KRS § 205.5375 — KY Code / Title XVII / Chapter 205 / Section 205.5375
205.5375 Definitions for section -- Presumptive eligibility -- Determination -- Requirements -- Administrative regulations
Status: in_force

205.5375 Definitions for section -- Presumptive eligibility -- Determination --

Requirements -- Administrative regulations.

(1) As used in this section:

(a) "Department" means the Department for Medicaid Services;

(b) "Period of presumptive eligibility" has the same meaning as in 42 C.F.R. sec.

435.1101; and

(c) "Qualified hospital" has the same meaning as in 42 C.F.R. 435.1110(b).

(2) If a qualified hospital determines that an individual meets the criteria for

presumptive eligibility using information provided and attested to by the individual,

the hospital shall:

(a) Notify the department of the determination within five (5) business days from

the date of determination in a form prescribed by the department;

(b) Provide a written eligibility notice to the individual. The written eligibility

notice shall, at a minimum, include the following information in plain

language and large print:

1. The beginning and end dates of the period of presumptive eligibility;

2. Notification that the individual is required to make an application for

Medicaid benefits through the individual's local Department for

Community Based Services office;

3. The location of the individual's local Department for Community Based

Services office;

4. Notification that if the individual does not file a full Medicaid

application before the last day of the following month, the period of

presumptive eligibility coverage will end on that day; and

5. Notification that if the individual does file a full Medicaid application

before the last day of the following month, presumptive eligibility

coverage will continue until an eligibility determination is made on the

application by the department;

(c) Issue a presumptive eligibility identification card or document to the

presumed eligible individual;

(d) Maintain a record of the presumptive eligibility screening for each

application; and

(e) Assist presumptively eligible individuals in completing a full Medicaid

application and understanding any documentation requirements.

(3) If a qualified hospital determines that an individual does not meet the criteria for

presumptive eligibility using information provided and attested to by the individual,

the hospital shall provide the individual with written notification of:

(a) The reason for the determination;

(b) Notification that the individual may file a full Medicaid application through

the individual's local Department for Community Based Services office if the

individual wishes to have a formal determination of eligibility made by the

department; and

(c) The location of the individual's local Department for Community Based

Services office.

(4) Notwithstanding any other provision of law to the contrary and to the extent

permitted under federal law, a pregnant individual shall be limited to one (1) period

of presumptive eligibility per pregnancy.

(5) (a) The department shall provide training on all applicable state and federal laws

related to presumptive eligibility to all qualified hospitals.

(b) Prior to conducting presumptive eligibility screenings and determinations, a

qualified hospital's staff, contractor, or vendor responsible for presumptive

eligibility screenings and determinations shall be required to complete

presumptive eligibility training provided by the department.

(6) If a qualified hospital uses a contractor or other vendor for the purpose of

conducting presumptive eligibility screenings and determinations, the hospital shall

be responsible for monitoring the contractor's or vendor's compliance with all

applicable state and federal laws related to presumptive eligibility.

(7) Within ninety (90) days after July 14, 2022, the department shall promulgate

administrative regulations in accordance with KRS Chapter 13A that are necessary

to administer this section. Administrative regulations promulgated pursuant to this

subsection shall include but not be limited to a thorough presumptive eligibility

application form to be used by qualified hospitals when making presumptive

eligibility determinations using information provided and attested to by an

individual.