{"data":{"id":"us-ky/krs-205.6412","jurisdiction":"us-ky","citation":"KRS 205.6412","heading":"Rate improvement programs for certain qualifying hospitals -- Terms --","body":"Eligibility -- Federal participation and approval required for implementation\nof programs.\nTo the extent permitted under federal law and in addition to, and separate from, the\nprograms developed pursuant to KRS 205.6406, the department shall develop programs\nto improve quality of and access to care for residents of the Commonwealth enrolled in\nthe state's Medicaid program by increasing Medicaid reimbursement rates for qualifying\nhospitals in accordance with the following:\n(1) A qualifying hospital shall be eligible to earn enhanced add -on payments from\nMedicaid managed care organizations based on the qualifying hospital's average\ncommercial rate for services provided, i ncluding but not limited to inpatient\nhospital services, outpatient hospital services, and professional services, if the\nqualifying hospital:\n(a) 1. Is a participant in the hospital rate improvement program developed\npursuant to KRS 205.6406;\n2. Is a Level II, III, or IV trauma center;\n3. Is located in a county in which the percentage of the county's population\nenrolled in the state's Medicaid program exceeds the statewide median\nMedicaid enrollment percentage for all counties as posted by the\nCabinet for H ealth and Family Services in the December edition of the\nMonthly Medicaid Counts by County report for the calendar year\npreceding the year in which the preprint is submitted; and\n4. Has an agreement for clinical rotations to train providers with a\nuniversity-affiliated graduate medical education program; or\n(b) Is a pediatric teaching hospital as defined in KRS 205.565, except that a\nhospital qualifying for enhanced add -on payments under this subparagraph\nshall only be eligible to receive enhanced add -on pa yments for services\ndelivered to a patient who is eighteen (18) years of age or younger;\n(2) (a) Within sixty (60) days after July 15, 2016, the Department for Medicaid\nServices shall submit a Medicaid preprint with a January 1, 2026, effective\ndate to the federal Centers for Medicare and Medicaid Services seeking\nauthorization to implement the state -directed payment program described in\nthis subsection.\n(b) If the preprint required to be submitted under paragraph (a) of this subsection\nis approved by the federal Centers for Medicare and Medicaid Services, a\nqualifying hospital shall be eligible to ear n enhanced add -on payments from\nMedicaid managed care organizations based on the equivalent Medicare rate\nfor services, including but not limited to physician and nonphysician\nprofessional services, provided to Medicaid beneficiaries by the qualifying\nhospital's affiliated physician groups or physicians or other professionals\nemployed by or contracted with the qualifying hospital if the qualifying\nhospital has an agreement to train providers with a state -owned university -\naffiliated graduate medical education program;\n(3) For state-directed payments authorized under this section:\n(a) There shall be an identified source of funding, which shall be separate from\nthe assessment authorized in KRS 205.6406 and shall not be from the general\nfund, for the nonfederal share that is in compliance with the requirements of\nthe United States Centers for Medicare and Medicaid Services;\n(b) A qualifying hospital shall be required to report the same quality measures as\nare applicable under:\n1. The state university teaching hos pital Medicaid directed payment plan\nfor the payment program authorized under subsection (1) of this section;\nand\n2. Similarly approved payment programs active in the Commonwealth for\nthe payment program authorized under subsection (2) of this section;\nand\n(c) Reimbursement for qualifying hospitals under this section shall only apply to\npatients covered by a Medicaid managed care organization;\n(4) The state-directed payment programs authorized under this section shall be separate\nand distinct from any state -directed payment program authorized under KRS\n205.6406, and the department shall only implement the program described in this\nsection if:\n(a) Medicaid documentation required for federal financial participation is\napproved by the United States Centers for Medicare and Medicaid Services;\n(b) The United States Centers for Medicare and Medicaid Services agrees to\nconsider the program through its own preprint and without affecting or\naltering any other state-directed payment program; and\n(c) 1. A source of fund ing that complies with subsection (3)(a) of this section\nhas been identified and is available to meet the requirement for the\nnonfederal share or state match funds for a state -directed payment\nprogram.\n2. If a source of funding for the nonfederal share or state match funds\nrequired for a state -directed payment program becomes unavailable, the\ndepartment shall terminate the state-directed payment program;\n(5) If the federal Centers for Medicare and Medicaid Services or any other federal\nagency at any time af ter July 15, 2026, seeks, for any reason, to recoup funds\nassociated with a state-directed payment program authorized under this section:\n(a) The state shall not be liable for providing reimbursement to the federal\ngovernment; and\n(b) The qualifying hospit als that received a state -directed payment under this\nsection shall be liable for all reimbursement that may be owed to the federal\nCenters for Medicare and Medicaid Services or any other federal agency; and\n(6) The department shall promulgate administrati ve regulations in accordance with\nKRS Chapter 13A to implement the programs described in this section.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=57637","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:04Z","sha256":"154df7153d3b0e4974fe3ecf82bab591b0413322102997eca221d8bc3a4dd0e6","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.6411","next":"us-ky/krs-205.642"},"notice":"GroundRules: Original legal text. Not legal advice."}