Page 1 of 2 205.6320 Cabinet to strengthen managed care component of KenPAC Program and to establish standards for access and quality for organizations serving <br>Medicaid recipients. (1) The Cabinet for Health and Family Services shall seek to strengthen the managed care component of the KenPAC Program. The cabinet shall by promulgation of <br>administrative regulation, pursuant to KRS Chapter 13A, establish the following: <br>(a) Inclusion of noninstitutionalized blind, aged, and disabled recipients in an effort to reduce inappropriate usage as permitted by federal Medicaid <br>regulations; (b) Financial incentives for KenPAC physicians who effectively manage the care of their patients. These incentives may include an increase in the case <br>management fee for demonstrated effective case management, or through <br>other arrangements that encourage the effective and efficient management of <br>patients. Clear and concise administrative regulations promulgated under KRS <br>Chapter 13A shall be established by the cabinet to determine physician <br>qualification for the incentives; (c) A pilot project to establish an oversight and education program in the KenPAC system to assist with patient education regarding the appropriate and <br>effective use of the system and to assist providers with more efficient <br>management of patients; (d) Criteria to avoid duplication of the provision of early and periodic screening, diagnosis, and treatment-type services to children in the KenPAC Program; (e) A review of the feasibility of a demonstration project to allow health maintenance organizations to bid on the provision of services to KenPAC <br>participants; (f) Extension of KenPAC to all counties within the state. The cabinet shall determine the feasibility of working with state-supported medical schools to <br>obtain physicians in the counties where KenPAC does not operate; and (g) More stringent reporting and verification requirements in contracts with KenPAC physicians regarding verification of services provided to KenPAC <br>patients. (2) The secretary shall promulgate by administrative regulation standards for access and quality which any health maintenance organizations serving Medicaid recipients <br>shall meet. The secretary shall not provide Medicaid services through a health <br>maintenance organization which does not demonstrate the capacity to meet the <br>standards. The standards shall address at least the following subjects: <br>(a) Access to care including patient to physician ratios, availability of appropriate specialists, distance to care, travel and waiting times, and physical and <br>language barriers; (b) Internal and external methods for monitoring quality of care; <br>(c) Data collection and reporting, including provision of data on utilization, outcomes, enrollee satisfaction, and the number, type, and resolution of <br>grievances and complaints, with subpopulation data for at-risk populations; Page 2 of 2 (d) Due-process procedures including written notice of appeal rights, timelines for resolution of complaints, and expedited appeals processes; (e) Consumer representation and patient advocacy; and <br>(f) Marketing practices including prohibited practices and standards for advertisements and printed marketing materials. Effective: June 20, 2005 <br>History: Amended 2005 Ky. Acts ch. 99, sec. 252, effective June 20, 2005. -- Amended 1998 Ky. Acts ch. 426, sec. 210, effective July 15, 1998. -- Amended 1996 Ky. Acts <br>ch. 371, sec. 31, effective July 15, 1996. -- Created 1994 Ky. Acts ch. 512, sec. 77, <br>effective July 15, 1994.
Page 1 of 2 205.6320 Cabinet to strengthen managed care component of KenPAC Program and to establish standards for access and quality for organizations serving <br>Medicaid recipients. (1) The Cabinet for Health and Family Services shall seek to strengthen the managed care component of the KenPAC Program. The cabinet shall by promulgation of <br>administrative regulation, pursuant to KRS Chapter 13A, establish the following: <br>(a) Inclusion of noninstitutionalized blind, aged, and disabled recipients in an effort to reduce inappropriate usage as permitted by federal Medicaid <br>regulations; (b) Financial incentives for KenPAC physicians who effectively manage the care of their patients. These incentives may include an increase in the case <br>management fee for demonstrated effective case management, or through <br>other arrangements that encourage the effective and efficient management of <br>patients. Clear and concise administrative regulations promulgated under KRS <br>Chapter 13A shall be established by the cabinet to determine physician <br>qualification for the incentives; (c) A pilot project to establish an oversight and education program in the KenPAC system to assist with patient education regarding the appropriate and <br>effective use of the system and to assist providers with more efficient <br>management of patients; (d) Criteria to avoid duplication of the provision of early and periodic screening, diagnosis, and treatment-type services to children in the KenPAC Program; (e) A review of the feasibility of a demonstration project to allow health maintenance organizations to bid on the provision of services to KenPAC <br>participants; (f) Extension of KenPAC to all counties within the state. The cabinet shall determine the feasibility of working with state-supported