STATEMENT OF EMERGENCY

900 KAR 10:100E

 

      This emergency administrative regulation is being promulgated to establish the policies and procedures relating to appeals of eligibility determinations for KHBE participation and insurance affordability programs in accordance with 42 U.S.C. 18031 and 45 C.F.R. parts 155 and 156. This administrative regulation must be promulgated on an emergency basis: (a) To meet the deadlines and requirements of 42 C.F.R. 155.105, which sets the standards for approval for Kentucky to operate a state-based Exchange. (b) Pursuant to 42 U.S.C. Section 18031, which sets forth the federal requirements in establishing a state-based Exchange, Kentucky must implement procedures for appeals by individuals of eligibility determinations for financial assistance issued by the Exchange. (c) Failure to enact this administrative regulation on an emergency basis will compromise the ability of the Exchange to timely respond to requests for appeals from individuals of eligibility determinations for financial assistance. This emergency administrative regulation shall be replaced by an ordinary administrative regulation to be concurrently filed with the Regulations Compiler. The ordinary administrative regulation is identical to this emergency administrative regulation.

 

STEVEN L. BESHEAR, Governor

AUDREY TAYSE HAYNES, Secretary

 

CABINET FOR HEALTH AND FAMILY SERVICES

Office of the Kentucky Health Benefit Exchange

(New Emergency Administrative Regulation)

 

      900 KAR 10:100E. Appeals of Eligibility Determinations for KHBE Participation and Insurance Affordability Programs.

 

      RELATES TO: KRS 194A.050(1), 42 U.S.C. 18031, 45 C.F.R. Parts 155, 156

      STATUTORY AUTHORITY: KRS 194A.050(1)

      EFFECTIVE: December 17, 2013

      NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and Family Services, Office of the Kentucky Health Benefit Exchange, has responsibility to administer the state-based American Health Benefit Exchange. KRS 194A.050(1) requires the secretary of the cabinet to promulgate administrative regulations necessary to protect, develop, and maintain the health, personal dignity, integrity, and sufficiency of the individual citizens of the Commonwealth; to operate the programs and fulfill the responsibilities vested in the cabinet; and to implement programs mandated by federal law or to qualify for the receipt of federal funds. This administrative regulation establishes the policies and procedures relating to appeals of eligibility determinations for KHBE participation and insurance affordability programs in accordance with 42 U.S.C. 18031 and 45 C.F.R. parts 155 and 156.

 

      Section 1. Definitions. (1) "Advanced payment of premium tax credits" or "APTC" means payment of the tax credits authorized by 26 U.S.C. 36B and its implementing regulations, which are provided on an advance basis to an eligible individual enrolled in a qualified health plan through an exchange in accordance with section 1412 of the Affordable Care Act.

      (2) "Adverse witness" means a person who gives unfavorable evidence against the party that called him or her as its witness.

      (3) "Agency head" means the secretary of the Cabinet for Health and Family Services.

      (4) "Appeal record" means the official record of hearing as defined by KRS 13B.130(1) through (10).

      (5) "Appeal request" means a clear expression, either orally or in writing, by an applicant, enrollee, employer, or small business employer or employee to have an eligibility determination or redetermination contained in a notice issued in accordance with 45 C.F.R. 155.310(g) or 45 C.F.R. 330(e)(1)(ii).

      (6) "Appellant" means the applicant or enrollee who is requesting an appeal.

      (7) "Applicant" means an individual who is seeking eligibility for himself or herself through an application submitted to the KHBE for at least one (1) of the following:

      (a) Enrollment in a QHP through the KHBE; or

      (b) Medicaid and KCHIP, if applicable.

      (8) "Authorized representative" means:

      (a) For an enrollee or applicant who is authorized by Kentucky law to provide written consent, an individual or entity acting on behalf of, and with written consent from, the enrollee or applicant; or

      (b) A legal guardian.

      (9) "Cost-sharing reduction" or "CSR" means a reduction in cost sharing for an eligible individual enrolled in a silver level plan in an exchange or for an individual who is an Indian enrolled in a qualified health plan in an exchange.

      (10) "DAH" means the Division of Administrative Hearings of the Cabinet for Health and Family Services.

