Summary of Original VersionAmend KRS 205.5372 to prohibit the Department for Medicaid Services from making any change to the Medicaid program without authorization from the General Assembly to do so; amend KRS 205.460 and 205.520 to conform; amend KRS 205.5371 to authorize the Cabinet for Health and Family Services to submit a community engagement waiver for able-bodied Medicaid beneficiaries without dependents; create a new section of KRS Chapter 205 to establish the Kentucky Medicaid rebate sequestration fund as a restricted fund within the Finance and Administration Cabinet; require all money received by the Department for Medicaid Services as rebates from pharmaceutical drug manufacturers to be deposited into the Kentucky Medicaid rebate sequestration fund; amend KRS 205.240 to conform; amend KRS 205.525 to require the Cabinet for Health and Family Services to submit a copy of any waiver renewal application to the Legislative Research Commission concurrent with submission of the application to a federal agency; repeal, reenact, and amend KRS 205.6328 to establish reporting requirements for the Department for Medicaid Services and Medicaid managed care organizations; create new sections of KRS Chapter 205 to require the Department for Medicaid Services to retain beneficiaries' data for at least seven years after the beneficiary is disenrolled from the Medicaid program; require the Department for Medicaid Services and Medicaid managed care organizations to cover up to 100 units of psychoeducational services per Medicaid beneficiary per year; create a new section of KRS Chapter 194A to require the Cabinet for Health and Family Services to notify the Legislative Research Commission of any anticipated barriers to implementing Medicaid-related legislation; direct the Department for Medicaid Services to reinstate all prior authorization requirements for behavioral health services that were in place on January 1, 2020; require the Cabinet for Health and Family Services to procure new Medicaid managed care contracts with an effective date of no later than January 1, 2027; direct Medicaid managed care organizations to collaborate on the development of a behavioral health and substance use disorder treatment services scorecard; require behavioral health and substance use disorder treatment services scorecard to be accessible by the public on each Medicaid managed care organization's website no later than December 31, 2025; EMERGENCY.
Summary of Amendment: House Committee Substitute 1Summary
Retain original provisions, except delete requirement for the Cabinet for Health and Family Services to obtain authorization from the General Assembly prior to making changes to Medicaid reimbursement rates and provisions designating funds deposited into the Kentucky Medicaid pharmaceutical rebate fund as unappropriated; and establish that the requirement for the Cabinet for Health and Family Services to obtain authorization from the General Assembly prior to making changes to the Medicaid program shall not apply to directed or supplemental Medicaid payment programs approved by the Centers for Medicare and Medicaid Services prior to the effective date of this Act or to the Medicaid preferred drug list established by the Department for Medicaid Services; direct the Cabinet for Health and Family Services to submit a waiver application to establish a community engagement program for certain Medicaid beneficiaries within 90 days after the effective date of this Act; require the Cabinet for Health and Family Services to provide a copy of the community engagement waiver application to the Legislative Research Commission and to update the Legislative Research Commission on the status of the application at least quarterly; establish that moneys in the Kentucky Medicaid pharmaceutical rebate fund at the close of state fiscal years 2024-2025 and 2025-2026 shall not lapse and shall carry forward; include KRS 142.361 in the list of providers taxes and assessments to be reported to the Legislative Research Commissions; increase the number of units of psychoeducational services that the Department for Medicaid Services and managed care organizations are required to cover and provide reimbursement for from 100 to 400; increase the number of units of psychoeducational services allowed per day from one to four; establish that the Cabinet for Health and Family Services is authorized to make any change to eligibility, coverage, or benefits in the Medicaid program provided for in 2024 Ky. Acts ch. 173, sec. 1(186) and 2024 Ky. Acts ch. 175, Part I, G., 3., b.; make technical corrections; EMERGENCY.
Summary of Amendment: Senate Committee Substitute 1Summary
Retain original provisions, except delete Medicaid coverage limitations for psychoeducational services; establish that changes to the Medicaid program necessitated by requirements imposed by the federal Centers for Medicare and Medicaid Services or related to payment programs for university hospitals shall be exempt from the requirement that the change be authorized by the General Assembly; locate the Kentucky Medicaid pharmaceutical rebate fund in the Cabinet for Health and Family Services instead of the Finance and Administration Cabinet; establish that moneys in the Kentucky Medicaid pharmaceutical rebate fund shall be expended in accordance with federal law for the purpose of providing Medicaid-covered services; create new sections of KRS Chapter 205 to require the Department for Medicaid Services to monitor utilization rates and expenditures for behavioral health and substance use disorder services and to report to the Legislative Research Commission on any service for which the utilization rate or expenditures increase by more than 10 percent over the previous calendar year and to limit the number of managed care organizations contracted by the Department for Medicaid Services to no more than three; establish that Medicaid beneficiaries receiving behavioral health services prior to the effective date of this Act for which prior authorization requirements are reinstated shall be permitted to continue to receive those services for 180 days without a prior authorization; establish that any managed care organization that failed during state fiscal year 2025-2026 to comply with 2024 Ky Acts ch. 175, Part I, G., 3., a., (2) and b., (7) be ineligible to for a new Medicaid managed care contract; require the Cabinet for Health and Family Services to develop a behavioral health and substance use disorder treatment services scorecard to be used by all contracted Medicaid managed care organizations; require the Cabinet for Health and Family Services to conduct a feasibility study for managed long-term services and supports.
Summary of Amendment: Senate Committee Substitute 2Summary
Retain original provisions, except delete Medicaid coverage limitations for psychoeducational services; establish that changes to the Medicaid program necessitated by requirements imposed by the federal Centers for Medicare and Medicaid Services or related to payment programs for university hospitals shall be exempt from the requirement that the change be authorized by the General Assembly; amend KRS 205.5371 to establish that the community engagement program shall be a mandatory waiver program; locate the Kentucky Medicaid pharmaceutical rebate fund in the Cabinet for Health and Family Services instead of the Finance and Administration Cabinet; establish that moneys in the Kentucky Medicaid pharmaceutical rebate fund shall be expended in accordance with federal law; create new sections of KRS Chapter 205 to require the Department for Medicaid Services to monitor utilization rates and expenditures for behavioral health and substance use disorder services and to report to the Legislative Research Commission on any service for which the utilization rate or expenditures increase by more than 10 percent over the previous calendar year; establish that any managed care organization that failed during state fiscal year 2025-2026 to comply with 2024 Ky Acts ch. 175, Part I, G., 3., a., (2) and b., (7) be ineligible for a new Medicaid managed care contract; require the Cabinet for Health and Family Services to develop a behavioral health and substance use disorder treatment services scorecard to be used by all contracted Medicaid managed care organizations; create various new sections of KRS Chapter 7A to establish the Medicaid Oversight and Advisory Board, the board's membership, and duties.
Statutes affected: Introduced: 205.5372, 205.460, 205.520, 205.5371, 205.240, 205.525, 205.6328
House Committee Substitute 1: 205.5372, 205.460, 205.520, 205.5371, 205.525, 205.6328
Senate Committee Substitute 1: 205.5372, 205.460, 205.520, 205.5371, 205.525, 205.6328
Senate Committee Substitute 2: 205.5372, 205.460, 205.520, 205.5371, 205.525, 205.6328
Current: 205.5372, 205.460, 205.520, 205.5371, 205.525, 205.6328
Acts Chapter 110: 205.5372, 205.460, 205.520, 205.5371, 205.525, 205.6328