medical schools to <br>obtain physicians in the counties where KenPAC does not operate; and (g) More stringent reporting and verification requirements in contracts with KenPAC physicians regarding verification of services provided to KenPAC <br>patients. (2) The secretary shall promulgate by administrative regulation standards for access and quality which any health maintenance organizations serving Medicaid recipients <br>shall meet. The secretary shall not provide Medicaid services through a health <br>maintenance organization which does not demonstrate the capacity to meet the <br>standards. The standards shall address at least the following subjects: <br>(a) Access to care including patient to physician ratios, availability of appropriate specialists, distance to care, travel and waiting times, and physical and <br>language barriers; (b) Internal and external methods for monitoring quality of care; <br>(c) Data collection and reporting, including provision of data on utilization, outcomes, enrollee satisfaction, and the number, type, and resolution of <br>grievances and complaints, with subpopulation data for at-risk populations; Page 2 of 2 (d) Due-process procedures including written notice of appeal rights, timelines for resolution of complaints, and expedited appeals processes; (e) Consumer representation and patient advocacy; and <br>(f) Marketing practices including prohibited practices and standards for advertisements and printed marketing materials. Effective: June 20, 2005 <br>History: Amended 2005 Ky. Acts ch. 99, sec. 252, effective June 20, 2005. -- Amended 1998 Ky. Acts ch. 426, sec. 210, effective July 15, 1998. -- Amended 1996 Ky. Acts <br>ch. 371, sec. 31, effective July 15, 1996. -- Created 1994 Ky. Acts ch. 512, sec. 77, <br>effective July 15, 1994.
Page 1 of 2 205.6320 Cabinet to strengthen managed care component of KenPAC Program and to establish standards for access and quality for organizations serving <br>Medicaid recipients. (1) The Cabinet for Health and Family Services shall seek to strengthen the managed care component of the KenPAC Program. The cabinet shall by promulgation of <br>administrative regulation, pursuant to KRS Chapter 13A, establish the following: <br>(a) Inclusion of noninstitutionalized blind, aged, and disabled recipients in an effort to reduce inappropriate usage as permitted by federal Medicaid <br>regulations; (b) Financial incentives for KenPAC physicians who effectively manage the care of their patients. These incentives may include an increase in the case <br>management fee for demonstrated effective case management, or through <br>other arrangements that encourage the effective and efficient management of <br>patients. Clear and concise administrative regulations promulgated under KRS <br>Chapter 13A shall be established by the cabinet to determine physician <br>qualification for the incentives; (c) A pilot project to establish an oversight and education program in the KenPAC system to assist with patient education regarding the appropriate and <br>effective use of the system and to assist providers with more efficient <br>management of patients; (d) Criteria to avoid duplication of the provision of early and periodic screening, diagnosis, and treatment-type services to children in the KenPAC Program; (e) A review of the feasibility of a demonstration project to allow health maintenance organizations to bid on the provision of services to KenPAC <br>participants; (f) Extension of KenPAC to all counties within the state. The cabinet shall determine the feasibility of working with state-supported medical schools to <br>obtain physicians in the counties where KenPAC does not operate; and (g) More stringent reporting and verification requirements in contracts with KenPAC physicians regarding verification of services provided to KenPAC <br>patients. (2) The secretary shall promulgate by administrative regulation standards for access and quality which any health maintenance organizations serving Medicaid recipients <br>shall meet. The secretary shall not provide Medicaid services through a health <br>maintenance organization which does not demonstrate the capacity to meet the <br>standards. The standards shall address at least the following subjects: <br>(a) Access to care including patient to physician ratios, availability of appropriate specialists, distance to care, travel and waiting times, and physical and <br>language barriers; (b) Internal and external methods for monitoring quality of care; <br>(c) Data collection and reporting, including provision of data on utilization, outcomes, enrollee satisfaction, and the number, type, and resolution of <br>grievances and complaints, with subpopulation data for at-risk populations; Page 2 of 2 (d) Due-process procedures including written notice of appeal rights, timelines for resolution of complaints, and expedited appeals processes; (e) Consumer representation and patient advocacy; and <br>(f) Marketing practices including prohibited practices and standards for advertisements and printed marketing materials. Effective: June 20, 2005 <br>History: Amended 2005 Ky. Acts ch. 99, sec. 252, effective June 20, 2005. -- Amended 1998 Ky. Acts ch. 426, sec. 210, effective July 15, 1998. -- Amended 1996 Ky. Acts <br>ch. 371, sec. 31, effective July 15, 1996. -- Created 1994 Ky. Acts ch. 512, sec. 77, <br>effective July 15, 1994.
