205.6485 State child health plan -- Eligibility criteria -- Schedule of benefits -- Premium contributions -- Access.
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<![CDATA[ Page 1 of 2 205.6485 State child health plan -- Eligibility criteria -- Schedule of benefits -- Premium contributions -- Access. (1) The Cabinet for Health and Family Services shall prepare a state child health plan meeting the requirements of Title XXI of the Federal Social Security Act, for <br>submission to the Secretary of the United States Department of Health and Human <br>Services within such time as will permit the state to receive the maximum amounts <br>of federal matching funds available under Title XXI. The cabinet shall, by <br>administrative regulation promulgated in accordance with KRS Chapter 13A, <br>establish the following: <br>(a) The eligibility criteria for children covered by the Kentucky Children's Health Insurance Program. However, no person eligible for services under Title XIX <br>of the Social Security Act 42 U.S.C. 1396 to 1396v, as amended, shall be <br>eligible for services under the Kentucky Children's Health Insurance Program <br>except to the extent that Title XIX coverage is expanded by KRS 205.6481 to <br>205.6495 and KRS 304.17A-340; (b) The schedule of benefits to be covered by the Kentucky Children's Health Insurance Program, which shall include preventive services, vision services <br>including glasses, and dental services including at least sealants, extractions, <br>and fillings, and which shall be at least equivalent to one (1) of the following: <br>1. The standard Blue Cross/Blue Shield preferred provider option under the <br>Federal Employees Health Benefit Plan established by U.S.C. sec. <br>8903(1); 2. A mid-range health benefit coverage plan that is offered and generally <br>available to state employees; or 3. Health insurance coverage offered by a health maintenance organization <br>that has the largest insured commercial, non-Medicaid enrollment of <br>covered lives in the state; (c) The premium contribution per family of health insurance coverage available under the Kentucky Children's Health Insurance Program with provisions for <br>the payment of premium contributions by families of children eligible for <br>coverage by the program based upon a sliding scale relating to family income. <br>Premium contributions shall be based on a six (6) month period not to exceed: <br>1. Ten dollars ($10), to be paid by a family with income between one <br>hundred percent (100%) to one hundred thirty-three percent (133%) of <br>the federal poverty level; 2. Twenty dollars ($20), to be paid by a family with income between one <br>hundred thirty-four percent (134%) to one hundred forty-nine percent <br>(149%) of the federal poverty level; and 3. One hundred twenty dollars ($120), to be paid by a family with income <br>between one hundred fifty percent (150%) to two hundred percent <br>(200%) of the federal poverty level, and which may be made on a partial <br>payment plan of twenty dollars ($20) per month or sixty dollars ($60) <br>per quarter; Page 2 of 2 (d) The level of copayments for services provided under the Kentucky Children's Health Insurance Program that shall not exceed those allowed by federal law; <br>and (e) The criteria for health services providers and insurers wishing to contract with the Commonwealth to provide the children's health insurance coverage. <br>However, the cabinet shall provide, in any contracting process for the <br>preventive health insurance program, the opportunity for a public health <br>department to bid on preventive health services to eligible children within the <br>public health department's service area. A public health department shall not <br>be disqualified from bidding because the department does not currently offer <br>all the services required by paragraph (b) of this subsection. The criteria shall <br>be set forth in administrative regulations under KRS Chapter 13A and shall <br>maximize competition among the providers and insurers. The Cabinet for <br>Finance and Administration shall provide oversight over contracting policies <br>and procedures to assure that the number of applicants for contracts is <br>maximized. (2) 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 <br>is available to all eligible children in all regions of the state. If necessary, in order to <br>meet this assurance, the cabinet shall institute its own program. (3) KCHIP recipients shall have direct access without a referral from any gatekeeper primary care provider to dentists for covered primary dental services and to <br>optometrists and ophthalmologists for covered primary eye and vision services. Effective: June 20, 2005 <br>History: Amended 2005 Ky. Acts ch. 99, sec. 261, effective June 20, 2005. -- Created 1998 Ky. Acts ch. 253, sec. 3, effective April 2, 1998. ]]>