"Federal Grants for Dentures 05 RS BR 118 AN ACT relating"
05 RS BR 118 AN ACT relating to newborn screening tests. Be it enacted by the General Assembly of the Commonwealth of Kentucky: 1 Section 1. KRS 214.155 is amended to read as follows: 2 (1) The administrative officer or other person in charge of each institution caring for 3 infants twenty-eight (28) days or less of age and the person required in pursuance of 4 the provisions of KRS 213.046 shall register the birth of a child and cause to have 5 administered to every such infant or child in its or his care tests for heritable 6 disorders including, but not limited to, phenylketonuria (PKU), sickle cell disease, 7 congenital hypothyroidism, and galactosemia in accordance with rules or 8 regulations prescribed by the secretary of the Cabinet for Health Services. Testing, 9 recording, and reporting of the results of newborn screening tests shall be performed 10 at the times and in the manner as may be prescribed by the secretary of the Cabinet 11 for Health Services or the secretary's designee. The secretary of the Cabinet for 12 Health Services shall by regulation establish and collect fees to cover the cost of 13 analyzing the testing samples for newborn screening tests. 14 (2) (a) As used in this subsection: 15 1. "Health care provider" has the same meaning as set forth in KRS 16 304.17A-005; 17 2. "Health facility" has the same meaning as set forth in KRS 216B.015; 18 and 19 3. "Qualified laboratory" means a clinical laboratory that: 20 a. Holds a current and valid certificate issued by the United States 21 Department for Health and Human Services pursuant to 42 22 U.S.C. sec. 236a; 23 b. Is licensed to perform newborn screening testing in any state; 24 c. Is not operated by the cabinet; and 25 d. Reports its screening results using normal pediatric reference Page 1 of 11 BR011800.100-118 05 RS BR 118 1 ranges. 2 (b) The Cabinet for Health Services shall develop information that explains the 3 availability of additional newborn screening tests not specified in subsection 4 (1) of this section that relate to heritable and genetic congenital disorders, 5 and the risks and costs of these tests. The cabinet shall make this 6 information available on the Internet and shall distribute information 7 regarding the availability of newborn screening information on the Internet 8 to: 9 1. All health facilities that provide care for infants twenty-eight (28) days 10 or less of age; and 11 2. All health care providers in this state that have a primary 12 responsibility for ordering screening tests to be performed. 13 (c) Each health facility and health care provider shall inform the infant's 14 parent or guardian of the availability of comprehensive newborn screening 15 tests. Information provided to the parent or guardian shall include, at a 16 minimum, the content provided on the cabinet's Internet site. Upon consent 17 of the parent or guardian, the health facility shall be responsible for 18 obtaining the specimen, sending the specimen to a qualified laboratory, and 19 providing the appropriate follow-up to the newborn screening, including but 20 not limited to diagnosis, treatment, and evaluation as necessary. 21 (d) The health facility or health care provider shall not be required to assume 22 the cost of additional testing. 23 (e) The cabinet may enter into agreements with public or private qualified 24 laboratories to perform newborn screening tests for any additional testing 25 conducted pursuant to this subsection. 26 (f) Any agreement entered into under paragraph (e) of this subsection shall not 27 preclude a health facility or health care provider from having newborn tests Page 2 of 11 BR011800.100-118 05 RS BR 118 1 analyzed by other qualified laboratories. 2 (3) Nothing in this section shall be construed to require the testing of any child whose 3 parents are members of a nationally recognized and established church or religious 4 denomination, the teachings of which are opposed to medical tests, and who object 5 in writing to the testing of his or her child on that ground. 6 (4)[(3)] The cabinet shall make available the names and addresses of health care 7 providers including, but not limited to, physicians, nurses, and nutritionists, who 8 may provide postpartum home visits to any family whose infant or child has tested 9 positive for a newborn screening test. 10 (5)[(4)] Contingent upon the receipt of federal grants or appropriations by the General 11 Assembly of the Commonwealth of Kentucky, the tests for heritable disorders for 12 newborns listed in subsection (1) of this section shall be expanded to include, but 13 not be limited to, medium-chain acyl-CoA dehydrogenase deficiency (MCAD), very 14 long-chain acyl-CoA deficiency (VLCAD), short-chain acyl-CoA dehydrogenase 15 deficiency (SCAD), maple syrup urine disease, congenital adrenal hyperplsia, 16 biotinidase disorder, and cystic fibrosis. 