AN ACT relating to reimbursements for pharmacist services.

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AN ACT relating to reimbursements for pharmacist services. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
Section 1. KRS 205.522 is amended to read as follows: 3
(1) With respect to the administration and provision of Medicaid benefits pursuant to 4
this chapter, the Department for Medicaid Services, any managed care organization 5
contracted to provide Medicaid benefits pursuant to this chapter, and the state's 6
medical assistance program shall be subject to, and comply with, the following, as 7
applicable: 8
(a) KRS 304.12-237; 9
(b) KRS 304.17A-129; 10
(c)[(b)] KRS 304.17A-145; 11
(d)[(c)] KRS 304.17A-163 and[; 12
(d) KRS] 304.17A-1631; 13
(e) KRS 304.17A-167; 14
(f) KRS 304.17A-235; 15
(g) KRS 304.17A-257; 16
(h) KRS 304.17A-259; 17
(i) KRS 304.17A-263; 18
(j) KRS 304.17A-264; 19
(k) KRS 304.17A-515; 20
(l) KRS 304.17A-580; 21
(m) KRS 304.17A-600, 304.17A-603, and 304.17A-607; and 22
(n) KRS 304.17A-740 to 304.17A-743. 23
(2) A managed care organization contracted to provide Medicaid benefits pursuant to 24
this chapter shall comply with the reporting requirements of KRS 304.17A-732. 25
Section 2. KRS 205.6485 is amended to read as follows: 26
(1) As used in this section, "KCHIP" means the Kentucky Children's Health Insurance 27
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Program. 1
(2) The Cabinet for Health and Family Services shall: 2
(a) Prepare a state child health plan, known as KCHIP, meeting t he requirements 3
of Title XXI of the Federal Social Security Act, for submission to the 4
Secretary of the United States Department of Health and Human Services 5
within such time as will permit the state to receive the maximum amounts of 6
federal matching funds available under Title XXI; and 7
(b) By administrative regulation promulgated in accordance with KRS Chapter 8
13A, establish the following: 9
1. The eligibility criteria for children covered by KCHIP, which shall 10
include a provision that no person eligible for services under Title XIX 11
of the Social Security Act, 42 U.S.C. secs. 1396 to 1396v, as amended, 12
shall be eligible for services under KCHIP, except to the extent that 13
Title XIX coverage is expanded by KRS 205.6481 to 205.6495 and KRS 14
304.17A-340; 15
2. The schedule of benefits to be covered by KCHIP, which shall: 16
a. Be at least equivalent to one (1) of the following: 17
i. The standard Blue Cross/Blue Shield preferred provider 18
option under the Federal Employees Health Benefit Plan 19
established by 5 U.S.C. sec. 8903(1); 20
ii. A mid-range health benefit coverage plan that is offered and 21
generally available to state employees; or 22
iii. Health insurance coverage offered by a health maintenance 23
organization that has the largest insured commercial, non -24
Medicaid enrollment of covered lives in the state; and 25
b. Comply with subsection (6) of this section; 26
3. The premium contribution per family for health insurance coverage 27
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available under KCHIP, which shall be based: 1
a. On a six (6) month period; and 2
b. Upon a sliding scale relating to family income not to exceed: 3
i. Ten dollars ($10), to be paid by a family w ith income 4
between one hundred percent (100%) to one hundred thirty -5
three percent (133%) of the federal poverty level; 6
ii. Twenty dollars ($20), to be paid by a family with income 7
between one hundred thirty -four percent (134%) to one 8
hundred forty -nine per cent (149%) of the federal poverty 9
level; and 10
iii. One hundred twenty dollars ($120), to be paid by a family 11
with income between one hundred fifty percent (150%) to 12
two hundred percent (200%) of the federal poverty level, and 13
which may be made on a partial payment plan of twenty 14
dollars ($20) per month or sixty dollars ($60) per quarter; 15
4. There shall be no copayments for services provided under KCHIP; and 16
5. a. The criteria for health services providers and insurers wishing to 17
contract with the Commonweal th to provide coverage under 18
KCHIP. 19
b. The cabinet shall provide, in any contracting process for coverage 20
of preventive services, the opportunity for a public health 21
department to bid on preventive health services to eligible children 22
within the public hea lth department's service area. A public health 23
department shall not be disqualified from bidding because the 24
department does not currently offer all the services required by 25
this section. The criteria shall be set forth in administrative 26
regulations under KRS Chapter 13A and shall maximize 27
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competition among the providers and insurers. The Finance and 1
Administration Cabinet shall provide oversight over contracting 2
policies and procedures to assure that the number of applicants for 3
contracts is maximized. 4
(3) Within twelve (12) months of federal approval of the state's Title XXI child health 5
plan, the Cabinet for Health and Family Services shall assure that a KCHIP 6
program is available to all eligible children in all regions of the state. If necessary, 7
in order to meet this assurance, the cabinet shall institute its own program. 8
(4) KCHIP recipients shall have direct access without a referral from any gatekeeper 9
primary care provider to dentists for covered primary dental services and to 10
optometrists and ophthalmologists for covered primary eye and vision services. 11
(5) KCHIP shall comply with: 12
(a) KRS 304.12-237; and 13
(b) KRS 304.17A-163 and 304.17A-1631. 14
(6) The schedule of benefits required under subsection (2)(b)2. of this section shall 15
include: 16
(a) Preventive services; 17
(b) Vision services, including glasses; 18
(c) Dental services, including sealants, extractions, and fillings; and 19
(d) The coverage required under KRS 304.17A-129 and 304.17A-145. 20
Section 3. If the Cabinet for H ealth and Family Services or the Department for 21
Medicaid Services determines that a state plan amendment, waiver, or any other form of 22
authorization or approval from any federal agency to implement Sections 1 and 2 of this 23
Act is necessary to prevent the l oss of federal funds or to comply with federal law, the 24
cabinet or department: 25
(1) Shall, within 90 days after the effective date of this section, request the 26
necessary federal authorization or approval to implement Sections 1 and 2 of this Act; 27
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and 1
(2) May only delay implementation of the provisions of Sections 1 and 2 of this 2
Act for which federal authorization or approval was deemed necessary until the federal 3
authorization or approval is granted. 4
Section 4. Sections 1 , 2, and 3 of this Act shall constitute the specific 5
authorization required under KRS 205.5372(1). 6