{"data":{"id":"us-ky/krs-205.6320","jurisdiction":"us-ky","citation":"KRS 205.6320","heading":"Cabinet to strengthen managed care component of KenPAC Program and","body":"to establish standards for access and quality for organizations serving\nMedicaid recipients.\n(1) The Cabinet for Health and Family Services shall seek to strengthen the managed\ncare c omponent of the KenPAC Program. The cabinet shall by promulgation of\nadministrative regulation, pursuant to KRS Chapter 13A, establish the following:\n(a) Inclusion of noninstitutionalized blind, aged, and disabled recipients in an\neffort to reduce inapprop riate usage as permitted by federal Medicaid\nregulations;\n(b) Financial incentives for KenPAC physicians who effectively manage the care\nof their patients. These incentives may include an increase in the case\nmanagement fee for demonstrated effective case management, or through\nother arrangements that encourage the effective and efficient management of\npatients. Clear and concise administrative regulations promulgated under KRS\nChapter 13A shall be established by the cabinet to determine physician\nqualification for the incentives;\n(c) A pilot project to establish an oversight and education program in the\nKenPAC system to assist with patient education regarding the appropriate and\neffective use of the system and to assist providers with more efficient\nmanagement of patients;\n(d) Criteria to avoid duplication of the provision of early and periodic screening,\ndiagnosis, and treatment-type services to children in the KenPAC Program;\n(e) A review of the feasibility of a demonstration project to allow health\nmaintenance organizations to bid on the provision of services to KenPAC\nparticipants;\n(f) Extension of KenPAC to all counties within the state. The cabinet shall\ndetermine the feasibility of working with state -supported medical schools to\nobtain physicians in the counties where KenPAC does not operate; and\n(g) More stringent reporting and verification requirements in contracts with\nKenPAC physicians regarding verification of services provided to KenPAC\npatients.\n(2) The secretary shall promulgate by administrative regulation standards for access and\nquality which any health maintenance organizations serving Medicaid recipients\nshall meet. The secretary shall not provide Medicaid services through a health\nmaintenance organization which does not demonstrate the capa city to meet the\nstandards. The standards shall address at least the following subjects:\n(a) Access to care including patient to physician ratios, availability of appropriate\nspecialists, distance to care, travel and waiting times, and physical and\nlanguage barriers;\n(b) Internal and external methods for monitoring quality of care;\n(c) Data collection and reporting, including provision of data on utilization,\noutcomes, enrollee satisfaction, and the number, type, and resolution of\ngrievances and complaints, with subpopulation data for at-risk populations;\n(d) Due-process procedures including written notice of appeal rights, timelines for\nresolution of complaints, and expedited appeals processes;\n(e) Consumer representation and patient advocacy; and\n(f) Marketing practices including prohibited practices and standards for\nadvertisements and printed marketing materials.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=7765","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:04Z","sha256":"643d8ee7a9e9d47af3dc81c2ac22c4026396fc1b036a662876e0f9148f88c4ee","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.632","next":"us-ky/krs-205.6322"},"notice":"GroundRules: Original legal text. Not legal advice."}