Kentucky — Chapter 205 — PUBLIC ASSISTANCE AND MEDICAL ASSISTANCE

• § 205.010 — Definitions for chapter
• § 205.170 — Powers of secretary
• § 205.172 — Required reports to Legislative Research Commission
• § 205.173 — Attorney General jurisdiction to enforce chapter and bring action -- Conditions
• § 205.175 — Confidential treatment of information and records -- Persons to whom furnished
• § 205.177 — Information may be shared by state and local governmental agencies -- Conditions
• § 205.1781 — Legislative findings
• § 205.1783 — Transitional benefit alternative -- Elderly Simplified Application Project - - Online employment and training program -- Administrative regulations
• § 205.179 — Annual review of sites where residents receive state supplemental benefits to determine registration status of boarding home
• § 205.180 — Destruction of records
• § 205.191 — Definitions for KRS 15.812, 205.178, 205.193, 205.200, 205.231, 205.232, and 205.525
• § 205.193 — Cabinet to establish and maintain policies and practices -- Restrictions on recipient's use of cash assistance benefits -- Penalties -- Duties of cabinet
• § 205.200 — Eligibility for public assistance
• § 205.2001 — "Public assistance under Title IV-A of the Federal Social Security Act standard of need" defined
• § 205.2003 — Administrative regulations for work program for public assistance recipients -- Supplemental Nutrition Assistance Program Employment and Training state plan initiatives -- Annual report
• § 205.2005 — Opt-out of 21 U.S.C. sec. 862a(a)
• § 205.201 — Duties of cabinet as to the aging and the minority elderly
• § 205.202 — Acceptance and disposition of gifts and grants
• § 205.203 — Authorization to provide in-home services to the aging -- Collection of fees
• § 205.204 — Cabinet to administer Older Americans Act -- Regulatory authority
• § 205.210 — Amount of assistance -- Proration in case of deficiency -- Resources defined
• § 205.211 — Secretary to correct any underpayment or overpayment of public assistance benefits
• § 205.213 — Technical amendment to material that has been incorporated by reference in administrative regulation governing Supplemental Nutrition Assistance Program
• § 205.220 — Payments, to whom made -- Accounting -- Exemption from assignment, levy or execution
• § 205.227 — Action by secretary against persons legally liable for support
• § 205.231 — Appeals -- Hearing officers -- Appeal board -- Procedure
• § 205.232 — Cash assistance benefits disqualification -- Protective payee -- Administrative regulations
• § 205.237 — Public assistance claimant may have counsel -- Fees
• § 205.240 — Public assistance funds -- Availability to secretary
• § 205.245 — Supplementary payments
• § 205.290 — Revolving fund -- Disbursement -- Balance not to lapse
• § 205.310 — Liability of stepparent for support furnished child
• § 205.400 — Energy Cost Assistance Program established -- Eligibility requirements -- Allocation of funds -- Payments
• § 205.455 — Definitions for KRS 205.460
• § 205.460 — Essential services -- Funding -- Collection of fees and contributions
• § 205.470 — Centralized resource and referral center for aging caregivers of individuals with an intellectual disability or other developmental disability
• § 205.510 — Definitions for medical assistance law
• § 205.513 — Eligibility determinations and redeterminations
• § 205.517 — Records retention
• § 205.520 — Title and purpose of KRS 205.510 to 205.630 -- Recovery from third parties for services rendered
• § 205.522 — Duty of Department for Medicaid Services and Medicaid managed care organizations to comply with specified sections of KRS Chapter 304
• § 205.524 — Annual legislative review of Medicaid state plan and KCHIP state plan -- Requirements and procedures for compliance
• § 205.525 — Application by cabinet for waiver, waiver amendment, waiver renewal, or request for state plan amendment -- Cabinet to provide updates upon request
• § 205.526 — Application for waiver to provide coverage to prerelease prisoners
• § 205.527 — Managing of IMPACT Plus program by Medicaid managed care organization -- Continuation of services for eligible children -- Billing -- Gaps in service and lack of access
• § 205.528 — Hospital-to-Home Transition Program
• § 205.529 — Synchronization of multiple prescriptions for treatment of a chronic illness
• § 205.531 — Administrative hearings
• § 205.5321 — Contracts for Medicaid services by managed care organizations -- Extension and procurement requirements -- Sunset
• § 205.533 — Website of managed care organization -- Requirements
