{"data":{"id":"us-ky/krs-205.6328","jurisdiction":"us-ky","citation":"KRS 205.6328","heading":"Medicaid managed care contracts after March 27, 2025, to include","body":"provision for collection of expenditure data -- Quarterly budget analysis report\nrequired -- Applicability of Open Records Act -- Quarterly reports from\nmanaged care companies to d epartment -- Quarterly enrollee demographics\nreport -- Quarterly health care provider tax and assessment report.\n(1) (a) A Medicaid managed care contract entered into by the Department for\nMedicaid Services on or after March 27, 2025, shall not be valid,  and a\npayment to a Medicaid managed care vendor by the Finance and\nAdministration Cabinet or the Cabinet for Health and Family Services shall\nnot be made, unless the Medicaid managed care contract contains a provision\nthat the contractor shall collect Medicaid expenditure data by the categories of\nservices paid for by the Medicaid Program. Actual statewide Medicaid\nexpenditure data by all categories of Medicaid services, including mandated\nand optional Medicaid services, special expenditures and offsets, recoupments\nand clawbacks, and disproportionate share hospital payments by type of\nhospital, shall be compiled by the Department for Medicaid Services for all\nMedicaid providers and forwarded to the Legislative Research Commission\nfor referral to the Medica id Oversight and Advisory Board, the Interim Joint\nCommittee on Appropriations and Revenue, the Interim Joint Committee on\nFamilies and Children, the Interim Joint Committee on Health Services, and\nthe Office of Budget Review on a quarterly basis. Projecti ons of Medicaid\nexpenditures by categories of Medicaid services shall be provided to the\nMedicaid Oversight and Advisory Board, the Interim Joint Committee on\nAppropriations and Revenue, the Interim Joint Committee on Families and\nChildren, the Interim Joi nt Committee on Health Services, and the Office of\nBudget Review upon request.\n(b) Medicaid expenditure data required to be collected and reported pursuant to\nparagraph (a) of this subsection shall include expenditures made by any third -\nparty administrator  contracted by a managed care organization to assist in\nproviding services and benefits to Medicaid beneficiaries, including but not\nlimited to any dental benefit administrator, vision benefit administrator,\nhearing benefit administrator, or transportation benefit administrator.\n(2) The Department for Medicaid Services shall submit a quarterly budget analysis\nreport to the Legislative Research Commission for referral to the Medicaid\nOversight and Advisory Board, the Interim Joint Committee on Appropriations  and\nRevenue, the Interim Joint Committee on Families and Children, the Interim Joint\nCommittee on Health Services, and the Office of Budget Review no later than\nseventy-five (75) days after the end of each quarter. The report shall provide\nmonthly detail of actual expenditures, eligibles, and average monthly cost per\neligible by eligibility category along with current trailing twelve (12) month\naverages for each of these figures. The report shall also provide actual figures for\nall categories of noneligibl e-specific expenditures such as supplemental medical\ninsurance premiums, Kentucky patient access to care, nonemergency transportation,\ndrug rebates, cost settlements, and disproportionate share hospital payments by type\nof hospital. The report shall compar e the actual expenditure experience with those\nunderlying the enacted or revised enacted budget and explain any significant\nvariances which may occur.\n(3) (a) Except as provided in KRS 61.878, all records and correspondence relating to\nKentucky Medicaid, r evenues derived from Kentucky Medicaid funds, and\nexpenditures utilizing Kentucky Medicaid funds of a Medicaid managed care\ncompany operating within the Commonwealth shall be subject to the\nKentucky Open Records Act, KRS 61.870 to 61.884. This subsection shall not\napply to any records and correspondence relating to Medicaid specifically\nprohibited from disclosure by the federal Health Insurance Portability and\nAccountability Act privacy rules.