{"data":{"id":"us-ky/krs-205.5370","jurisdiction":"us-ky","citation":"KRS 205.5370","heading":"Waiver programs -- Definitions for section -- Application -- Waitlists --","body":"Assessments and reevaluations -- Eligibility -- Report of possible violations --\nQuarterly report.\n(1) As used in this section:\n(a) \"Department\":\n1. Means the Department for Medicaid Services; and\n2. Includes any other agency of state government or nongovernmental\nentity contracted by the department to administer any aspect of a waiver\nprogram;\n(b) \"Waiver program\" means a 1915(c) home and community based waiver\nprogram approved by the federal Centers for Medicare and Medicaid Services\nand administered by the department or any other subdivision of the cabinet;\nand\n(c) \"Waiver program application\" means any waiver program application,\nincluding a waiver waitlist application o r application to begin receiving\nwaiver program services.\n(2) (a) The department shall require any individual applying for waiver program\nservices, including any individuals applying for or requesting placement on a\nwaiver waitlist, to submit a completed w aiver program application that\nincludes a provider's recommendation for waiver program services and\nprovider attestation to the primary diagnosis for which the individual is\nseeking waiver program services.\n(b) Except as provided in paragraph (c) of this subsection, the department shall\nnot place any individual on a waiver waitlist or approve any individual to\nreceive waiver program services if the individual has not completed and\nsubmitted a waiver program appli cation that includes a provider's\nrecommendation for waiver program services and provider attestation to the\nprimary diagnosis for which the individual is seeking waiver program\nservices.\n(c) An individual who was placed on a waiver waitlist on or before A pril 14,\n2026, shall be allowed twelve (12) months from April 14, 2026, to submit a\nwaiver program application that includes a provider's recommendation for\nwaiver program services and provider attestation to the primary diagnosis for\nwhich the individual is seeking waiver program services. Any individual who\nwas placed on a waiver waitlist on or before April 14, 2026, who fails to\ncomply with the requirements of this paragraph shall be removed from the\nwaiver waitlist.\n(d) As used in this subsection, \"prov ider\" means a physician or physician\nassistant licensed under KRS Chapter 311, an advanced practice registered\nnurse licensed under KRS Chapter 314, or a licensed psychologist licensed\nunder KRS Chapter 319.\n(3) By July 1, 2026, the department shall identi fy, designate, and require the use of a\nwaiver-specific level of care assessment tool for each waiver program operated by\nthe department. The level of care assessment tools designated under this subsection\nshall:\n(a) Be nationally recognized;\n(b) At a minimum, recommend the frequency, duration, and intensity of services\nneeded by the individual; and\n(c) Be age -appropriate relative to the population served by the waiver program\nfor which it is designated.\n(4) All level of care assessments, including annual l evel of care reevaluations, shall\nutilize the waiver -specific level of care assessment tools designated in accordance\nwith subsection (3) of this section.\n(5) Notwithstanding subsections (3) and (4) of this section, an individual who is\neighteen (18) years  of age or younger and currently receiving waiver services on\nApril 14, 2026, shall not be reassessed using the level of care assessment tools\ndesignated under subsection (3) of this section and shall continue to be reassessed\nas required under state and f ederal law using the assessment tool in effect on April\n14, 2026, until he or she reaches eighteen (18) years of age.\n(6) The department shall undertake efforts to encourage waiver service providers to\ndevelop innovative programs that increase the quality and value of care while\nreducing costs of the waiver programs.\n(7) (a) Except as provided in paragraphs (b) and (c) of this subsection and to the\nextent permitted under federal law, in order to be eligible for enrollment in a\nwaiver program an individual s hall be a citizen of the United States or a\nqualified alien as defined in 8 U.S.C. sec. 1641 and have been a resident of\nthe Commonwealth for at least one (1) year prior to enrollment.\n(b) Notwithstanding paragraph (a) of this subsection, an individual who  has been\na resident of the Commonwealth for less than one (1) year may be enrolled in\na waiver program for which there is no waitlist.\n(c) This subsection shall not apply to:\n1. Individuals enrolled in a waiver program prior to April 14, 2026; or\n2. Members of the United States Armed Forces, their spouses or\ndependents, or veterans.\n(8) (a) The cabinet shall reserve capacity in each waiver program to ensure\navailability of waiver slots for individuals determined to have an emergency\nneed status and shall d evelop waitlist management policies for individuals\nseeking emergency placement in a waiver program, including but not limited\nto, by January 1, 2027, for each waiver program, development of waiver -\nspecific emergency need allocation criteria for any waiver  program for which\nsuch criteria do not already exist on April 14, 2026.\n(b) Allocation criteria developed pursuant to this subsection for the home and\ncommunity based waiver, or HCB waiver, shall prioritize the allocation of\nreserve capacity waiver slots to individuals determined through assessment to\nbe in need of skilled nursing services through a waiver program.\n(9) (a) For the purposes of identifying and eliminating waste, fraud, and abuse in the\n1915(c) waiver programs, any person who knows or has rea sonable cause to\nbelieve that a violation of waiver program policy or law, including but not\nlimited to this section, this chapter, any administrative regulation promulgated\nunder this chapter, waiver program documents approved by the federal\nCenters for M edicare and Medicaid Services, federal Medicaid -related\nstatutes or regulations, or contracts entered into by any agency of state\ngovernment for administration of the waiver programs, has been or is being\ncommitted by any person, corporation, or entity, sh all report or cause to be\nreported to the Office of Medicaid Fraud and Abuse Control in the Office of\nthe Attorney General, or the Medicaid Fraud and Abuse hotline as required\nunder KRS 205.8465.\n(b) This subsection and KRS 205.8465 shall apply to area dev elopment districts,\nor any other agency of state government, quasi -governmental agency, or\nprivate entity tasked with administering or overseeing a patient directed\nservices program under which waiver participants are permitted to directly\nemploy caregiving staff. Any person who knows or has reasonable cause to\nbelieve that any fraudulent activity in the hiring, employment, or\ncompensation of patient directed services staff has occurred or is ongoing\nshall report or cause to be reported to the Office of Medicaid Fraud and Abuse\nControl.\n(10) On a quarterly basis beginning July 1, 2026, the cabinet shall prepare and submit a\nreport to the Legislative Research Commission for referral to the Interim Joint\nCommittees on Appropriations and Revenue and Families an d Children and the\nMedicaid Oversight and Advisory Board on waiver program expenditures and\nwaiver service utilization rates for the quarter immediately preceding the most\nrecent quarter.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=57035","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:03Z","sha256":"1299fbfcb8b80f4dcb12da5445cac1606a2226a56cf6a440a90b5b6dd1d8e6b9","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.5369","next":"us-ky/krs-205.5371"},"notice":"GroundRules: Original legal text. Not legal advice."}