• § 205.534 — Toll-free telephone line -- Duties relating to adverse determinations -- In-person meeting -- Reprocessing claims -- Internal appeals -- Provider audits -- Timely decisions on authorization and preauthorization requests -- Monthly and annual reports -- Penalties -- Administrative regulations
• § 205.535 — Medicaid enrollee not automatically assigned to managed care organization
• § 205.5353 — Dental services -- Administrative service organization delivery model -- Legislative findings -- Medicaid dental director -- Procurement -- Administrative regulations -- Dental Services Advisory Panel -- Annual report
• § 205.5355 — Identification and disenrollment of nonresidents and individuals concurrently enrolled in multiple states -- Procedures -- Notice -- Penalties
• § 205.5356 — Contracts for Medicaid services by managed care organizations -- Required terms and provisions -- Prohibited actions -- Requirements -- Disenrollment of beneficiary with unknown address -- Penalties
• § 205.5357 — Medicaid managed care organization compliance fund
• § 205.536 — Utilization review -- Prohibition against prospective or concurrent review of prescription drug for alcohol or opioid use disorder
• § 205.5361 — Utilization rates and expenditures for all Medicaid-covered behavioral health and substance use disorder services -- Annual report
• § 205.5363 — Nonemergency medical transportation services -- Annual report
• § 205.5365 — Prohibition on expenditure of Medicaid funds for cross-sex hormones for treatment of gender dysphoria or gender reassignment surgery
• § 205.5366 — Coverage for prescription drugs prescribed primarily for weight loss prohibited
• § 205.5367 — Prohibition of coverage for psychoeducational services
• § 205.5369 — Report to the Legislative Research Commission on prior authorization
• § 205.5370 — Waiver programs -- Definitions for section -- Application -- Waitlists -- Assessments and reevaluations -- Eligibility -- Report of possible violations -- Quarterly report
• § 205.5371 — Demonstrated community engagement -- Definitions for section
• § 205.5372 — Specific authorization from General Assembly required to exercise state's option to develop basic health program under federal law or make changes related to eligibility, coverage, or benefits -- Fiscal impact assessment required -- Construction
• § 205.5373 — Department's duties when limited in ability to disenroll individuals from state medical assistance program
• § 205.5374 — Limitation on designation of cabinet or Department for Medicaid Services as qualified health entity
• § 205.5375 — Definitions for section -- Presumptive eligibility -- Determination -- Requirements -- Administrative regulations
• § 205.5376 — Substance use disorder treatment for incarcerated individuals -- Requirements
• § 205.538 — Statistics report on cancer services for colorectal cancer among Medicaid recipients
• § 205.539 — Coverage and reimbursement for at-home anticoagulation management -- Administrative regulations
• § 205.540 — Advisory Council for Medical Assistance -- Membership -- Expenses -- Meetings -- Qualifications of members
• § 205.541 — Application of clinical criteria for sepsis
• § 205.550 — Subjects on which council advises
• § 205.5510 — Definitions for KRS 205.5510 to 205.5520
• § 205.5512 — Selection of and contract with third-party administrator as pharmacy benefit manager for Medicaid managed care organizations -- Requirements for department’s contracts, procurement process, disclosure of information, and legislative committee review
• § 205.5514 — Department’s duties regarding state pharmacy benefit management
• § 205.5516 — Compliance of payment arrangements with state and federal laws and regulations
• § 205.5518 — Required and prohibited actions by pharmacy benefit manager -- Penalty for violation
• § 205.5520 — Annual recommendations regarding pharmacy benefit reimbursement methodologies and dispensing fees
• § 205.553 — Kentucky Medicaid pharmaceutical rebate fund
• § 205.556 — Coverage for lactation consultation, breastfeeding equipment, in-home programs for pregnant and postpartum women, and telehealth or digital health services related to maternity care
• § 205.557 — Medicaid reimbursement for advocacy center's child medical evaluation -- Waivers -- Administrative regulations
• § 205.558 — Prescreening and admissions review system
• § 205.559 — Requirements for Medicaid reimbursement to participating providers for telehealth consultations -- Reimbursement for rural health clinics, federally qualified health centers, and federally qualified health center look-alikes -- Location in state not required if provider offers services exclusively by telehealth -- Audio-only encounters
