205.6328 Medicaid managed care contracts after March 27, 2025, to include
1,200 words·~5 min read·
/ky/205-6328A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
provision for collection of expenditure data -- Quarterly budget analysis report
required -- Applicability of Open Records Act -- Quarterly reports from
managed care companies to department -- Quarterly enrollee demographics
report -- Quarterly health care provider tax and assessment report.
(a)A Medicaid managed care contract entered into by the Department for
Medicaid Services on or after March 27, 2025, shall not be valid, and a
payment to a Medicaid managed care vendor by the Finance and
Administration Cabinet or the Cabinet for Health and Family Services shall
not be made, unless the Medicaid managed care contract contains a provision
that the contractor shall collect Medicaid expenditure data by the categories of
services paid for by the Medicaid Program. Actual statewide Medicaid
expenditure data by all categories of Medicaid services, including mandated
and optional Medicaid services, special expenditures and offsets, recoupments
and clawbacks, and disproportionate share hospital payments by type of
hospital, shall be compiled by the Department for Medicaid Services for all
Medicaid providers and forwarded to the Legislative Research Commission
for referral to the Medicaid Oversight and Advisory Board, the Interim Joint
Committee on Appropriations and Revenue, the Interim Joint Committee on
Families and Children, the Interim Joint Committee on Health Services, and
the Office of Budget Review on a quarterly basis. Projections of Medicaid
expenditures by categories of Medicaid services shall be provided to the
Medicaid Oversight and Advisory Board, the Interim Joint Committee on
Appropriations and Revenue, the Interim Joint Committee on Families and
Children, the Interim Joint Committee on Health Services, and the Office of
Budget Review upon request.
(b)Medicaid expenditure data required to be collected and reported pursuant to
paragraph
(a)of this subsection shall include expenditures made by any third-
party administrator contracted by a managed care organization to assist in
providing services and benefits to Medicaid beneficiaries, including but not
limited to any dental benefit administrator, vision benefit administrator,
hearing benefit administrator, or transportation benefit administrator.
(2)The Department for Medicaid Services shall submit a quarterly budget analysis
report to the Legislative Research Commission for referral to the Medicaid
Oversight and Advisory Board, the Interim Joint Committee on Appropriations and
Revenue, the Interim Joint Committee on Families and Children, the Interim Joint
Committee on Health Services, and the Office of Budget Review no later than
seventy-five
(75)days after the end of each quarter. The report shall provide
monthly detail of actual expenditures, eligibles, and average monthly cost per
eligible by eligibility category along with current trailing twelve
(12)month
averages for each of these figures. The report shall also provide actual figures for
all categories of noneligible-specific expenditures such as supplemental medical
insurance premiums, Kentucky patient access to care, nonemergency transportation,
drug rebates, cost settlements, and disproportionate share hospital payments by type
of hospital. The report shall compare the actual expenditure experience with those
underlying the enacted or revised enacted budget and explain any significant
variances which may occur.
(a)Except as provided in KRS 61.878, all records and correspondence relating to
Kentucky Medicaid, revenues derived from Kentucky Medicaid funds, and
expenditures utilizing Kentucky Medicaid funds of a Medicaid managed care
company operating within the Commonwealth shall be subject to the
Kentucky Open Records Act, KRS 61.870 to 61.884. This subsection shall not
apply to any records and correspondence relating to Medicaid specifically
prohibited from disclosure by the federal Health Insurance Portability and
Accountability Act privacy rules.
(b)No later than sixty
(60)days after the end of each quarter, each Medicaid
managed care company operating within the Commonwealth shall prepare
and submit to the Department for Medicaid Services sufficient information to
allow the department to meet the following requirements ninety
(90)days
after the end of each quarter. The department shall forward to the Legislative
Research Commission for referral to the Medicaid Oversight and Advisory
Board, the Interim Joint Committee on Appropriations and Revenue, the
Interim Joint Committee on Families and Children, the Interim Joint
Committee on Health Services, and the Office of Budget Review a quarterly
report detailing monthly actual expenditures by service category, monthly
eligibles, and average monthly cost per eligible for Medicaid and the
Kentucky Children's Health Insurance Program along with current trailing
twelve
(12)month averages for each of these figures. The report shall also
provide actual figures for other categories such as pharmacy rebates and
reinsurance. Finally, the department shall include in this report the most
recent information or report available regarding the amount withheld to meet
Department of Insurance reserve requirements, and any distribution of
moneys received or retained in excess of these reserve requirements.
(4)The Cabinet for Health and Family Services shall submit a quarterly enrollee
demographics report to the Legislative Research Commission for referral to the
Medicaid Oversight and Advisory Board, the Interim Joint Committee on
Appropriations and Revenue, the Interim Joint Committee on Families and
Children, the Interim Joint Committee on Health Services, and the Office of Budget
Review no later than seventy-five
(75)days after the end of each quarter. The
enrollee demographics report shall provide a summary of enrollee demographics
and shall include data on at least the following demographic characteristics for
enrollees by county:
(a)The total number of individuals enrolled in the Medicaid program during each
month of the previous quarter by eligibility category;
(b)The number of individuals enrolled in the Medicaid program by employment
status, including full-time employment, part-time employment, and
unemployed;
(c)The number of individuals enrolled in the Medicaid program by race and
ethnicity;
(d)The number of individuals enrolled in the Medicaid program by citizenship
status, refugee status, legal immigration status, illegal or undocumented
immigration status, or other status under which an individual is present in the
United States;
(e)The number of beneficiaries enrolled in the Medicaid program with
dependents;
(f)The total number of dependents enrolled in the Medicaid program; and
(g)Any other information or data related to Medicaid beneficiaries requested by
the Legislative Research Commission.
(5)The Department for Medicaid Services shall submit a quarterly health care provider
tax and assessment report to the Legislative Research Commission for referral to
the Medicaid Oversight and Advisory Board, the Interim Joint Committee on
Appropriations and Revenue, the Interim Joint Committee on Families and
Children, the Interim Joint Committee on Health Services, and the Office of Budget
Review no later than seventy-five
(75)days after the end of each quarter. The
health care provider tax report shall include the total amount of revenue generated
during the previous quarter and the corresponding federal funding match generated
during the previous quarter under:
(a)KRS 142.303;
(b)KRS 142.307;
(c)KRS 142.314;
(d)KRS 142.315;
(e)KRS 142.316;
(f)KRS 142.318;
(g)KRS 142.361;
(h)KRS 142.363;
(i)KRS 205.6406(3)(h);
(j)KRS 205.6406(3)(j);
(k)KRS 205.6412; and
(l)Any other provider tax or assessment on healthcare providers.
(6)All reports required to be submitted to the Legislative Research Commission under
this section shall be submitted in a form and manner prescribed by the Legislative
Research Commission.
(7)As used in this section, the term "Medicaid program" includes the Kentucky
Medical Assistance Program established in KRS 205.510 to 205.5630 and the
Kentucky Children's Health Insurance Program established in KRS 205.6483.