17 (6)[(5)] The secretary for health services or his or her designee shall apply for any 18 federal grants available through the Public Health Service Act to expand or improve 19 programs to provide screening, counseling, testing, or specialty services for 20 newborns or children at risk for heritable disorders. 21 (7)[(6)] The secretary for health services or his or her designee shall apply for any 22 federal grants available through the Public Health Service Act to evaluate the 23 effectiveness of newborn screening, counseling, or health care services in reducing 24 the morbidity and mortality caused by heritable disorders in newborns and children. 25 Section 2. KRS 205.560 is amended to read as follows: 26 (1) The scope of medical care for which the Cabinet for Health Services undertakes to 27 pay shall be designated and limited by regulations promulgated by the cabinet, Page 3 of 11 BR011800.100-118 05 RS BR 118 1 pursuant to the provisions in this section. Within the limitations of any 2 appropriation therefor, the provision of complete upper and lower dentures to 3 recipients of Medical Assistance Program benefits who have their teeth removed by 4 a dentist resulting in the total absence of teeth shall be a mandatory class in the 5 scope of medical care. Payment to a dentist of any Medical Assistance Program 6 benefits for complete upper and lower dentures shall only be provided on the 7 condition of a preauthorized agreement between an authorized representative of the 8 Medical Assistance Program and the dentist prior to the removal of the teeth. The 9 selection of another class or other classes of medical care shall be recommended by 10 the council to the secretary for health services after taking into consideration, 11 among other things, the amount of federal and state funds available, the most 12 essential needs of recipients, and the meeting of such need on a basis insuring the 13 greatest amount of medical care as defined in KRS 205.510 consonant with the 14 funds available, including, but not limited to, the following categories, except where 15 the aid is for the purpose of obtaining an abortion: 16 (a) Hospital care, including drugs, and medical supplies and services during any 17 period of actual hospitalization; 18 (b) Nursing-home care, including medical supplies and services, and drugs during 19 confinement therein on prescription of a physician, dentist, or podiatrist; 20 (c) Drugs, nursing care, medical supplies, and services during the time when a 21 recipient is not in a hospital but is under treatment and on the prescription of a 22 physician, dentist, or podiatrist. For purposes of this paragraph, drugs shall 23 include those amino acid modified preparations and low-protein modified 24 food products for the treatment of the following inherited metabolic diseases, 25 if the amino acid modified preparations or low-protein modified food products 26 are prescribed for therapeutic treatment and are administered under the 27 direction of a physician, and are limited to the following conditions: Page 4 of 11 BR011800.100-118 05 RS BR 118 1 1. Phenylketonuria; 2 2. Hyperphenylalaninemia; 3 3. Tyrosinemia (types I, II, and III); 4 4. Maple syrup urine disease; 5 5. A-ketoacid dehydrogenase deficiency; 6 6. Isovaleryl-CoA dehydrogenase deficiency; 7 7. 3-methylcrotonyl-CoA carboxylase deficiency; 8 8. 3-methylglutaconyl-CoA hydratase deficiency; 9 9. 3-hydroxy-3-methylglutaryl-CoA lyase deficiency (HMG-CoA lyase 10 deficiency); 11 10. B-ketothiolase deficiency; 12 11. Homocystinuria; 13 12. Glutaric aciduria (types I and II); 14 13. Lysinuric protein intolerance; 15 14. Non-ketotic hyperglycinemia; 16 15. Propionic acidemia; 17 16. Gyrate atrophy; 18 17. Hyperornithinemia/hyperammonemia/homocitrullinuria syndrome; 19 18. Carbamoyl phosphate synthetase deficiency; 20 19. Ornithine carbamoyl transferase deficiency; 21 20. Citrullinemia; 22 21. Arginosuccinic aciduria; 23 22. Methylmalonic acidemia; and 24 23. Argininemia; 25 (d) Physician, podiatric, and dental services; 26 (e) Optometric services for all age groups shall be limited to prescription services, 27 services to frames and lenses, and diagnostic services provided by an Page 5 of 11 BR011800.100-118 05 RS BR 118 1 optometrist, to the extent the optometrist is licensed to perform the services 2 and to the extent the services are covered in the ophthalmologist portion of the 3 physician's program. Eyeglasses shall be provided only to children under age 4 twenty-one (21); 5 (f) Drugs on the prescription of a physician used to prevent the rejection of 6 transplanted organs if the patient is indigent; 7 (g) Nonprofit neighborhood health organizations or clinics where some or all of 8 the medical services are provided by licensed registered nurses or by advanced 9 medical students presently enrolled in a medical school accredited by the 10 Association of American Medical Colleges and where the students or licensed 11 registered nurses are under the direct