• § 205.5591 — Medicaid providers using telehealth -- Duties of cabinet, Department for Medicaid Services, and managed care organizations -- Administrative regulations -- Policies and guidelines
• § 205.560 — Scope of care to be designated by administrative regulations -- Reimbursements mandated or prohibited -- Payments to community mental health centers -- Participation of providers in Medical Assistance Program
• § 205.5601 — Cabinet’s reimbursement for qualifying ground ambulance service transports
• § 205.5602 — Definitions for this section and KRS 205.5601 and 205.5603 -- Duties of Department for Medicaid Services regarding ground ambulance service transports -- Assessment amount and administration -- Need for state plan or waiver amendment -- Reports
• § 205.5603 — Ambulance service assessment fund -- Appropriation and transfer of fund moneys -- Sole purposes of fund -- Effect of invalidity of KRS 205.5602
• § 205.5604 — Department for Medicaid Services to submit Medicaid preprint to establish supplemental payment program for public ground ambulance providers -- Administration of program -- Funding -- Eligibility
• § 205.5605 — Definitions for KRS 205.5605 to 205.5607
• § 205.5606 — Kentucky Independence Plus Through Consumer-Directed Services Program -- Consumer participation -- Responsibilities of cabinet and fiscal intermediary -- Background screening -- Regulations
• § 205.5607 — Applicability of KRS Chapter 342
• § 205.561 — Report on the dispensing of prescription medications
• § 205.5621 — Definitions for KRS 205.5621 to 205.5625
• § 205.5622 — Kentucky Pharmaceutical Assistance Program -- Contingency for establishment -- Purpose -- Eligibility -- Enrollment priority
• § 205.5623 — Department's powers in providing program benefits
• § 205.5624 — Payment of benefits -- Limitations -- Qualification for coverage
• § 205.5625 — Residency standards
• § 205.5631 — Definitions for KRS 205.5631 to 205.5639
• § 205.5632 — Prior authorization requirements -- Administrative regulations
• § 205.5634 — Coordination of use of utilization data -- Identification of appropriate use of pharmaceuticals -- Determination of need for educational intervention
• § 205.5636 — Drug Management Review Advisory Board -- Membership -- Officers -- Meetings
• § 205.5638 — Duties and responsibilities of board
• § 205.5639 — Effect of board recommendations -- Written exceptions -- Final decision - - Appeal
• § 205.564 — Pharmacy and Therapeutics Advisory Committee -- Membership -- Duties -- Information posted on Web site -- Recommendations -- Presentations by interested parties -- Appeals -- Administrative regulations
• § 205.5641 — Prior authorization not required for medication-assisted therapies in pilot project -- No restrictions on participating pharmacies and pharmacists
• § 205.565 — Cabinet to recognize unique costs of pediatric teaching hospital
• § 205.566 — Electronic medical record database
• § 205.585 — Review of services and treatment for sickle cell disease -- Annual report -- Short title
• § 205.590 — Technical advisory committees
• § 205.591 — "Fair market value" of applicant's property if used to determine eligibility
• § 205.592 — Eligibility of pregnant women, new mothers, and children up to age 1 to participate in Kentucky Medical Assistance Program
• § 205.593 — Prohibition against health insurer's considering individual's eligibility for or receipt of medical assistance in enrollment or payment of benefits -- Application of claims payment requirements to Medicaid services
• § 205.594 — Health coverage for child under medical child support order -- Duties of health insurers
• § 205.595 — Health coverage for child under medical child support order -- Duties of employers
• § 205.596 — Prohibition against health insurer's imposing requirements on state agency assigned rights of individual eligible for medical assistance that are different from those applicable to agent or assignee of other covered individual
• § 205.597 — Health coverage through insurer of noncustodial parent of child under medical child support order
• § 205.598 — Withholding of income and state tax refund of person required by court to provide cost of child's health service -- Priority of claims for child support over costs of reimbursement of child medical support
• § 205.615 — Use of allowable Medicaid funding for trauma care costs
• § 205.617 — Expansion of Medicaid coverage for screening and treatment of breast or cervical cancer or precancerous conditions -- Short title
• § 205.618 — Coverage for tobacco cessation medications and services
