KRS § 7A.286 — KY Code / Title II / Chapter 7A / Section 7A.286
7A.286 Board duties and permitted activities
Status: in_force

7A.286 Board duties and permitted activities.

(1) The board, consistent with its purpose as established in KRS 7A.273, shall:

(a) On an ongoing basis, conduct an impartial review of all state laws and

regulations governing the Medicaid program and recommend to the General

Assembly any changes it finds desirable with respect to program

administration, including delivery system models, program financing, benefits

and coverage policies, reimbursement rates, payment methodologies, provider

participation, or any other aspect of the program;

(b) On an ongoing basis, review any change or proposed change in federal laws

and regulations governing the Medicaid program and report to the Legislative

Research Commission on the probable costs, possible budgetary implications,

potential effect on healthcare outcomes, and the overall desirability of any

change or proposed change in federal laws or regulations governing the

Medicaid program;

(c) At the request of the Speaker of the House of Representatives or the President

of the Senate, evaluate proposed changes to state laws affecting the Medicaid

program and report to the Speaker or the President on the probable costs,

possible budgetary implications, potential effect on healthcare outcomes, and

overall desirability as a matter of public policy;

(d) At the request of the Legislative Research Commission, research issues

related to the Medicaid program;

(e) Beginning in 2026 and at least once every five (5) years thereafter, cause a

review to be made of the administrative expenses and operational cost of the

Medicaid program. The review shall include but not be limited to evaluating

the level and growth of administrative costs, the potential for legislative

changes to reduce administrative costs, and administrative changes the

department may make to reduce administrative costs or staffing needs. At the

discretion of the Legislative Research Commission, the review may be

conducted by a consultant retained by the board;

(f) Beginning in 2027 and at least once every five (5) years thereafter, cause a

program evaluation to be conducted of the Medicaid program. In any instance

in which a program evaluation indicates inadequate operating or

administrative system controls or procedures, inaccuracies, inefficiencies,

waste, extravagance, unauthorized or unintended activities, or other

deficiencies, the board shall report its findings to the Legislative Research

Commission. The program evaluation shall be performed by a consultant

retained by the board;

(g) Beginning in 2028 and at least once every five (5) years thereafter, cause an

actuarial analysis to be performed of the Medicaid program, to evaluate the

sufficiency and appropriateness of Medicaid reimbursement rates established

by the department and those paid by any managed care organization

contracted by the department for the delivery of Medicaid services. The

actuarial analysis shall be performed by an actuary retained by the board;

(h) Beginning in 2029 and at least once every five (5) years thereafter, cause the

overall health of the Medicaid population to be assessed. The assessment shall

include but not be limited to a review of health outcomes, healthcare

disparities among program beneficiaries and as compared to the general

population, and the effect of the overall health of the Medicaid population on

program expenses. The assessment shall be performed by a consultant

retained by the board; and

(i) Beginning in 2026 and annually thereafter, publish a report covering the

board's evaluations and recommendations with respect to the Medicaid

program. The report shall be submitted to the Legislative Research

Commission no later than December 1 of each year, and shall include at a

minimum a summary of the board's current evaluation of the program and any

legislative recommendations made by the board.

(2) The board, consistent with its purpose as established in KRS 7A.273, may:

(a) Review all new or amended administrative regulations related to the Medicaid

program and provide comments to the Administrative Regulation Review

Subcommittee established in KRS 13A.020;

(b) Make recommendations to the General Assembly, the Governor, the secretary

of the cabinet, and the commissioner of the department regarding program

administration, including benefits and coverage policies, access to services

and provider network adequacy, healthcare outcomes and disparities,

reimbursement rates, payment methodologies, delivery system models,

funding, and administrative regulations. Recommendations made pursuant to

this section shall be nonbinding and shall not have the force of law; and

(c) On or before December 1 of each calendar year, adopt an annual research

agenda. The annual research agenda may include studies, research, and

investigations considered by the board to be significant. Board staff shall

prepare a list of study and research topics related to the Medicaid program for

consideration by the board in the adoption of the annual research agenda. An

annual research agenda adopted by the board may be amended by the

Legislative Research Commission to include any studies or reports mandated

by the General Assembly during the next succeeding regular session.

(3) At the discretion of the Legislative Research Commission, studies and research

projects included in an annual research agenda adopted by the board pursuant to

subsection (2)(c) of this section may be conducted by outside consultants, analysts,

or researchers to ensure the timely completion of the research agenda.