KRS 205.5370: Waiver programs -- Definitions for section -- Application -- Waitlists --

Assessments and reevaluations -- Eligibility -- Report of possible violations --

Quarterly report.

(1) As used in this section:

(a) "Department":

1. Means the Department for Medicaid Services; and

2. Includes any other agency of state government or nongovernmental

entity contracted by the department to administer any aspect of a waiver

program;

(b) "Waiver program" means a 1915(c) home and community based waiver

program approved by the federal Centers for Medicare and Medicaid Services

and administered by the department or any other subdivision of the cabinet;

and

(c) "Waiver program application" means any waiver program application,

including a waiver waitlist application o r application to begin receiving

waiver program services.

(2) (a) The department shall require any individual applying for waiver program

services, including any individuals applying for or requesting placement on a

waiver waitlist, to submit a completed w aiver program application that

includes a provider's recommendation for waiver program services and

provider attestation to the primary diagnosis for which the individual is

seeking waiver program services.

(b) Except as provided in paragraph (c) of this subsection, the department shall

not place any individual on a waiver waitlist or approve any individual to

receive waiver program services if the individual has not completed and

submitted a waiver program appli cation that includes a provider's

recommendation for waiver program services and provider attestation to the

primary diagnosis for which the individual is seeking waiver program

services.

(c) An individual who was placed on a waiver waitlist on or before A pril 14,

2026, shall be allowed twelve (12) months from April 14, 2026, to submit a

waiver program application that includes a provider's recommendation for

waiver program services and provider attestation to the primary diagnosis for

which the individual is seeking waiver program services. Any individual who

was placed on a waiver waitlist on or before April 14, 2026, who fails to

comply with the requirements of this paragraph shall be removed from the

waiver waitlist.

(d) As used in this subsection, "prov ider" means a physician or physician

assistant licensed under KRS Chapter 311, an advanced practice registered

nurse licensed under KRS Chapter 314, or a licensed psychologist licensed

under KRS Chapter 319.

(3) By July 1, 2026, the department shall identi fy, designate, and require the use of a

waiver-specific level of care assessment tool for each waiver program operated by

the department. The level of care assessment tools designated under this subsection

shall:

(a) Be nationally recognized;

(b) At a minimum, recommend the frequency, duration, and intensity of services

needed by the individual; and

(c) Be age -appropriate relative to the population served by the waiver program

for which it is designated.

(4) All level of care assessments, including annual l evel of care reevaluations, shall

utilize the waiver -specific level of care assessment tools designated in accordance

with subsection (3) of this section.

(5) Notwithstanding subsections (3) and (4) of this section, an individual who is

eighteen (18) years of age or younger and currently receiving waiver services on

April 14, 2026, shall not be reassessed using the level of care assessment tools

designated under subsection (3) of this section and shall continue to be reassessed

as required under state and f ederal law using the assessment tool in effect on April

14, 2026, until he or she reaches eighteen (18) years of age.

(6) The department shall undertake efforts to encourage waiver service providers to

develop innovative programs that increase the quality and value of care while

reducing costs of the waiver programs.

(7) (a) Except as provided in paragraphs (b) and (c) of this subsection and to the

extent permitted under federal law, in order to be eligible for enrollment in a

waiver program an individual s hall be a citizen of the United States or a

qualified alien as defined in 8 U.S.C. sec. 1641 and have been a resident of

the Commonwealth for at least one (1) year prior to enrollment.

(b) Notwithstanding paragraph (a) of this subsection, an individual who has been

a resident of the Commonwealth for less than one (1) year may be enrolled in

a waiver program for which there is no waitlist.

(c) This subsection shall not apply to:

1. Individuals enrolled in a waiver program prior to April 14, 2026; or

2. Members of the United States Armed Forces, their spouses or

dependents, or veterans.

(8) (a) The cabinet shall reserve capacity in each waiver program to ensure

availability of waiver slots for individuals determined to have an emergency

need status and shall d evelop waitlist management policies for individuals

seeking emergency placement in a waiver program, including but not limited

to, by January 1, 2027, for each waiver program, development of waiver -

specific emergency need allocation criteria for any waiver program for which

such criteria do not already exist on April 14, 2026.

(b) Allocation criteria developed pursuant to this subsection for the home and

community based waiver, or HCB waiver, shall prioritize the allocation of

reserve capacity waiver slots to individuals determined through assessment to

be in need of skilled nursing services through a waiver program.

(9) (a) For the purposes of identifying and eliminating waste, fraud, and abuse in the

1915(c) waiver programs, any person who knows or has rea sonable cause to

believe that a violation of waiver program policy or law, including but not

limited to this section, this chapter, any administrative regulation promulgated

under this chapter, waiver program documents approved by the federal

Centers for M edicare and Medicaid Services, federal Medicaid -related

statutes or regulations, or contracts entered into by any agency of state

government for administration of the waiver programs, has been or is being

committed by any person, corporation, or entity, sh all report or cause to be

reported to the Office of Medicaid Fraud and Abuse Control in the Office of

the Attorney General, or the Medicaid Fraud and Abuse hotline as required

under KRS 205.8465.

(b) This subsection and KRS 205.8465 shall apply to area dev elopment districts,

or any other agency of state government, quasi -governmental agency, or

private entity tasked with administering or overseeing a patient directed

services program under which waiver participants are permitted to directly

employ caregiving staff. Any person who knows or has reasonable cause to

believe that any fraudulent activity in the hiring, employment, or

compensation of patient directed services staff has occurred or is ongoing

shall report or cause to be reported to the Office of Medicaid Fraud and Abuse

Control.

(10) On a quarterly basis beginning July 1, 2026, the cabinet shall prepare and submit a

report to the Legislative Research Commission for referral to the Interim Joint

Committees on Appropriations and Revenue and Families an d Children and the

Medicaid Oversight and Advisory Board on waiver program expenditures and

waiver service utilization rates for the quarter immediately preceding the most

recent quarter.