• § 205.619 — Medicaid plan amendment to permit establishing of Kentucky Long-Term Care Partnership Insurance Program
• § 205.621 — Increased reimbursement for Medicaid
• § 205.622 — Billing of third party by vendor for medical services
• § 205.623 — Information on claims paid for insurance policyholders and dependents -- Use of data -- Confidentiality of information -- Prohibited fees
• § 205.624 — Assignment to cabinet by recipient of rights to third-party payments -- Right of recovery by cabinet
• § 205.626 — Time assignment becomes enforceable -- Payment to cabinet -- Attorney's fees
• § 205.628 — Liability of recipient
• § 205.629 — Notification of cabinet in actions seeking recovery for recipient
• § 205.630 — Prohibited activity by cabinet -- Injunctive relief
• § 205.631 — Life settlement proceeds for long-term care services not considered as resource or asset for Medicaid eligibility -- Notice of exhaustion of proceeds -- Medicaid and applied income payments to begin immediately upon exhaustion of life settlement proceeds -- Administrative regulations
• § 205.6310 — Cabinet to establish system to reduce unnecessary hospital emergency room utilization and costs
• § 205.6311 — Substance use disorder treatment benefit -- Administrative regulations -- Contracts with Medicaid managed care organizations -- Annual report
• § 205.6312 — Cost-sharing requirements
• § 205.6313 — Medicaid reimbursement for primary care practitioners at community mental health centers
• § 205.6314 — Review of reimbursement rates for emergency transportation providers -- Promulgation of administrative regulations relating to emergency transportation providers
• § 205.6315 — Requirements when private peer review organization is contracted with to conduct reviews of levels of care
• § 205.6316 — Review of procedures for medical assistance reimbursement of pharmacists to reduce fraud and abuse -- Dispensing fee
• § 205.6317 — Department for Medicaid Services to develop strategies for reimbursing and paying persons participating in the Supports for Community Living Waiver Program -- Allocation of slots -- Administrative regulations -- Funding
• § 205.63171 — Short title for KRS 205.6317
• § 205.6318 — Cabinet to establish integrated system to enhance program integrity of Medical Assistance Program
• § 205.632 — Pilot project to create coverage provisions and reimbursement criteria for telemonitoring services based on evidence-based best practices provided by a qualified medical provider or community action agency
• § 205.6320 — Cabinet to strengthen managed care component of KenPAC Program and to establish standards for access and quality for organizations serving Medicaid recipients
• § 205.6322 — Cabinet to seek to prohibit sheltering of assets in long-term-care cases
• § 205.6324 — Cabinet to enhance third-party resource collection capacity
• § 205.6326 — Review of Medicaid reimbursement systems -- Implementation of a standardized patient assessment tool and consistent quality-of-care mandates
• § 205.6332 — System for monitoring use of covered services using appropriate technology and identification card
• § 205.6333 — Reimbursement for in-network suppliers of durable medical equipment, prosthetics, orthotics, and supplies -- Reimbursement rate -- Timeframe for claim submissions
• § 205.6334 — Request for necessary waivers of federal law
• § 205.6338 — Implementation of pilot projects to provide health care to frail elderly Medicaid-eligible individuals
• § 205.634 — Payments prohibited to out-of-state health facility providing services without required certificate of need -- Nonreimbursement of out-of-state providers of residential care for children -- Exception -- Administrative regulations
• § 205.635 — Skilled nursing services provided to Medicaid recipients by adult day health care programs
• § 205.636 — Temporary COVID-19 personal care attendant -- Training and competency requirements -- Application for waiver or plan amendment
• § 205.637 — Enhanced Medicaid payments to county-owned or operated hospitals -- Payments to other hospitals
• § 205.638 — Portion of hospital provider tax collections to fund enhancements to inpatient payments to hospitals
• § 205.639 — Definitions for KRS 205.639 to 205.640
• § 205.640 — Medical Assistance Revolving Trust Fund (MART) -- Distribution of disproportionate share funds -- Authority for administrative regulations -- Duties of hospitals receiving funds from MART
• § 205.6401 — Penalty for failure of Medicaid managed care organization to provide accurate paid claims listing
• § 205.6403 — Administrative regulations to comply with change in federal law -- Payments contingent on federal participation