      (11) "DCBS" means the Department for Community Based Services.

      (12) "Department of Health and Human Services" or "HHS" means the U.S. Department of Health and Human Services.

      (13) "Enrollee" means an eligible individual enrolled in a qualified health plan.

      (14) "Exemption" means an exemption from the shared responsibility payment.

      (15) "Final order" is defined by KRS 13B.010(6).

      (16) "Hearing" is defined by KRS 13B.010(2).

      (17) "Hearing officer" means a hearing officer employed by DAH.

      (18) "Indian" is defined by 25 U.S.C. 450b(d).

      (19) "Judicial review" means a court's review of factual or legal findings of an administrative body.

      (20) "Kentucky Children’s Health Insurance Program” or "KCHIP" means the separate child health program established by the Commonwealth of Kentucky under title XXI of the Social Security Act in accordance with implementing regulations at 42 C.F.R. 457.

      (21) "Kentucky Health Benefit Exchange" or "KHBE" means the Kentucky state-based health insurance marketplace that includes an:

      (a) Individual exchange; and

      (b) Small Business Health Options Program.

      (22) "MAGI-based income" is defined by 42 C.F.R 435.603(e).

      (23) "Personally identifiable information" means any data about an individual that could potentially identify that individual.

      (24) "Qualified health plan" or "QHP" means a health plan that has in effect a certification issued by the KHBE that it meets the standards described in 45 C.F.R. 156 subpart C.

      (25) "Recommended order" is defined by KRS 13B.010(5).

      (26) "Tax filer" is defined by 45 C.F.R. 155.300.

      (27) "Vacate" means to set aside a previous action.

 

      Section 2. Right to Appeal an Individual Eligibility Determination or Redetermination. (1) An applicant or an enrollee shall have the right to make an appeal request of:

      (a) An eligibility determination made in accordance with 45 C.F.R. 155, subpart D and 900 KAR 10:030, including:

      1. An initial determination of eligibility for enrollment in a QHP, including the amount of APTC and CSR, made in accordance with the standards specified in 45 C.F.R. 155.305(a) through (h); or

      2. A redetermination of eligibility, including the amount of APTC and CSR, made in accordance with 45 C.F.R. 155.330 and 155.335;

      (b) A failure by the KHBE to provide timely notice of an eligibility determination pursuant to 45 C.F.R. 155.310(g), 155.330(e)(1)(ii), 155.335(h)(1)(ii) or 156.610(i);

      (c) A denial of a request to vacate dismissal made by DAH in accordance with 45 C.F.R. 155.530(d)(2), made pursuant to Section 9(3) of this administrative regulation; or

      (d) An eligibility determination for an exemption made in accordance with 45 C.F.R. 155.605.

      (2) Upon exhaustion of the appeal process established in this administrative regulation, an appellant shall have the right to:

      (a) Appeal to HHS according to regulations adopted by the secretary of HHS; and

      (b) Seek a judicial review of an appeal decision pursuant to KRS 13B.140.

      (3) The state Medicaid agency shall retain authority for an appeal of a Medicaid or a KCHIP MAGI-based income determination of eligibility.

      (4) The DAH shall conduct an appeal of an individual eligibility determination, except for an eligibility determination for an exemption made in accordance with 45 C.F.R. 155.605.

      (5) An appeal of an eligibility determination of an exemption shall be conducted by HHS.

 

      Section 3. Designation of a Representative. (1) An appellant may represent himself or herself or be represented during an appeal process by:

      (a) Legal counsel;

      (b) An authorized representative as set forth in 900 KAR 10:030;

      (c) A relative;

      (d) A friend; or

      (e) Another individual not listed in paragraph (a), (b), (c), or (d) of this subsection.

      (2) KHBE shall designate a representative to act on behalf of the KHBE for the hearing.

 

      Section 4. Notice of Appeal Rights. (1) An applicant or an enrollee shall be notified of a right to appeal at the time:

      (a) The applicant submits an application; and

      (b) A notice of eligibility determination is sent by KHBE under 45 C.F.R. 155.310(g), 155.330(e)(1)(ii), or by HHS under 45 C.F.R.155.610(i).

