Healthcare (Medicare)

Create a new section of KRS Chapter 205 to define "community intervener"; require the Michelle P. waiver program to cover community intervener services if approved by the federal Centers for Medicare and Medicaid Services; require the Department for Medicaid Services to promulgate administrative regulations; require the cabinet or the Department for Medicaid Services to seek federal approval if it is determined that such approval is necessary; provide authorization from the General Assembly to make changes in the Medicaid program as required under KRS 205.5372(1).

Amend KRS 304.17A-257 to require health benefit plans to provide coverage for colorectal cancer examinations and laboratory tests specified in the most recent version of a Centers for Medicare and Medicaid Services national coverage determination or nationally recognized clinical practice guidelines or recommendations; direct that coverage requirements for colorectal cancer examinations and laboratory tests applies to health benefit plans issued or renewed on or after the effective date of the Act; require the Cabinet for Health and Family Services or the Department for Medicaid Services to obtain federal approval, if necessary; provide authorization from the General Assembly to make changes in the Medicaid program as required under KRS 205.5372(1); EMERGENCY.

Amend KRS 205.6412 to require the Department for Medicaid Services to seek authorization from the United States Centers for Medicare and Medicaid Services to implement a state-directed payment for physician and nonphysician professional services provided to a Medicaid beneficiary by a qualifying hospital's affiliated physician groups or physicians and other professionals employed or contracted by the qualified hospital; require the Department of Medicaid Services to direct Medicaid managed care organizations to issue payments back to January 1, 2026, upon federal approval; RETROACTIVE.

Amend KRS 205.6412 to require the Department for Medicaid Services to seek authorization from the United States Centers for Medicare and Medicaid Services to implement a state-directed payment for physician and nonphysician professional services provided to a Medicaid beneficiary by a qualifying hospital's affiliated physician groups or physicians and other professionals employed or contracted by the qualified hospital; require the Department of Medicaid Services to direct Medicaid managed care organizations to issue payments back to January 1, 2026, upon federal approval; RETROACTIVE.

Direct the Cabinet for Health and Family Services to withdraw the 1115(a) demonstration waiver application that was submitted on June 25, 2025, to the federal Centers for Medicare and Medicaid Services to implement a mandatory community engagement program; EMERGENCY

Create a new section of KRS Chapter 205 to define terms; direct the Cabinet for Health and Family Services to prepare and submit a waiver amendment application to the federal Centers for Medicare and Medicaid Services to amend the 1915(c) HCB waiver program to include coverage for assisted living services; establish coverage limits; require the cabinet to promulgate administrative regulations; require the cabinet or the Department for Medicaid Services to seek federal approval if it is determined that such approval is necessary; provide authorization from the General Assembly to make changes in the Medicaid program as required under KRS 205.5372(1).