{"data":{"id":"us-ky/krs-205.6310","jurisdiction":"us-ky","citation":"KRS 205.6310","heading":"Cabinet to establish system to reduce unnecessary hospital emergency","body":"room utilization and costs.\nThe Cabinet for Health and Family Services shall establish a system within the Medical\nAssistance Program to reduce unnecessary hospital emergency room u tilization and costs\nby redefining and controlling hospital emergency utilization. The cabinet shall establish\nby promulgation of administrative regulations, pursuant to KRS Chapter 13A, the\nfollowing:\n(1) Criteria and procedures, at least annually updated , that differentiate children and\nadults, and which conform to the Federal Emergency Medical Treatment and Active\nLabor Act (42 U.S.C. sec. 1395dd), as amended, and any other applicable federal\nlaw or regulation for determining if a medical emergency exists;\n(2) Reimbursement rates that provide for nominal reimbursement of emergency room\ncare for care that does not meet the criteria established for a medical emergency;\n(3) Reimbursement, at rates determined by the cabinet, for ancillary services which,\nbased upon the symptoms of the patient, are medically appropriate to determine if a\nmedical emergency exists;\n(4) Except for emergency room services rendered to children under the age of six (6),\nprohibition of reimbursement at hospital emergency room rates fo r diagnosis and\ntreatment for a condition that does not meet the criteria established for a medical\nemergency; and\n(5) The provisions of this section shall apply to any managed care program for\nMedicaid recipients.\nThe cabinet or its designated peer review organization shall review all claims for payment\nof nonemergency hospital care and deny payment for any ancillary services determined as\nnot medically appropriate.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=7757","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:04Z","sha256":"8c5eeaa5eb40b090641d9c389c1d3fa0f12efb4713f31bdc933cd0a8d7e0100e","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.631","next":"us-ky/krs-205.6311"},"notice":"GroundRules: Original legal text. Not legal advice."}