 1, 2027, to Medicaid enrolled 7
individuals within pilot site areas who ar e subject to federally established demonstrated 8
community engagement requirements. 9
(3) The purpose of the pilot program shall be to: 10
(a) Establish the operational, technological, and community infrastructure 11
groundwork for full -scale federally required dem onstrated community engagement 12
compliance by January 1, 2027; and 13
(b) Provide wraparound services and supports to Medicaid enrolled individuals 14
who are subject to federal demonstrated community engagement requirements to promote 15
workforce participation and self-sufficiency. 16
(4) Volunteers of America shall: 17
(a) Collaborate with community organizations within pilot site areas including 18
but not limited to Appalachian Regional Healthcare, Eastern Kentucky Concentrated 19
Employment Program, Family Scholar House, and KentuckianaWorks; and 20
(b) Submit quarterly reports beginning October 1, 2026, to the Legislative 21
Research Commission for referral to the Medicaid Oversight and Advisory Board and the 22
Interim Joint Committee on Appropriations and Revenue. The quarterly r eports required 23
under this subsection shall include information on enrollment, compliance rates, 24
outcomes, pilot program expenditures, and readiness benchmarks for statewide 25
implementation. 26
Section 33. Whereas recently enacted federal changes to the Medicaid program 27
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and significant increases in the Commonwealth's Medicaid budget over the last decade 1
create an urgent need to bolster legislative oversight of the Medicaid program, take 2
immediate steps to comply with new fe deral requirements, and ensure that Medicaid 3
expenditures support the healthcare needs of only those individuals the program is 4
intended to serve, an emergency is declared to exist, and this Act takes effect upon its 5
passage and approval by the Governor or upon its otherwise becoming a law. 6