KRS § 205.6328 — KY Code / Title XVII / Chapter 205 / Section 205.6328
205.6328 Medicaid managed care contracts after March 27, 2025, to include provision for collection of expenditure data -- Quarterly budget analysis report required -- Applicability of Open Records Act -- Quarterly reports from managed care companies to department -- Quarterly enrollee demographics report -- Quarterly health care provider tax and assessment report
Status: in_force

205.6328 Medicaid managed care contracts after March 27, 2025, to include

provision for collection of expenditure data -- Quarterly budget analysis report

required -- Applicability of Open Records Act -- Quarterly reports from

managed care companies to department -- Quarterly enrollee demographics

report -- Quarterly health care provider tax and assessment report.

(1) (a) A Medicaid managed care contract entered into by the Department for

Medicaid Services on or after March 27, 2025, shall not be valid, and a

payment to a Medicaid managed care vendor by the Finance and

Administration Cabinet or the Cabinet for Health and Family Services shall

not be made, unless the Medicaid managed care contract contains a provision

that the contractor shall collect Medicaid expenditure data by the categories of

services paid for by the Medicaid Program. Actual statewide Medicaid

expenditure data by all categories of Medicaid services, including mandated

and optional Medicaid services, special expenditures and offsets, recoupments

and clawbacks, and disproportionate share hospital payments by type of

hospital, shall be compiled by the Department for Medicaid Services for all

Medicaid providers and forwarded to the Legislative Research Commission

for referral to the Medicaid Oversight and Advisory Board, the Interim Joint

Committee on Appropriations and Revenue, the Interim Joint Committee on

Families and Children, the Interim Joint Committee on Health Services, and

the Office of Budget Review on a quarterly basis. Projections of Medicaid

expenditures by categories of Medicaid services shall be provided to the

Medicaid Oversight and Advisory Board, the Interim Joint Committee on

Appropriations and Revenue, the Interim Joint Committee on Families and

Children, the Interim Joint Committee on Health Services, and the Office of

Budget Review upon request.

(b) Medicaid expenditure data required to be collected and reported pursuant to

paragraph (a) of this subsection shall include expenditures made by any third-

party administrator contracted by a managed care organization to assist in

providing services and benefits to Medicaid beneficiaries, including but not

limited to any dental benefit administrator, vision benefit administrator,

hearing benefit administrator, or transportation benefit administrator.

(2) The Department for Medicaid Services shall submit a quarterly budget analysis

report to the Legislative Research Commission for referral to the Medicaid

Oversight and Advisory Board, the Interim Joint Committee on Appropriations and

Revenue, the Interim Joint Committee on Families and Children, the Interim Joint

Committee on Health Services, and the Office of Budget Review no later than

seventy-five (75) days after the end of each quarter. The report shall provide

monthly detail of actual expenditures, eligibles, and average monthly cost per

eligible by eligibility category along with current trailing twelve (12) month

averages for each of these figures. The report shall also provide actual figures for

all categories of noneligible-specific expenditures such as supplemental medical

insurance premiums, Kentucky patient access to care, nonemergency transportation,

drug rebates, cost settlements, and disproportionate share hospital payments by type

of hospital. The report shall compare the actual expenditure experience with those

underlying the enacted or revised enacted budget and explain any significant

variances which may occur.

(3) (a) Except as provided in KRS 61.878, all records and correspondence relating to

Kentucky Medicaid, revenues derived from Kentucky Medicaid funds, and

expenditures utilizing Kentucky Medicaid funds of a Medicaid managed care

company operating within the Commonwealth shall be subject to the

Kentucky Open Records Act, KRS 61.870 to 61.884. This subsection shall not

apply to any records and correspondence relating to Medicaid specifically

prohibited from disclosure by the federal Health Insurance Portability and

Accountability Act privacy rules.

(b) No later than sixty (60) days after the end of each quarter, each Medicaid

managed care company operating within the Commonwealth shall prepare

and submit to the Department for Medicaid Services sufficient information to

allow the department to meet the following requirements ninety (90) days

after the end of each quarter. The department shall forward to the Legislative

Research Commission for referral to the Medicaid Oversight and Advisory

Board, the Interim Joint Committee on Appropriations and Revenue, the

Interim Joint Committee on Families and Children, the Interim Joint

Committee on Health Services, and the Office of Budget Review a quarterly

report detailing monthly actual expenditures by service category, monthly

eligibles, and average monthly cost per eligible for Medicaid and the

Kentucky Children's Health Insurance Program along with current trailing

twelve (12) month averages for each of these figures. The report shall also

provide actual figures for other categories such as pharmacy rebates and

reinsurance. Finally, the department shall include in this report the most

recent information or report available regarding the amount withheld to meet

Department of Insurance reserve requirements, and any distribution of

moneys received or retained in excess of these reserve requirements.

(4) The Cabinet for Health and Family Services shall submit a quarterly enrollee

demographics report to the Legislative Research Commission for referral to the

Medicaid Oversight and Advisory Board, the Interim Joint Committee on

Appropriations and Revenue, the Interim Joint Committee on Families and

Children, the Interim Joint Committee on Health Services, and the Office of Budget

Review no later than seventy-five (75) days after the end of each quarter. The

enrollee demographics report shall provide a summary of enrollee demographics

and shall include data on at least the following demographic characteristics for

enrollees by county:

(a) The total number of individuals enrolled in the Medicaid program during each

month of the previous quarter by eligibility category;

(b) The number of individuals enrolled in the Medicaid program by employment

status, including full-time employment, part-time employment, and

unemployed;

(c) The number of individuals enrolled in the Medicaid program by race and

ethnicity;

(d) The number of individuals enrolled in the Medicaid program by citizenship

status, refugee status, legal immigration status, illegal or undocumented

immigration status, or other status under which an individual is present in the

United States;

(e) The number of beneficiaries enrolled in the Medicaid program with

dependents;

(f) The total number of dependents enrolled in the Medicaid program; and

(g) Any other information or data related to Medicaid beneficiaries requested by

the Legislative Research Commission.

(5) The Department for Medicaid Services shall submit a quarterly health care provider

tax and assessment report to the Legislative Research Commission for referral to

the Medicaid Oversight and Advisory Board, the Interim Joint Committee on

Appropriations and Revenue, the Interim Joint Committee on Families and

Children, the Interim Joint Committee on Health Services, and the Office of Budget

Review no later than seventy-five (75) days after the end of each quarter. The

health care provider tax report shall include the total amount of revenue generated

during the previous quarter and the corresponding federal funding match generated

during the previous quarter under:

(a) KRS 142.303;

(b) KRS 142.307;

(c) KRS 142.314;

(d) KRS 142.315;

(e) KRS 142.316;

(f) KRS 142.318;

(g) KRS 142.361;

(h) KRS 142.363;

(i) KRS 205.6406(3)(h);

(j) KRS 205.6406(3)(j);

(k) KRS 205.6412; and

(l) Any other provider tax or assessment on healthcare providers.

(6) All reports required to be submitted to the Legislative Research Commission under

this section shall be submitted in a form and manner prescribed by the Legislative

Research Commission.

(7) As used in this section, the term "Medicaid program" includes the Kentucky

Medical Assistance Program established in KRS 205.510 to 205.5630 and the

Kentucky Children's Health Insurance Program established in KRS 205.6483.