      (2) A notice described in subsection (1) of this section shall include:

      (a) An explanation of the applicant or enrollee’s appeal rights in accordance with this administrative regulation;

      (b) A description of the procedure to request an appeal;

      (c) Information on the applicant or enrollee’s right to represent himself or herself or to be represented by legal counsel or other authorized person;

      (d) An explanation of the circumstances under which the appellant’s eligibility may be maintained or reinstated pending an appeal decision in accordance with Section 8 of this administrative regulation; and

      (e) An explanation that an appeal decision for one (1) household member may result in a:

      1. Change in eligibility for another household members; or

      2. Redetermination of eligibility in accordance with 900 KAR 10:030.

 

      Section 5. Appeal Requests. (1) An applicant or an enrollee may submit an appeal request:

      (a) By phone by contacting the kynect contact center;

      (b) By mail to the KHBE;

      (c) In person at a local DCBS office; or

      (d) Via the internet at Kynect.ky.gov.

      (2) Upon request, the KHBE or the DAH shall assist an applicant or enrollee in filing an appeal.

      (3) An applicant or enrollee’s right to appeal shall not be limited or interfered with by an employee or agent of the KHBE.

      (4) An applicant or enrollee shall have thirty (30) days from the date of notice of an eligibility determination or redetermination to submit an appeal request.

      (5) The date of notice shall be five (5) calendar days after the date on the notice unless an applicant or enrollee can show that the notice was not received within the five (5) day period.

 

      Section 6. Informal Resolution. (1) After receiving an appeal request, the Office of the Kentucky Health Benefit Exchange shall:

      (a) Conduct a desk review of an appeal prior to sending the appeal to the DAH; and

      (b) Complete the review within ten (10) days of receipt of the appeal request.

      (2) The desk review shall consider information submitted during the application process and any supporting documentation used to determine an appellant’s eligibility.

      (3) An appellant shall:

      (a) Have the right to a hearing if the appellant is dissatisfied with the outcome of the informal resolution process; and

      (b) Not have to provide duplicative information or documentation previously provided during the application.

      (4) The outcome of an informal resolution shall be final and binding and the appeal shall not advance to a hearing if the appellant:

      (a) Is satisfied with the outcome of the informal resolution process: and

      (b) Withdraws his or her appeal request in accordance with Section 12 of this administrative regulation.

 

      Section 7. Acknowledgement of Appeal Request and Eligibility Record. (1) A request for an appeal shall be sent to the DAH no later than ten (10) days of receipt of the appeal request.

      (2) A request for an appeal shall be reviewed by DAH to ensure that the appeal request is valid.

      (3) Upon receipt of a valid appeal request, the DAH shall:

      (a) Send timely notice to the appellant of receipt of the valid appeal request by certified mail, return receipt requested, to include:

      1. Information regarding the appellant’s eligibility pending appeal in accordance with Section 8 of this administrative regulation;

      2. An explanation that any APTCs paid on behalf of a tax filer pending appeal are subject to reconciliation under 26 C.F.R. 1.36B-4; and

      3. The hearing requirements contained in Section 10 of this administrative regulation;

      (b) Send timely notice of the appeal request to the KHBE and, if applicable, instructions to provide eligibility pending appeal pursuant to Section 8 of this administrative regulation; and

      (c) Confirm receipt of the records transferred by KHBE pursuant to subsection (5) of this section.

      (4) The DAH shall consider an appeal request valid that was incorrectly delivered or mailed to a department or division of the Cabinet for Health and Family Services but is otherwise valid.

      (5) Upon receipt of an appeal request that is not valid, the DAH shall:

      (a) Send written notice to the appellant that the appeal request has not been accepted and of the nature of the defect in the appeal request; and

      (b) Accept an amended appeal request as valid that meets the requirements of this administrative regulation.

      (6) Upon receipt of a notice under subsection (2)(b) of this section, the KHBE shall submit the appellant’s eligibility record to the DAH.

 

      Section 8. Eligibility Pending Appeal. (1) An appellant who has submitted a valid appeal of a redetermination of eligibility in accordance with Section 5 of this administrative regulation shall be considered eligible while the appeal is pending.

