205.6320 Cabinet to strengthen managed care component of KenPAC Program and
435 words·~2 min read·
/ky/205-6320A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
to establish standards for access and quality for organizations serving
Medicaid recipients.
(1)The Cabinet for Health and Family Services shall seek to strengthen the managed
care component of the KenPAC Program. The cabinet shall by promulgation of
administrative regulation, pursuant to KRS Chapter 13A, establish the following:
(a)Inclusion of noninstitutionalized blind, aged, and disabled recipients in an
effort to reduce inappropriate usage as permitted by federal Medicaid
regulations;
(b)Financial incentives for KenPAC physicians who effectively manage the care
of their patients. These incentives may include an increase in the case
management fee for demonstrated effective case management, or through
other arrangements that encourage the effective and efficient management of
patients. Clear and concise administrative regulations promulgated under KRS
Chapter 13A shall be established by the cabinet to determine physician
qualification for the incentives;
(c)A pilot project to establish an oversight and education program in the
KenPAC system to assist with patient education regarding the appropriate and
effective use of the system and to assist providers with more efficient
management of patients;
(d)Criteria to avoid duplication of the provision of early and periodic screening,
diagnosis, and treatment-type services to children in the KenPAC Program;
(e)A review of the feasibility of a demonstration project to allow health
maintenance organizations to bid on the provision of services to KenPAC
participants;
(f)Extension of KenPAC to all counties within the state. The cabinet shall
determine the feasibility of working with state-supported medical schools to
obtain physicians in the counties where KenPAC does not operate; and
(g)More stringent reporting and verification requirements in contracts with
KenPAC physicians regarding verification of services provided to KenPAC
patients.
(2)The secretary shall promulgate by administrative regulation standards for access and
quality which any health maintenance organizations serving Medicaid recipients
shall meet. The secretary shall not provide Medicaid services through a health
maintenance organization which does not demonstrate the capacity to meet the
standards. The standards shall address at least the following subjects:
(a)Access to care including patient to physician ratios, availability of appropriate
specialists, distance to care, travel and waiting times, and physical and
language barriers;
(b)Internal and external methods for monitoring quality of care;
(c)Data collection and reporting, including provision of data on utilization,
outcomes, enrollee satisfaction, and the number, type, and resolution of
grievances and complaints, with subpopulation data for at-risk populations;
(d)Due-process procedures including written notice of appeal rights, timelines for
resolution of complaints, and expedited appeals processes;
(e)Consumer representation and patient advocacy; and
(f)Marketing practices including prohibited practices and standards for
advertisements and printed marketing materials.