KRS § 205.6485 — KY Code / Title XVII / Chapter 205 / Section 205.6485
205.6485 State child health plan -- Eligibility criteria -- Schedule of benefits -- Premium contributions -- Access
Status: in_force

205.6485 State child health plan -- Eligibility criteria -- Schedule of benefits --

Premium contributions -- Access.

(1) As used in this section, "KCHIP" means the Kentucky Children's Health Insurance

Program.

(2) The Cabinet for Health and Family Services shall:

(a) Prepare a state child health plan, known as KCHIP, meeting the requirements

of Title XXI of the Federal Social Security Act, for submission to the

Secretary of the United States Department of Health and Human Services

within such time as will permit the state to receive the maximum amounts of

federal matching funds available under Title XXI; and

(b) By administrative regulation promulgated in accordance with KRS Chapter

13A, establish the following:

1. The eligibility criteria for children covered by KCHIP, which shall

include a provision that no person eligible for services under Title XIX

of the Social Security Act, 42 U.S.C. secs. 1396 to 1396v, as amended,

shall be eligible for services under KCHIP, except to the extent that

Title XIX coverage is expanded by KRS 205.6481 to 205.6495 and KRS

304.17A-340;

2. The schedule of benefits to be covered by KCHIP, which shall:

a. Be at least equivalent to one (1) of the following:

i. The standard Blue Cross/Blue Shield preferred provider

option under the Federal Employees Health Benefit Plan

established by 5 U.S.C. sec. 8903(1);

ii. A mid-range health benefit coverage plan that is offered and

generally available to state employees; or

iii. Health insurance coverage offered by a health maintenance

organization that has the largest insured commercial, non-

Medicaid enrollment of covered lives in the state; and

b. Comply with subsection (6) of this section;

3. The premium contribution per family for health insurance coverage

available under KCHIP, which shall be based:

a. On a six (6) month period; and

b. Upon a sliding scale relating to family income not to exceed:

i. Ten dollars ($10), to be paid by a family with income

between one hundred percent (100%) to one hundred thirty-

three percent (133%) of the federal poverty level;

ii. Twenty dollars ($20), to be paid by a family with income

between one hundred thirty-four percent (134%) to one

hundred forty-nine percent (149%) of the federal poverty

level; and

iii. One hundred twenty dollars ($120), to be paid by a family

with income between one hundred fifty percent (150%) to

two hundred percent (200%) of the federal poverty level, and

which may be made on a partial payment plan of twenty

dollars ($20) per month or sixty dollars ($60) per quarter;

4. There shall be no copayments for services provided under KCHIP; and

5. a. The criteria for health services providers and insurers wishing to

contract with the Commonwealth to provide coverage under

KCHIP.

b. The cabinet shall provide, in any contracting process for coverage

of preventive services, the opportunity for a public health

department to bid on preventive health services to eligible children

within the public health department's service area. A public health

department shall not be disqualified from bidding because the

department does not currently offer all the services required by

this section. The criteria shall be set forth in administrative

regulations under KRS Chapter 13A and shall maximize

competition among the providers and insurers. The Finance and

Administration Cabinet shall provide oversight over contracting

policies and procedures to assure that the number of applicants for

contracts is maximized.

(3) Within twelve (12) months of federal approval of the state's Title XXI child health

plan, the Cabinet for Health and Family Services shall assure that a KCHIP

program is available to all eligible children in all regions of the state. If necessary,

in order to meet this assurance, the cabinet shall institute its own program.

(4) KCHIP recipients shall have direct access without a referral from any gatekeeper

primary care provider to dentists for covered primary dental services and to

optometrists and ophthalmologists for covered primary eye and vision services.

(5) KCHIP shall comply with KRS 304.17A-163 and 304.17A-1631.

(6) The schedule of benefits required under subsection (2)(b)2. of this section shall

include:

(a) Preventive services;

(b) Vision services, including glasses;

(c) Dental services, including sealants, extractions, and fillings; and

(d) The coverage required under KRS 304.17A-129 and 304.17A-145.