{"data":{"id":"us-ky/krs-205.5353","jurisdiction":"us-ky","citation":"KRS 205.5353","heading":"Dental services -- Administrative service organization delivery model --","body":"Legislative findings -- Medicaid dental director -- Procurement --\nAdministrative regulations -- Dental Services Advisory Panel -- Annual report.\n(1) The General Assembly finds and declares that:\n(a) Effective management of Medicaid-covered dental services is essential for the\noverall health of Medicaid beneficiaries and that specialized administration of\ndental services may improve programmatic efficiency, oral health, and overall\nhealth outcomes in the Commonwealth; and\n(b) It is the intent of the General Assembly to authorize the Department for\nMedicaid Services to administer Medicaid -covered dental services under an\nadministrative service organization delivery model beginning January 1, 2029,\nand for the administrative service organization contracted in accordance with\nthis section to perform administrative functions necessary to manage or\nprocess claims, prior authorization requests, coordination of care, network\nadequacy, and customer service related to Medicaid-covered dental services.\n(2) As used in this section:\n(a) \"Administrative service organization\" or \"ASO\" means the entity contracted\nby the department in accordance with subsection (3) of this section to perform\nspecified administrative functions related to the administration of Medicaid -\ncovered dental services without assuming a financial or insurance risk; and\n(b) \"Department\" means the Department for Medicaid Services.\n(3) The department shall:\n(a) Beginning Ju ly 1, 2028, employ a full -time Medicaid dental director who\nshall:\n1. Be licensed under KRS Chapter 313;\n2. Report to the commissioner of the department; and\n3. Be responsible for overseeing the administration of Medicaid -covered\ndental services;\n(b) Consider any recommendations that may be made by the Medicaid Oversight\nand Advisory Board, or a subcommittee thereof, regarding the transition of\nMedicaid-covered dental services from a managed care delivery model to an\nASO delivery model;\n(c) In accordance with KRS Chapter 45A and subsection (5) of this section, select\nand contract with a third -party ASO to administer Medicaid -covered dental\nservices. The contract entered into under this paragraph shall have an effective\ndate of January 1, 2029;\n(d) Promulgate administrative regulations in accordance with KRS Chapter 13A\nto implement this section;\n(e) Beginning January 1, 2029:\n1. Transition all Medicaid beneficiaries  from Medicaid managed care\norganization coverage into ASO coverage for the administration of all\nMedicaid-covered dental services; and\n2. Establish a Dental Services Advisory Panel which shall:\na. Include the following members:\ni. The Medicaid dental dire ctor employed pursuant to\nparagraph (a) of this subsection;\nii. The members of the Technical Advisory Committee on\nDental Care established in KRS 205.590; and\niii. A representative from the ASO contracted with pursuant to\nparagraph (c) of this subsection;\nb. Be attached to the department for administrative purposes; and\nc. Provide ongoing consultation, recommendations, and guidance to\nthe department to continually improve administration and delivery\nof Medicaid-covered dental services; and\n(f) On January 1,  2029, begin utilizing an ASO delivery model for the\nadministration of all Medicaid-covered dental services.\n(4) (a) The ASO contracted with pursuant to this section shall operate on an\nadministrative-services-only basis. The ASO shall not assume any financial or\ninsurance risk for the cost of dental claims incurred by the Commonwealth,\nand the Commonwealth shall remain fully financially responsible for all\nMedicaid-covered dental claims.\n(b) The duties and responsibilities of the ASO contracted with pursua nt to this\nsection shall be limited to the following administrative services:\n1. Assisting with and facilitating the transitioning of all Medicaid\nbeneficiaries from Medicaid managed care organization coverage into\nASO coverage for dental services;\n2. Processing and paying Medicaid -covered dental services claims in\naccordance with the department's established fee schedule and clinical\nguidelines;\n3. Employing utilization control strategies established by the department\nand managing all prior authorization r equests for Medicaid -covered\ndental services;\n4. Providing coordination of care with a Medicaid beneficiary's Medicaid\nmanaged care organization;\n5. Providing customer service and support to Medicaid beneficiaries and\nMedicaid-participating dental providers; and\n6. Any other administrative duties or responsibilities contractually\nassigned to the ASO by the department.\n(c) The ASO contracted with pursuant to this section shall not include in any\nanalysis of network adequacy an inactive Medicaid provider as d efined in\nKRS 205.5356;\n(5) (a) Notwithstanding any provision of law to the contrary, including subsection\n(3)(c) of this section, the department shall not initiate a procurement process\nto contract with a third -party ASO to administer Medicaid -covered dental\nservices prior to January 1, 2028.\n(b) Any contract entered into under this section shall be submitted to the\nGovernment Contract Review Committee of the Legislative Research\nCommission for comment and review.\n(6) On an annual basis, the department, in collaboration with the Dental S ervices\nAdvisory Panel, shall:\n(a) Evaluate the dental ASO's performance based on metrics, including but not\nlimited to the following:\n1. Accuracy and timeliness of claims processing;\n2. Efficiency of processing prior authorization requests;\n3. Observed network adequacy improvements;\n4. Availability of and access to services; and\n5. Satisfaction ratings from participating dental service providers and\nMedicaid beneficiaries; and\n(b) Prepare and submit a report on the evaluation required under this subsection\nto the Legislative Research Commission for referral to the Interim Joint\nCommittees on Appropriations and Revenue and Health Services, and the\nMedicaid Oversight and Advisory Board by August 1, 2029, and August 1 of\neach year thereafter.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=57044","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:03Z","sha256":"0e6ebc36e368bbb4d479b9dc4dfa070c53cbadbc3d56880e26cdda6fe84d0faa","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.535","next":"us-ky/krs-205.5355"},"notice":"GroundRules: Original legal text. Not legal advice."}