supervision of a licensed physician who 12 rotates his services in this supervisory capacity between two (2) or more of the 13 nonprofit neighborhood health organizations or clinics specified in this 14 paragraph; 15 (h) Services provided by health-care delivery networks as defined in KRS 16 216.900;[ and] 17 (i) Services provided by midlevel health-care practitioners as defined in KRS 18 216.900; and 19 (j) Beginning January 1, 2007, newborn screening tests recommended by the 20 American College of Medical Genetics in a report commissioned by federal 21 Health Resources and Services Administration. These recommendations 22 shall be superseded by any future recommendations of the Advisory 23 Committee on Heritable Disorders and Genetic Disease in Newborns and 24 Children established by the United States Department for Health and 25 Human Services. 26 (2) Payments for hospital care, nursing-home care, and drugs or other medical, 27 ophthalmic, podiatric, and dental supplies shall be on bases which relate the amount Page 6 of 11 BR011800.100-118 05 RS BR 118 1 of the payment to the cost of providing the services or supplies. It shall be one (1) of 2 the functions of the council to make recommendations to the Cabinet for Health 3 Services with respect to the bases for payment. In determining the rates of 4 reimbursement for long-term-care facilities participating in the Medical Assistance 5 Program, the Cabinet for Health Services shall, to the extent permitted by federal 6 law, not allow the following items to be considered as a cost to the facility for 7 purposes of reimbursement: 8 (a) Motor vehicles that are not owned by the facility, including motor vehicles 9 that are registered or owned by the facility but used primarily by the owner or 10 family members thereof; 11 (b) The cost of motor vehicles, including vans or trucks, used for facility business 12 shall be allowed up to fifteen thousand dollars ($15,000) per facility, adjusted 13 annually for inflation according to the increase in the consumer price index-u 14 for the most recent twelve (12) month period, as determined by the United 15 States Department of Labor. Medically equipped motor vehicles, vans, or 16 trucks shall be exempt from the fifteen thousand dollar ($15,000) limitation. 17 Costs exceeding this limit shall not be reimbursable and shall be borne by the 18 facility. Costs for additional motor vehicles, not to exceed a total of three (3) 19 per facility, may be approved by the Cabinet for Health Services if the facility 20 demonstrates that each additional vehicle is necessary for the operation of the 21 facility as required by regulations of the cabinet; 22 (c) Salaries paid to immediate family members of the owner or administrator, or 23 both, of a facility, to the extent that services are not actually performed and are 24 not a necessary function as required by regulation of the cabinet for the 25 operation of the facility. The facility shall keep a record of all work actually 26 performed by family members; 27 (d) The cost of contracts, loans, or other payments made by the facility to owners, Page 7 of 11 BR011800.100-118 05 RS BR 118 1 administrators, or both, unless the payments are for services which would 2 otherwise be necessary to the operation of the facility and the services are 3 required by regulations of the Cabinet for Health Services. Any other 4 payments shall be deemed part of the owner's compensation in accordance 5 with maximum limits established by regulations of the Cabinet for Health 6 Services. Interest paid to the facility for loans made to a third party may be 7 used to offset allowable interest claimed by the facility; 8 (e) Private club memberships for owners or administrators, travel expenses for 9 trips outside the state for owners or administrators, and other indirect 10 payments made to the owner, unless the payments are deemed part of the 11 owner's compensation in accordance with maximum limits established by 12 regulations of the Cabinet for Health Services; and 13 (f) Payments made to related organizations supplying the facility with goods or 14 services shall be limited to the actual cost of the goods or services to the 15 related organization, unless it can be demonstrated that no relationship 16 between the facility and the supplier exists. A relationship shall be considered 17 to exist when an individual, including brothers, sisters, father, mother, aunts, 18 uncles, and in-laws, possesses a total of five percent (5%) or more of 19 ownership equity in the facility and the supplying business. An exception to 20 the relationship shall exist if fifty-one percent (51%) or more of the supplier's 21 business activity of the type carried on with the facility is transacted with 22 persons and organizations other than the facility and its related organizations. 23 (3) No vendor payment shall be made unless the class and type of medical care 24 rendered and the cost basis therefor has first been designated by regulation. 