      (2) If a tax filer or appellant accepts eligibility pending an appeal of an eligibility redetermination, the appellant’s eligibility for an APTC or CSR or enrollment in a QHP as applicable shall be continued in accordance with the level of eligibility immediately before the redetermination being appealed.

      (3) An appellant may waive receipt of APTCs pending the outcome of an appeal.

      (4) The continued receipt of APTCs during an appeal may impact the amount owed or due by an appellant during the reconciliation set forth in 26 C.F.R. 1.36B-4, depending upon the appeal decision.

      (5) Eligibility pending appeal shall not be applicable to an appellant appealing an initial denial of eligibility for APTCs.

 

      Section 9. Dismissal of an Appeal. (1) An appeal shall be administratively dismissed by DAH without the need for a final order if the appellant:

      (a) Withdraws the appeal request in accordance with Section 12 of this administrative regulation;

      (b) Fails to appear at a scheduled hearing without good cause;

      (c) Fails to submit a valid appeal request as specified in Section 5 of this administrative regulation; or

      (d) Dies while the appeal is pending.

      (2) If an appeal is administratively dismissed in accordance with subsection (1) of this section, DAH shall provide timely written notice:

      (a) To the appellant that includes:

      1. The reason for the administrative dismissal;

      2. An explanation of the effect of the administrative dismissal on the appellant’s eligibility; and

      3. An explanation of how the appellant may show good cause why the administrative dismissal should be administratively vacated in accordance with subsection (3)(a) of this section; and

      (b) To the KHBE agency that includes:

      1. The eligibility determination to implement; and

      2. Discontinuing eligibility provided under Section 8 of this administrative regulation, if applicable.

      (3) DAH shall:

      (a) Vacate an administrative dismissal under this section and proceed with the appeal if the appellant makes a written request within thirty (30) days of the date of the notice of administrative dismissal showing good cause why the administrative dismissal should be vacated; and

      (b) Provide timely written notice of the recommendation to the secretary of the Cabinet for Health and Family Services to deny the request to vacate an administrative dismissal to the appellant, if the request is denied.

 

      Section 10. Hearing Requirements. (1) DAH shall provide written notice to an appellant prior to a hearing with the acknowledgement of appeal request to include:

      (a) Date;

      (b) Time;

      (c) Location;

      (d) Format of the hearing; and

      (e) The requirements in KRS 13B.050.

      (2) An appellant shall have the opportunity to:

      (a) Review the appeal record, including all documents and records to be used at the hearing prior to the date of the hearing and during the hearing;

      (b) Bring witnesses to testify;

      (c) Establish all relevant facts and circumstances;

      (d) Present an argument without undue interference; and

      (e) Question or refute any testimony or evidence, including the opportunity to confront and cross-examine an adverse witness.

      (3) The DAH shall:

      (a) Consider the information used to determine an appellant’s eligibility;

      (b) Consider additional relevant evidence presented during the course of the appeal, including at the hearing; and

      (c) Review the appeal without deference to a prior decision in the appeal case.

      (4) A hearing shall be conducted:

      (a) In accordance with the requirements of KRS 13B.080 and KRS 13B.090;

      (b) At a reasonable date, time, and location or format;

      (c) After notice of the hearing provided pursuant to subsection (1) of this section;

      (d) Consistent with subsection (3) of this section; and

      (e) By one (1) or more impartial officials who have not been directly involved in the eligibility determination or any prior appeal decision in the same matter.

      (5) Unless a request is made by an appellant for an in person hearing, the hearing shall be conducted via telephone.

 

      Section 11. Expedited Appeals. (1) An appellant shall have the right to an expedited appeal if:

      (a) There is an immediate need for a health service; and

      (b) The standard appeal process described in Section 10 of this administrative regulation could seriously endanger the appellant’s life, health, or ability to attain, maintain, or regain maximum function.

      (2) An expedited appeal shall be requested in the same manner as a standard appeal as set forth in Section 5 of this administrative regulation.

      (3) If an expedited appeal is requested, an appellant shall submit evidence of the reason for the expedited appeal.

      (4) If an appeal request under this section is denied by the DAH, the DAH shall:

      (a) Conduct the appeal under the standard appeal process as set forth in Section 10 of this administrative regulation;

      (b) Inform the appellant through electronic or oral notification, if possible, of the denial within the timeframes established by the secretary of HHS; and

      (c) If notification is oral, follow up with the appellant by written notice.

