7A.286 Board duties and permitted activities.
759 words·~3 min read·
/ky/chapter-7a/7a-286A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(1)The board, consistent with its purpose as established in KRS 7A.273, shall:
(a)On an ongoing basis, conduct an impartial review of all state laws and
regulations governing the Medicaid program and recommend to the General
Assembly any changes it finds desirable with respect to program
administration, including delivery system models, program financing, benefits
and coverage policies, reimbursement rates, payment methodologies, provider
participation, or any other aspect of the program;
(b)On an ongoing basis, review any change or proposed change in federal laws
and regulations governing the Medicaid program and report to the Legislative
Research Commission on the probable costs, possible budgetary implications,
potential effect on healthcare outcomes, and the overall desirability of any
change or proposed change in federal laws or regulations governing the
Medicaid program;
(c)At the request of the Speaker of the House of Representatives or the President
of the Senate, evaluate proposed changes to state laws affecting the Medicaid
program and report to the Speaker or the President on the probable costs,
possible budgetary implications, potential effect on healthcare outcomes, and
overall desirability as a matter of public policy;
(d)At the request of the Legislative Research Commission, research issues
related to the Medicaid program;
(e)Beginning in 2026 and at least once every five
(5)years thereafter, cause a
review to be made of the administrative expenses and operational cost of the
Medicaid program. The review shall include but not be limited to evaluating
the level and growth of administrative costs, the potential for legislative
changes to reduce administrative costs, and administrative changes the
department may make to reduce administrative costs or staffing needs. At the
discretion of the Legislative Research Commission, the review may be
conducted by a consultant retained by the board;
(f)Beginning in 2027 and at least once every five
(5)years thereafter, cause a
program evaluation to be conducted of the Medicaid program. In any instance
in which a program evaluation indicates inadequate operating or
administrative system controls or procedures, inaccuracies, inefficiencies,
waste, extravagance, unauthorized or unintended activities, or other
deficiencies, the board shall report its findings to the Legislative Research
Commission. The program evaluation shall be performed by a consultant
retained by the board;
(g)Beginning in 2028 and at least once every five
(5)years thereafter, cause an
actuarial analysis to be performed of the Medicaid program, to evaluate the
sufficiency and appropriateness of Medicaid reimbursement rates established
by the department and those paid by any managed care organization
contracted by the department for the delivery of Medicaid services. The
actuarial analysis shall be performed by an actuary retained by the board;
(h)Beginning in 2029 and at least once every five
(5)years thereafter, cause the
overall health of the Medicaid population to be assessed. The assessment shall
include but not be limited to a review of health outcomes, healthcare
disparities among program beneficiaries and as compared to the general
population, and the effect of the overall health of the Medicaid population on
program expenses. The assessment shall be performed by a consultant
retained by the board; and
(i)Beginning in 2026 and annually thereafter, publish a report covering the
board's evaluations and recommendations with respect to the Medicaid
program. The report shall be submitted to the Legislative Research
Commission no later than December 1 of each year, and shall include at a
minimum a summary of the board's current evaluation of the program and any
legislative recommendations made by the board.
(2)The board, consistent with its purpose as established in KRS 7A.273, may:
(a)Review all new or amended administrative regulations related to the Medicaid
program and provide comments to the Administrative Regulation Review
Subcommittee established in KRS 13A.020;
(b)Make recommendations to the General Assembly, the Governor, the secretary
of the cabinet, and the commissioner of the department regarding program
administration, including benefits and coverage policies, access to services
and provider network adequacy, healthcare outcomes and disparities,
reimbursement rates, payment methodologies, delivery system models,
funding, and administrative regulations. Recommendations made pursuant to
this section shall be nonbinding and shall not have the force of law; and
(c)On or before December 1 of each calendar year, adopt an annual research
agenda. The annual research agenda may include studies, research, and
investigations considered by the board to be significant. Board staff shall
prepare a list of study and research topics related to the Medicaid program for
consideration by the board in the adoption of the annual research agenda. An
annual research agenda adopted by the board may be amended by the