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Bill > HB695


KY HB695

KY HB695
AN ACT relating to the Medicaid program and declaring an emergency.


summary

Introduced
02/19/2025
In Committee
03/27/2025
Crossed Over
03/05/2025
Passed
03/14/2025
Dead
Vetoed
03/26/2025
Veto Overridden
03/27/2025
Signed/Enacted/Adopted
03/27/2025

Introduced Session

2025 Regular Session

Bill Summary

Retain original provisions, except delete Medicaid coverage limitations for psychoeducational services; establish that changes to the Medicaid program necessitated by requirements imposed by the federal Centers for Medicare and Medicaid Services or related to payment programs for university hospitals shall be exempt from the requirement that the change be authorized by the General Assembly; amend KRS 205.5371 to establish that the community engagement program shall be a mandatory waiver program; locate the Kentucky Medicaid pharmaceutical rebate fund in the Cabinet for Health and Family Services instead of the Finance and Administration Cabinet; establish that moneys in the Kentucky Medicaid pharmaceutical rebate fund shall be expended in accordance with federal law; create new sections of KRS Chapter 205 to require the Department for Medicaid Services to monitor utilization rates and expenditures for behavioral health and substance use disorder services and to report to the Legislative Research Commission on any service for which the utilization rate or expenditures increase by more than 10 percent over the previous calendar year; establish that any managed care organization that failed during state fiscal year 2025-2026 to comply with 2024 Ky Acts ch. 175, Part I, G., 3., a., (2) and b., (7) be ineligible to for a new Medicaid managed care contract; require the Cabinet for Health and Family Services to develop a behavioral health and substance use disorder treatment services scorecard to be used by all contracted Medicaid managed care organizations; create various new sections of KRS Chapter 7A to establish the Medicaid Oversight and Advisory Board, the board's membership, and duties.

AI Summary

This bill establishes comprehensive reforms to Kentucky's Medicaid program, focusing on enhanced legislative oversight, financial management, and service delivery. The bill creates a new Medicaid Oversight and Advisory Board composed of 21 members (10 legislative and 11 nonvoting members) to review, analyze, and make recommendations about the Medicaid program, including benefits, coverage policies, health outcomes, and administrative expenses. The board will have broad investigative powers, including requiring information from state agencies and managed care organizations, conducting public hearings, and commissioning periodic reviews of the program's administrative costs, program effectiveness, and overall population health. The legislation mandates several new reporting requirements, including quarterly reports on Medicaid expenditures, enrollee demographics, and utilization of behavioral health services. Additionally, the bill establishes a Kentucky Medicaid pharmaceutical rebate fund, requires reinstatement of prior authorization for behavioral health services, directs the development of a behavioral health services scorecard, and sets new guidelines for Medicaid managed care contracts. The bill also modifies existing laws to require legislative authorization for significant changes to the Medicaid program, with exceptions for federal compliance and emergency situations, and declares an emergency to emphasize the urgency of implementing these reforms.

Committee Categories

Budget and Finance

Sponsors (3)

Last Action

delivered to Secretary of State (Acts Ch. 110) (on 03/27/2025)

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