• § 205.6405 — Definitions for KRS 205.6405 to 205.6408
• § 205.6407 — Hospital Medicaid assessment fund
• § 205.6408 — Uses of excess disproportionate share taxes
• § 205.6411 — Definitions for KRS 205.6411 and 205.6412
• § 205.6412 — Rate improvement programs for certain qualifying hospitals -- Terms -- Eligibility -- Federal participation and approval required for implementation of programs
• § 205.642 — Pervasive developmental disorders -- Definition for KRS 200.654, 200.660, 347.020, and 387.510 -- Waiver application -- Report
• § 205.643 — IMPACT Plus Program -- Provider to receive copy of criteria used in audit, evaluation, or review
• § 205.645 — Recognition of varying overhead costs
• § 205.646 — External independent third-party review of Medicaid managed care organization's final decision denying a health care service or a claim for reimbursement -- Submission of multiple claims in a single review -- Appeal -- Administrative regulations -- Applicability of statute
• § 205.647 — State pharmacy benefit manager's report to Department for Medicaid Services -- Requirements for Medicaid services contracts entered into or renewed on or after March 27, 2020 -- Administrative regulations -- Reimbursement rates between pharmacy benefit manager and contracted pharmacy
• § 205.648 — Plan amendment, waiver, or alternative payment model for services of certified community health workers -- Reimbursement -- Services provided -- Not be considered duplicative -- Administrative regulations and approvals
• § 205.6481 — Legislative findings
• § 205.6483 — Kentucky Children's Health Insurance Program -- Purposes
• § 205.6485 — State child health plan -- Eligibility criteria -- Schedule of benefits -- Premium contributions -- Access
• § 205.6487 — Establishment of trust fund -- Maintenance
• § 205.6489 — Administration -- Outreach -- Data collection
• § 205.6495 — Short title for KRS 205.6481 to 205.6495 and KRS 304.17A-340
• § 205.6497 — Required provisions in plans
• § 205.690 — Reports to General Assembly
• § 205.702 — Educational and vocational programs for parents receiving public assistance -- Reports by cabinet
• § 205.703 — Educational and vocational programs eligible for supportive services -- Prohibition against discontinuance of service to low income parents except under certain circumstances
• § 205.704 — Preparation and submission of strategic plan to further education of low-income parents -- Parties included in planning process
• § 205.705 — Legislative intent regarding child support statutes
• § 205.830 — Legislative intent
• § 205.835 — Disclosure of financial data pertinent to applicants for or recipients of benefits -- Fee -- Written consent
• § 205.8451 — Definitions for KRS 205.8451 to 205.8483
• § 205.8453 — Responsibility for control of fraud and abuse
• § 205.8455 — Recipient Utilization Review Committee -- Authority
• § 205.8457 — Responsibility of managed care primary physician
• § 205.8459 — Emergency service
• § 205.8461 — Unlawful referral practices of provider -- Penalties
• § 205.8463 — Fraudulent acts -- Penalties
• § 205.8465 — Mandatory reporting of violations -- Confidentiality -- Prohibition against employer discrimination or retaliation
• § 205.8467 — Liability of violators -- Payment of penalties to Medicaid trust fund
• § 205.8469 — Enforcement proceedings by Attorney General
• § 205.8471 — Lien on property of provider or recipient defrauding Medicaid program
• § 205.8473 — Reliance on written governmental advice as defense
• § 205.8475 — Forfeiture of provider's license
• § 205.8477 — Disclosure requirements for Medicaid providers, fiscal agents, and managed care entities -- Disclosure requirements for owners and investors of health facilities and health services -- When disclosure must be provided
• § 205.8479 — Report of license or certificate suspension, revocation, or limitation
• § 205.8481 — Prohibition against representation of provider by staff of Attorney General in private practice
• § 205.8483 — Toll-free hotline for receiving reports of fraud and abuse -- Report
• § 205.900 — Definitions for KRS 205.905 to 205.920
• § 205.905 — Subsidy for personal care assistance
• § 205.910 — Eligibility standard -- Subsidy not income for federal law purposes -- Supplements other programs
• § 205.915 — Appeal of decision by aggrieved party
• § 205.920 — Regulations
• § 205.925 — Implementation of KRS 205.900 to 205.920 by cabinet
• § 205.935 — Definitions for KRS 205.940
• § 205.940 — Representative payee fund
• § 205.990 — Penalties
• § 205.992 — Penalties for child support recovery offenses