Healthcare (Medicaid)

Create a new section of KRS Chapter 205 to prohibit the Department for Medicaid Services, any Medicaid managed care organization contracted by the department, and the Medicaid state pharmacy benefit manager from denying coverage for a nonopioid analgesic in favor of opioid analgesic or establishing more restrictive or more extensive utilization controls for nonopioid analgesics than the least restrictive or extensive utilization controls for any opioid or narcotic analgesic; require the Cabinet for Health and Family Services or the Department for Medicaid to seek federal approval if it is determined that such approval is necessary; provide authorization from the General Assembly to make changes to the Medicaid program as required under KRS 205.5372(1).

Create a new section of Subtitle 17A of KRS Chapter 304 to require health benefit plans to cover at least 2 medically necessary epinephrine devices per covered person; limit a covered person's cost-sharing amount to $100 annually; amend KRS 304.17A-099 to exempt the epinephrine device coverage requirement from being suspended under state law due to the triggering of federal cost defrayment requirements; amend KRS 205.522, 205.6485, 164.2871, and 18A.225 to require Medicaid, KCHIP, self-insured employer group health plans offered by the governing board of a state postsecondary education institution, and the state employee health plan to comply with the epinephrine device coverage requirement; provide that various sections apply to health benefit plans issued or renewed on or after January 1, 2027; require the Department of Insurance to determine whether the epinephrine devices coverage requirement would be in addition to essential health benefits required under federal law; require the Department of Insurance to obtain federal approval, if necessary; 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); EFFECTIVE, in part, January 1, 2027.

Create a new section of KRS Chapter 205 to define terms; require Medicaid-enrolled providers prescribing psychotropic drugs to children to provide an FDA Medication Guide to parents or legal guardians; require medical care providers prescribing psychotropic drugs to children covered by Medicaid to obtain signed informed consent from a parent or guardian; require the Cabinet for Health and Family Services to develop and maintain an adverse drug reaction online reporting system; require the cabinet to compile and submit an annual report of the adverse drug reaction online reporting system to the Legislative Research Commission; require the cabinet to submit an annual report summarizing the implementation efforts and compliance statistics of Medicaid-enrolled providers; establish penalties; require the cabinet to promulgate administrative regulations to implement the system.

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

Amend KRS 205.522 and 205.6485 to require Medicaid and KCHIP to comply with pharmacy reimbursement requirements established in KRS 304.12-237; require the Cabinet for Health and Family Services or the Department for Medicaid to seek federal approval if it is determined that such approval is necessary; provide authorization from the General Assembly to make changes to the Medicaid program as required under KRS 205.5372(1).

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).

Propose to create a new section of the Constitution of Kentucky to enshrine Medicaid expansion coverage; direct the Secretary of State to advertise the proposed constitutional amendment prior to a general election vote; provide ballot language; submit to voters for ratification or rejection.

Direct the Legislative Research Commission to procure a vendor to conduct a feasibility study for an Accountable Communities for Health Medicaid delivery model pilot project; require the results of the study to be submitted to the Legislative Research Commission by November 1, 2026; strongly encourage the Legislative Research Commission to begin the procurement process immediately upon the adoption of this Resolution; establish that a pilot project resulting from the feasibility study shall be known as the 20 by 30 Accountable Care Pilot Project.

Create new sections of KRS 304.17A-600 to 304.17A-633 to define terms; prohibit insurers of health benefit plans from requiring prior authorization for a health care service for which the provider has an exemption; require insurers of health benefit plans to establish a program under which participating providers may qualify for exemptions from prior authorization; establish mandatory and permitted provisions of an insurer's prior authorization exemption program; establish requirements for sending forms and notices; require the commissioner of the Department of Insurance to submit an annual report relating to prior authorization, provide a detailed briefing upon request, and promulgate administrative regulations; amend KRS 304.17A-605 to conform; amend KRS 304.17A-611 to prohibit conducting a retrospective review that is based solely on a participating provider having a prior authorization exemption; provide that certain utilization review time frames do not apply to retrospective reviews conducted for the purposes of determining eligibility for a prior authorization exemption; create a new section of KRS Chapter 205 to require the commissioner of the Department for Medicaid Services to submit an annual report relating to prior authorization, provide a detailed briefing upon request, and promulgate administrative regulations; amend KRS 205.536 to conform; apply the provisions to contracts delivered, entered, renewed, extended, or amended on or after January 1, 2028; EFFECTIVE, in part, January 1, 2027, and January 1, 2028.

Amend KRS 205.520 to establish that it is the policy of the Commonwealth to provide Medicaid eligibility for all residents of the Commonwealth who may be eligible under federal law; amend KRS 205.6312 to require the establishment of cost-sharing requirements in the Medicaid program to the extent required under federal law; require the Governor to commission an independent third-party analysis of the current Medicaid expansion; require the Cabinet for Health and Family Services 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 the Medicaid program as required under KRS 205.5372(1).