{"data":{"id":"us-ky/krs-205.6405","jurisdiction":"us-ky","citation":"KRS 205.6405","heading":"Definitions for KRS 205.6405 to 205.6408.","body":"As used in KRS 205.6405 to 205.6408:\n(1) \"Assessment\" means the hospital assessment authorized by KRS 205.6406;\n(2) \"Commissioner\" means the commissioner of the Department for Medicaid Services;\n(3) \"Department\" means the Department for Medicaid Services;\n(4) \"Excess disproportionate share taxes\"  means any excess provider tax revenues\ncollected under KRS 142.303 that are not needed to fund the state share of hospital\ndisproportionate share payments under KRS 205.640 due to federal\ndisproportionate share allotments being reduced and limited to the portion of\nprovider tax revenues collected under KRS 142.303 necessary to fund the state\nshare of the difference between the unreduced disproportionate share allotment and\nthe reduced disproportionate share allotment;\n(5) \"Intergovernmental transfer\" means  any transfer of money by or on behalf of a\npublic agency for purposes of qualifying funds for federal financial participation in\naccordance with 42 C.F.R. sec. 433.51;\n(6) \"Long-term acute hospital\" means an in-state hospital that is certified as a long-term\ncare hospital under 42 U.S.C. sec. 1395ww(d)(1)(B)(iv);\n(7) \"Managed care\" means the provision of Medicaid benefits through managed care\norganizations under contract with the department pursuant to 42 C.F.R. sec. 438;\n(8) \"Managed care gap\" means:\n(a) For hospital inpatient services, the difference between the maximum\nactuarially sound amount that can be included in managed care rates for\nhospital inpatient services provided by qualifying hospitals and the amount of\ntotal payments for hospital inpatient  services provided by qualifying hospitals\npaid by managed care organizations. For purposes of the managed care gap,\ntotal payments shall exclude payments established under KRS 205.6405 to\n205.6408; and\n(b) For hospital outpatient services, the difference between the maximum\nactuarially sound amount that can be included in managed care rates for\nhospital outpatient services provided by qualifying hospitals and the amount\nof total payments for hospital outpati ent services provided by qualifying\nhospitals paid by managed care organizations. For purposes of the managed\ncare gap, total payments shall exclude payments established under KRS\n205.6405 to 205.6408;\n(9) \"Managed care organization\" means an entity contra cted with the department to\nprovide Medicaid benefits pursuant to 42 C.F.R. sec. 438;\n(10) \"Non-state government-owned hospital\" means the same as non -state government-\nowned or operated facilities in 42 C.F.R. sec. 447.272 and represents one (1) group\nof hospitals for purposes of estimating the upper payment limit;\n(11) \"Pediatric teaching hospital\" means the same as in KRS 205.565;\n(12) \"Private hospitals\" means the same as privately owned and operated facilities in 42\nC.F.R. sec. 447.272 and represents on e (1) group of hospitals for purposes of\nestimating the upper payment limit;\n(13) \"Program year\" means the state fiscal year during which an assessment is assessed\nand rate improvement payments are made;\n(14) \"Psychiatric access hospital\" means an in -state psychiatric hospital licensed under\nKRS Chapter 216B that:\n(a) Is not located in a Metropolitan Statistical Area;\n(b) Provides at least sixty -five thousand (65,000) days of inpatient care as\nreflected in the department's hospital rate data for state fiscal year 1998-1999;\n(c) Provides at least twenty percent (20%) of inpatient care to Medicaid -eligible\nrecipients as reflected in the department's hospital rate data for state fiscal\nyear 1998-1999; and\n(d) Provides at least five thousand (5,000) days of inpa tient psychiatric care to\nMedicaid recipients in a state fiscal year;\n(15) \"Qualifying hospital\":\n(a) Means a Medicaid-participating, in-state hospital licensed under KRS Chapter\n216B, including a long-term acute hospital, but excluding a university hospital\nand a state mental hospital as defined in KRS 205.639. The department may,\nbut is not required to, exclude critical access hospitals and rural emergency\nhospitals from the definition of \"qualifying hospital\" for purposes of\ncalculating the quarterly ass essments. Notwithstanding the permission\nreferenced in this subsection, or any other provision of the law to the contrary,\nthe department may include critical access hospitals and rural emergency\nhospitals for purposes of calculating and paying the quarter ly supplemental\npayments authorized in KRS 205.6406; and\n(b) Notwithstanding paragraph (a) of this subsection, a university hospital that is\nnot located on the affiliated university's primary campus may be deemed to be\na qualifying hospital if the universi ty hospital does not participate in a\nseparate directed payment program for university hospitals;\n(16) \"Qualifying hospital disproportionate share percentage\" means a percentage equal\nto the amount of hospital provider taxes paid pursuant to KRS 142.303 by\nqualifying hospitals in state fiscal year 2016-2017 divided by the amount of hospital\nprovider taxes paid pursuant to KRS 142.303 by all hospitals in state fiscal year\n2016-2017;\n(17) \"University hospital\" means a state university teaching hospital, owned  or operated\nby either the University of Kentucky College of Medicine or the University of\nLouisville School of Medicine, including a hospital owned or operated by a related\norganization pursuant to 42 C.F.R. sec. 413.17;\n(18) \"University hospital disproportionate share percentage\" means a percentage equal to\nthe amount of hospital provider taxes paid pursuant to KRS 142.303 by university\nhospitals and state mental hospitals, as defined in KRS 205.639, in state fiscal year\n2016-2017 divided by the amount of  hospital provider taxes paid pursuant to KRS\n142.303 by all hospitals in fiscal year 2016-2017;\n(19) \"Upper payment limit\" or \"UPL\" means the methodology permitted by federal\nregulation to achieve the maximum allowable amount on aggregate hospital\nMedicaid payments to non -state government-owned hospitals and private hospitals\nunder 42 C.F.R. sec. 447.272. A separate UPL shall be estimated for non -state\ngovernment-owned hospitals and private hospitals; and\n(20) \"UPL gap\" means the difference between the UPL  and amount of total fee -for-\nservice payments paid by the department for hospital inpatient services provided by\nnon-state government -owned hospitals and private hospitals to Medicaid\nbeneficiaries and excluding payments established under KRS 205.6405 to\n205.6408. A separate UPL gap shall be estimated for the non -state government -\nowned hospitals and private hospitals.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=54956","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:04Z","sha256":"027e30efd70eef32b3a496f49843212e7e89a1e75c704dc626ce8e018a6bde1e","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.6403","next":"us-ky/krs-205.6406"},"notice":"GroundRules: Original legal text. Not legal advice."}