AN ACT relating to medical transportation and lodging for Medicaid and Medicare recipients with ongoing or potentially terminal health conditions

 AN ACT relating to medical transportation and lodging for Medicaid and Medicare recipients with ongoing or potentially terminal health conditions.

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Be it enacted by the General Assembly of the Commonwealth of Kentucky:

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 SECTION 1. A NEW SECTION OF KRS CHAPTER 205 IS CREATED TO READ AS FOLLOWS:

1. (1) The General Assembly finds and declares that:

(a) Many Kentuckians with chronic, rare, or potentially terminal illnesses must travel outside the Commonwealth to obtain specialized or life-saving medical care;

(b) Existing administrative limits on out-of-state medical transportation and lodging assistance create unnecessary barriers to treatment access; and

(c) It is the policy of the Commonwealth to ensure equitable, uninterrupted access to medically necessary care for all Medicaid and Medicare recipients with ongoing or potentially terminal health conditions, regardless of location.

2. (2) As used in this section:

(a) “Ongoing or potentially terminal health condition” means a medically verified chronic illness, rare disease, or life-threatening condition that requires continued specialist care, including but not limited to cancer, autoimmune disorders, organ failure, or vasculitis;

(b) “Out-of-state medical transportation” means travel beyond the borders of the Commonwealth of Kentucky for the purpose of obtaining medically necessary services covered under Medicaid, Medicare, or both; and

(c) “Lodging expenses” means reasonable costs for overnight accommodations for the recipient and one medically necessary attendant or caregiver during treatment.

3. (3) Notwithstanding any limitation contained in 907 KAR 3:066, 907 KAR 1:060, or any successor administrative regulation, the Department for Medicaid Services shall provide coverage for:

(a) An unlimited number of out-of-state medical trips per calendar year for any recipient diagnosed with an ongoing or potentially terminal health condition, provided that:

    1. The service sought is not available within the Commonwealth of Kentucky; and

    2. The treatment is prescribed or referred by a licensed physician or specialist;

(b) Lodging expenses associated with medical travel as provided in paragraph (a) of this subsection, up to limits established by the Cabinet for Health and Family Services consistent with federal per diem guidelines; and

(c) Transportation and lodging expenses for one medically necessary caregiver or attendant, if certified as necessary by the treating provider.

4. (4) The Department for Medicaid Services shall promulgate administrative regulations under KRS Chapter 13A to implement this section within one hundred eighty (180) days of the effective date of this Act.

5. (5) The Department shall coordinate with the Centers for Medicare and Medicaid Services to obtain any necessary state plan amendments or federal waivers, and may utilize the Human Service Transportation Delivery Regions for administration, but shall not impose any annual or numerical limitation on the number of qualifying out-of-state trips.

6. (6) Funding for this section shall be derived from existing Medicaid appropriations and any available federal matching funds. The Cabinet for Health and Family Services may pursue federal grants or public-private partnerships to offset travel and lodging costs.

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 SECTION 2. AMEND KRS 205.560 TO READ AS FOLLOWS:

Insert a new subsection ( ) to read:

 “The Cabinet for Health and Family Services shall ensure that all policies governing medical transportation, including those under 907 KAR 1:060 and 907 KAR 3:066, are consistent with the provisions of Section 1 of this Act.”

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SECTION 3. EFFECTIVE DATE.

This Act shall take effect upon its passage and approval by the Governor or upon its otherwise becoming law.