Bill > SB92

This bill mandates that the Department for Medicaid Services (DMS) and its contracted managed care organizations provide coverage for palliative care services to eligible individuals. To qualify, a person must be enrolled in Medicaid, be in the last two years of life as determined by their care team, be at risk for high healthcare usage, and have a qualifying condition such as Stage IV cancer, advanced heart failure, chronic obstructive pulmonary disease, end-stage renal or liver disease, advanced neurological disease, or advanced dementia, with the DMS able to define additional qualifying conditions through regulations, including for pediatric patients. However, individuals with a primary diagnosis of substance use disorder are excluded, and specific criteria apply for children under eighteen with advanced illnesses. Palliative care services must include physician oversight, an interdisciplinary team approach, 24/7 access to care, regular in-person visits (with telehealth as a supplement), and be provided by licensed hospice organizations and enrolled Medicare and Medicaid providers. The DMS will establish reimbursement rates, identify qualifying Stage III cancers, and implement quality control measures, including tracking hospitalization and emergency department use, transitions to hospice, advanced care planning completion, and patient experience, through administrative regulations. If federal approval is needed to implement these changes, the Cabinet for Health and Family Services or DMS must seek it within 90 days and can only delay implementation until approval is granted, with these provisions serving as specific authorization for changes to the Medicaid program.

https://apps.legislature.ky.gov/record/26RS/sb92.html