2014 Kentucky Revised Statutes CHAPTER 205 - PUBLIC ASSISTANCE AND MEDICAL ASSISTANCE 205.6310 Cabinet to establish system to reduce unnecessary hospital emergency room utilization and costs.
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205.6310 Cabinet to establish system to reduce unnecessary hospital
emergency room utilization and costs.
The Cabinet for Health and Family Services shall establish a system within the
Medical Assistance Program to reduce unnecessary hospital emergency room
utilization and costs by redefining and controlling hospital emergency utilization. The
cabinet shall establish by promulgation of administrative regulations, pursuant to
KRS Chapter 13A, the following:
(1) Criteria and procedures, at least annually updated, that differentiate children
and adults, and which conform to the Federal Emergency Medical Treatment
and Active Labor Act (42 U.S.C. sec. 1395dd), as amended, and any other
applicable federal law or regulation for determining if a medical emergency
exists;
(2) Reimbursement rates that provide for nominal reimbursement of emergency
room care for care that does not meet the criteria established for a medical
emergency;
(3) Reimbursement, at rates determined by the cabinet, for ancillary services
which, based upon the symptoms of the patient, are medically appropriate to
determine if a medical emergency exists;
(4) Except for emergency room services rendered to children under the age of six
(6), prohibition of reimbursement at hospital emergency room rates for
diagnosis and treatment for a condition that does not meet the criteria
established for a medical emergency; and
(5) The provisions of this section shall apply to any managed care program for
Medicaid recipients.
The cabinet or its designated peer review organization shall review all claims for
payment of nonemergency hospital care and deny payment for any ancillary
services determined as not medically appropriate.
Effective:June 20, 2005
History: Amended 2005 Ky. Acts ch. 99, sec. 248, effective June 20, 2005. -Amended 1998 Ky. Acts ch. 426, sec. 206, effective July 15, 1998. -- Created
1994 Ky. Acts ch. 512, sec. 72, effective July 15, 1994.
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