KRS 7A.286: Board duties and permitted activities.

(1) The board, consistent with its purpose as established in KRS 7A.273, shall:

(a) On an ongoing basis, conduct an impartial review of all state laws and

regulations governing the Medicaid program and recommend to the General

Assembly any changes it finds des irable with respect to program

administration, including delivery system models, program financing, benefits

and coverage policies, reimbursement rates, payment methodologies, provider

participation, or any other aspect of the program;

(b) On an ongoing ba sis, review any change or proposed change in federal laws

and regulations governing the Medicaid program and report to the

Commission on the probable costs, possible budgetary implications, potential

effect on healthcare outcomes, and the overall desirabil ity of any change or

proposed change in federal laws or regulations governing the Medicaid

program;

(c) At the request of the Speaker of the House of Representatives or the President

of the Senate, evaluate proposed changes to state laws affecting the Medi caid

program and report to the Speaker or the President on the probable costs,

possible budgetary implications, potential effect on healthcare outcomes, and

overall desirability as a matter of public policy;

(d) At the request of the Commission, research i ssues related to the Medicaid

program;

(e) Beginning in 2027 and at least once every five (5) years thereafter, cause:

1. A review to be made of the administrative expenses and operational cost

of the Medicaid program. The review shall include but not be l imited to

evaluating the level and growth of administrative costs, the potential for

legislative changes to reduce administrative costs, and administrative

changes the department may make to reduce administrative costs or

staffing needs. At the discretion of the Commission, the review may be

conducted by a consultant retained by the board;

2. A program evaluation to be conducted of the Medicaid program. In any

instance in which a program evaluation indicates inadequate operating

or administrative system con trols or procedures, inaccuracies,

inefficiencies, waste, extravagance, unauthorized or unintended

activities, or other deficiencies, the board shall report its findings to the

Commission. The program evaluation shall be performed by a

consultant retained by the board; and

3. An actuarial analysis to be performed of the Medicaid program, to

evaluate the sufficiency and appropriateness of Medicaid reimbursement

rates established by the department and those paid by any managed care

organization contracted by the department for th e delivery of Medicaid

services. The actuarial analysis shall be performed by an actuary

retained by the board;

(f) Beginning in 2029 and at least once every five (5) years thereafter, cause the

overall health of the Medicaid population to be assessed. The assessment shall

include but not be limited to a review of health outcomes, healthcare

disparities among program beneficiaries and as compared to the general

population, and the effect of the overall health of the Medicaid population on

program expenses. The assessment shall be performed by a consultant

retained by the board; and

(g) Beginning in 2026 and annually thereafter, publish a report covering the

board's evaluations and recommendations with respect to the Medicaid

program. The report shall be subm itted to the Commission no later than

December 1 of each year, and shall include at a minimum a summary of the

board's current evaluation of the program and any legislative

recommendations made by the board.

(2) The board, consistent with its purpose as established in KRS 7A.273, may:

(a) Review all new or amended administrative regulations related to the Medicaid

program and provide comments to the Administrative Regulation Review

Subcommittee established in KRS 13A.020;

(b) Make recommendations to the General Assembly, the Governor, the secretary

of the cabinet, and the commissioner of the department regarding program

administration, including benefits and coverage policies, access to services

and provider network adequacy, healthcare outcomes and disparit ies,

reimbursement rates, payment methodologies, delivery system models,

funding, and administrative regulations. Recommendations made pursuant to

this section shall be nonbinding and shall not have the force of law; and

(c) On or before December 1 of each calendar year, adopt an annual research

agenda. The annual research agenda may include studies, research, and

investigations considered by the board to be significant. Board staff shall

prepare a list of study and research topics related to the Medicaid p rogram for

consideration by the board in the adoption of the annual research agenda. An

annual research agenda adopted by the board may be amended by the

Commission to include any studies or reports mandated by the General

Assembly during the next succeeding regular session.

(3) At the discretion of the Commission, studies and research projects included in an

annual research agenda adopted by the board pursuant to subsection (2)(c) of this

section may be conducted by outside consultants, analysts, or resear chers to ensure

the timely completion of the research agenda.