25 (4) The rules and regulations of the Cabinet for Health Services shall require that a 26 written statement, including the required opinion of a physician, shall accompany 27 any claim for reimbursement for induced premature births. This statement shall Page 8 of 11 BR011800.100-118 05 RS BR 118 1 indicate the procedures used in providing the medical services. 2 (5) The range of medical care benefit standards provided and the quality and quantity 3 standards and the methods for determining cost formulae for vendor payments 4 within each category of public assistance and other recipients shall be uniform for 5 the entire state, and shall be designated by regulation promulgated within the 6 limitations established by the Social Security Act and federal regulations. It shall 7 not be necessary that the amount of payments for units of services be uniform for 8 the entire state but amounts may vary from county to county and from city to city, as 9 well as among hospitals, based on the prevailing cost of medical care in each locale 10 and other local economic and geographic conditions, except that insofar as allowed 11 by applicable federal law and regulation, the maximum amounts reimbursable for 12 similar services rendered by physicians within the same specialty of medical 13 practice shall not vary according to the physician's place of residence or place of 14 practice, as long as the place of practice is within the boundaries of the state. 15 (6) Nothing in this section shall be deemed to deprive a woman of all appropriate 16 medical care necessary to prevent her physical death. 17 (7) To the extent permitted by federal law, no medical assistance recipient shall be 18 recertified as qualifying for a level of long-term care below the recipient's current 19 level, unless the recertification includes a physical examination conducted by a 20 physician licensed pursuant to KRS Chapter 311 or by an advanced registered nurse 21 practitioner licensed pursuant to KRS Chapter 314 and acting under the physician's 22 supervision. 23 (8) If payments made to community mental health centers, established pursuant to KRS 24 Chapter 210, for services provided to the mentally retarded exceed the actual cost of 25 providing the service, the balance of the payments shall be used solely for the 26 provision of other services to the mentally retarded through community mental 27 health centers. Page 9 of 11 BR011800.100-118 05 RS BR 118 1 (9) No long-term-care facility, as defined in KRS 216.510, providing inpatient care to 2 recipients of medical assistance under Title XIX of the Social Security Act on July 3 15, 1986, shall deny admission of a person to a bed certified for reimbursement 4 under the provisions of the Medical Assistance Program solely on the basis of the 5 person's paying status as a Medicaid recipient. No person shall be removed or 6 discharged from any facility solely because they became eligible for participation in 7 the Medical Assistance Program, unless the facility can demonstrate the resident or 8 the resident's responsible party was fully notified in writing that the resident was 9 being admitted to a bed not certified for Medicaid reimbursement. No facility may 10 decertify a bed occupied by a Medicaid recipient or may decertify a bed that is 11 occupied by a resident who has made application for medical assistance. 12 (10) Family-practice physicians practicing in geographic areas with no more than one (1) 13 primary-care physician per five thousand (5,000) population, as reported by the 14 United States Department of Health and Human Services, shall be reimbursed one 15 hundred twenty-five percent (125%) of the standard reimbursement rate for 16 physician services. 17 (11) The Cabinet for Health Services shall make payments under the Medical Assistance 18 program for services which are within the lawful scope of practice of a chiropractor 19 licensed pursuant to KRS Chapter 312, to the extent the Medical Assistance 20 Program pays for the same services provided by a physician. 21 SECTION 3. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 IS 22 CREATED TO READ AS FOLLOWS: 23 (1) A health benefit plan that provides coverage for a family or dependent shall 24 provide coverage for a newborn of the insured and shall include coverage for 25 comprehensive newborn screening, including all tests recommended by the 26 American College of Medical Genetics in a report commissioned by federal 27 Health Resources and Services Administration. These recommendations shall be Page 10 of 11 BR011800.100-118 05 RS BR 118 1 superseded by any future recommendations of the Advisory Committee on 2 Heritable Disorders and Genetic Disease in Newborns and Children established 3 by the United States Department for Health and Human Services. 4 (2) The requirements of this section shall apply to all health benefit plans delivered 5 on and after January 1, 2007. Page 11 of 11 BR011800.100-118