205.6485 State child health plan -- Eligibility criteria -- Schedule of benefits --
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(1)As used in this section, "KCHIP" means the Kentucky Children's Health Insurance
Program.
(2)The Cabinet for Health and Family Services shall:
(a)Prepare a state child health plan, known as KCHIP, meeting the requirements
of Title XXI of the Federal Social Security Act, for submission to the
Secretary of the United States Department of Health and Human Services
within such time as will permit the state to receive the maximum amounts of
federal matching funds available under Title XXI; and
(b)By administrative regulation promulgated in accordance with KRS Chapter
13A, establish the following:
1. The eligibility criteria for children covered by KCHIP, which shall
include a provision that no person eligible for services under Title XIX
of the Social Security Act, 42 U.S.C. secs. 1396 to 1396v, as amended,
shall be eligible for services under KCHIP, except to the extent that
Title XIX coverage is expanded by KRS 205.6481 to 205.6495 and KRS
304.17A-340;
2. The schedule of benefits to be covered by KCHIP, which shall:
a. Be at least equivalent to one
(1)of the following:
i. The standard Blue Cross/Blue Shield preferred provider
option under the Federal Employees Health Benefit Plan
established by 5 U.S.C. sec. 8903(1);
ii. A mid-range health benefit coverage plan that is offered and
generally available to state employees; or
iii. Health insurance coverage offered by a health maintenance
organization that has the largest insured commercial, non-
Medicaid enrollment of covered lives in the state; and
b. Comply with subsection
(6)of this section;
3. The premium contribution per family for health insurance coverage
available under KCHIP, which shall be based:
a. On a six
(6)month period; and
b. Upon a sliding scale relating to family income not to exceed:
i. Ten dollars ($10), to be paid by a family with income
between one hundred percent (100%) to one hundred thirty-
three percent (133%) of the federal poverty level;
ii. Twenty dollars ($20), to be paid by a family with income
between one hundred thirty-four percent (134%) to one
hundred forty-nine percent (149%) of the federal poverty
level; and
iii. One hundred twenty dollars ($120), to be paid by a family
with income between one hundred fifty percent (150%) to
two hundred percent (200%) of the federal poverty level, and
which may be made on a partial payment plan of twenty
dollars ($20) per month or sixty dollars ($60) per quarter;
4. There shall be no copayments for services provided under KCHIP; and
5. a. The criteria for health services providers and insurers wishing to
contract with the Commonwealth to provide coverage under
KCHIP.
b. The cabinet shall provide, in any contracting process for coverage
of preventive services, the opportunity for a public health
department to bid on preventive health services to eligible children
within the public health department's service area. A public health
department shall not be disqualified from bidding because the
department does not currently offer all the services required by
this section. The criteria shall be set forth in administrative
regulations under KRS Chapter 13A and shall maximize
competition among the providers and insurers. The Finance and
Administration Cabinet shall provide oversight over contracting
policies and procedures to assure that the number of applicants for
contracts is maximized.
(3)Within twelve
(12)months of federal approval of the state's Title XXI child health
plan, the Cabinet for Health and Family Services shall assure that a KCHIP
program is available to all eligible children in all regions of the state. If necessary,
in order to meet this assurance, the cabinet shall institute its own program.
(4)KCHIP recipients shall have direct access without a referral from any gatekeeper
primary care provider to dentists for covered primary dental services and to
optometrists and ophthalmologists for covered primary eye and vision services.
(5)KCHIP shall comply with KRS 304.17A-163 and 304.17A-1631.
(6)The schedule of benefits required under subsection (2)(b)2. of this section shall
include:
(a)Preventive services;
(b)Vision services, including glasses;
(c)Dental services, including sealants, extractions, and fillings; and
(d)The coverage required under KRS 304.17A-129 and 304.17A-145.