\n(b) No later than sixty (60) days after the end of each quarter,  each Medicaid\nmanaged care company operating within the Commonwealth shall prepare\nand submit to the Department for Medicaid Services sufficient information to\nallow the department to meet the following requirements ninety (90) days\nafter the end of each quarter. The department shall forward to the Legislative\nResearch Commission for referral to the Medicaid Oversight and Advisory\nBoard, the Interim Joint Committee on Appropriations and Revenue, the\nInterim Joint Committee on Families and Children, the Int erim Joint\nCommittee on Health Services, and the Office of Budget Review a quarterly\nreport detailing monthly actual expenditures by service category, monthly\neligibles, and average monthly cost per eligible for Medicaid and the\nKentucky Children's Health Insurance Program along with current trailing\ntwelve (12) month averages for each of these figures. The report shall also\nprovide actual figures for other categories such as pharmacy rebates and\nreinsurance. Finally, the department shall include in this re port the most\nrecent information or report available regarding the amount withheld to meet\nDepartment of Insurance reserve requirements, and any distribution of\nmoneys received or retained in excess of these reserve requirements.\n(4) The Cabinet for Health  and Family Services shall submit a quarterly enrollee\ndemographics report to the Legislative Research Commission for referral to the\nMedicaid Oversight and Advisory Board, the Interim Joint Committee on\nAppropriations and Revenue, the Interim Joint Commit tee on Families and\nChildren, the Interim Joint Committee on Health Services, and the Office of Budget\nReview no later than seventy -five (75) days after the end of each quarter. The\nenrollee demographics report shall provide a summary of enrollee demograph ics\nand shall include data on at least the following demographic characteristics for\nenrollees by county:\n(a) The total number of individuals enrolled in the Medicaid program during each\nmonth of the previous quarter by eligibility category;\n(b) The number of individuals enrolled in the Medicaid program by employment\nstatus, including full -time employment, part -time employment, and\nunemployed;\n(c) The number of individuals enrolled in the Medicaid program by race and\nethnicity;\n(d) The number of individuals enrolled in the Medicaid program by citizenship\nstatus, refugee status, legal immigration status, illegal or undocumented\nimmigration status, or other status under which an individual is present in the\nUnited States;\n(e) The number of beneficiaries enrolled in the Medicaid program with\ndependents;\n(f) The total number of dependents enrolled in the Medicaid program; and\n(g) Any other information or  data related to Medicaid beneficiaries requested by\nthe Legislative Research Commission.\n(5) The Department for Medicaid Services shall submit a quarterly health care provider\ntax and assessment report to the Legislative Research Commission for referral t o\nthe Medicaid Oversight and Advisory Board, the Interim Joint Committee on\nAppropriations and Revenue, the Interim Joint Committee on Families and\nChildren, the Interim Joint Committee on Health Services, and the Office of Budget\nReview no later than seve nty-five (75) days after the end of each quarter. The\nhealth care provider tax report shall include the total amount of revenue generated\nduring the previous quarter and the corresponding federal funding match generated\nduring the previous quarter under:\n(a) KRS 142.303;\n(b) KRS 142.307;\n(c) KRS 142.314;\n(d) KRS 142.315;\n(e) KRS 142.316;\n(f) KRS 142.318;\n(g) KRS 142.361;\n(h) KRS 142.363;\n(i) KRS 205.6406(3)(h);\n(j) KRS 205.6406(3)(j);\n(k) KRS 205.6412; and\n(l) Any other provider tax or assessment on healthcare providers.\n(6) All reports required to be submitted to the Legislative Research Commission under\nthis section shall be submitted in a form and manner prescribed by the Legislative\nResearch Commission.\n(7) As used in this section, the term \"Medicaid pro gram\" includes the Kentucky\nMedical Assistance Program established in KRS 205.510 to 205.5630 and the\nKentucky Children's Health Insurance Program established in KRS 205.6483.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=55969","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:04Z","sha256":"596b40c0dafe70a385f6b5cb5e2dcbc7af3ac671dce9839e5e05f4ce7d20e45d","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.6326","next":"us-ky/krs-205.6330"},"notice":"GroundRules: Original legal text. Not legal advice."}