KRS 205.6320: Cabinet to strengthen managed care component of KenPAC Program and

to establish standards for access and quality for organizations serving

Medicaid recipients.

(1) The Cabinet for Health and Family Services shall seek to strengthen the managed

care c omponent of the KenPAC Program. The cabinet shall by promulgation of

administrative regulation, pursuant to KRS Chapter 13A, establish the following:

(a) Inclusion of noninstitutionalized blind, aged, and disabled recipients in an

effort to reduce inapprop riate usage as permitted by federal Medicaid

regulations;

(b) Financial incentives for KenPAC physicians who effectively manage the care

of their patients. These incentives may include an increase in the case

management fee for demonstrated effective case management, or through

other arrangements that encourage the effective and efficient management of

patients. Clear and concise administrative regulations promulgated under KRS

Chapter 13A shall be established by the cabinet to determine physician

qualification for the incentives;

(c) A pilot project to establish an oversight and education program in the

KenPAC system to assist with patient education regarding the appropriate and

effective use of the system and to assist providers with more efficient

management of patients;

(d) Criteria to avoid duplication of the provision of early and periodic screening,

diagnosis, and treatment-type services to children in the KenPAC Program;

(e) A review of the feasibility of a demonstration project to allow health

maintenance organizations to bid on the provision of services to KenPAC

participants;

(f) Extension of KenPAC to all counties within the state. The cabinet shall

determine the feasibility of working with state -supported medical schools to

obtain physicians in the counties where KenPAC does not operate; and

(g) More stringent reporting and verification requirements in contracts with

KenPAC physicians regarding verification of services provided to KenPAC

patients.

(2) The secretary shall promulgate by administrative regulation standards for access and

quality which any health maintenance organizations serving Medicaid recipients

shall meet. The secretary shall not provide Medicaid services through a health

maintenance organization which does not demonstrate the capa city to meet the

standards. The standards shall address at least the following subjects:

(a) Access to care including patient to physician ratios, availability of appropriate

specialists, distance to care, travel and waiting times, and physical and

language barriers;

(b) Internal and external methods for monitoring quality of care;

(c) Data collection and reporting, including provision of data on utilization,

outcomes, enrollee satisfaction, and the number, type, and resolution of

grievances and complaints, with subpopulation data for at-risk populations;

(d) Due-process procedures including written notice of appeal rights, timelines for

resolution of complaints, and expedited appeals processes;

(e) Consumer representation and patient advocacy; and

(f) Marketing practices including prohibited practices and standards for

advertisements and printed marketing materials.