      (5) A written notice pursuant to subsection (4)(c) of this section shall include:

      (a) The reason for the denial;

      (b) An explanation that the appeal request will be transferred to the standard process described in Section 10 of this administrative regulation; and

      (c) An explanation of the appellant’s rights under the standard process in Section 10 of this administrative regulation.

 

      Section 12. Withdrawal of an Appeal. An appellant shall withdraw a request for an appeal:

      (1) In writing;

      (2) By phone by contacting the kynector contact center; or

      (3) Orally to the hearing officer during an appeal proceeding.

 

      Section 13. Hearing Decision. (1) After the hearing is concluded or a decision is made not to reverse an administrative dismissal of an appeal, the hearing officer shall issue a recommended order in accordance with the requirements of KRS 13B.110.

      (2) A recommended order rendered by the DAH shall be based only on the:

      (a) Information and evidence specified in 45 C.F.R. 155.535(e);

      (b) Eligibility requirements in 900 KAR 10:030; and

      (c) Eligibility requirements under 45 C.F.R. subpart D.

      (3) A recommended order shall:

      (a) Be sent to the appellant and the appellant’s authorized representative, if applicable, and KBHE;

      (b) State the decision;

      (c) Include a plain language description of the effect of the decision on an appellant’s eligibility;

      (d) Summarize the facts relevant to the appeal;

      (e) Identify the legal basis, including an administrative regulation that supports the decision; and

      (f) State the effective date of the decision.

      (4) If either the appellant or KHBE is dissatisfied with the recommended order, either party shall have fifteen (15) days from the date the recommended order is mailed to file exceptions to the recommendations with the secretary of the Cabinet for Health and Family Services.

      (5) The secretary of the Cabinet for Health and Family Services shall consider the appeal record, including the recommended order and any exceptions filed to a recommended order in accordance with KRS 13B.120.

      (6) The secretary of the Cabinet for Health and Family Services may:

      (a) Accept the recommended order of the hearing officer and adopt it as the agency’s final order;

      (b) Reject or modify, in whole or in part, the recommended order; or

      (c) Remand the matter, in whole or in part, to the hearing officer for further proceedings as appropriate.

      (7) The secretary of the Cabinet for Health and Family Services shall:

      (a) Issue written notice of the final order to the appellant within ninety (90) days of the date an appeal request under Section 5 of this administrative regulation is received;

      (b) In the case of an appeal request submitted under Section 11 of this administrative regulation that is determined to meet the criteria for an expedited appeal, issue the final order as expeditiously as:

      1. The appellant’s health condition requires; and

      2. Reasonably possible, consistent with the timeframe established by the secretary of HHS; and

      (c) Provide notice of the appeal decision and instructions to cease pended eligibility to:

      1. The appellant, if applicable; and

      2. KHBE.

      (8) Upon receipt of a notice described in subsection (7) of this section, the KHBE shall:

      (a) Implement the appeal decision:

      1. Retroactive to the date the incorrect eligibility determination was made; or

      2. At a time determined under 45 C.F.R. 155.330(f); and

      (b) Redetermine the eligibility of a household member who has not appealed an eligibility determination but whose eligibility may be affected by the appeal decision, in accordance with the standards described in:

      1. 900 KAR 10:030; and

      2. 45 C.F.R. 155.305.

 

      Section 14. Right to Appeal to HHS. (1) If an appellant disagrees with an appeal decision made in accordance with Section 13 of this administrative regulation or notice of denial of a request to vacate a dismissal under Section 9(3)(b) of this administrative regulation, the appellant may request an appeal from HHS within thirty (30) days of the date of the appeal notice.

      (2) Upon receipt of a notice of an appeal under subsection (1) of this section, DAH shall transmit via secure electronic interface the appellant’s appeal record, including the appellant’s eligibility record received from KHBE, to HHS.

      (3) An applicant or an enrollee denied a request for an exemption by HHS under 45 C.F.R. 155.625(b) may appeal the decision to HHS.

 

      Section 15. Release of Records. (1) An appellant shall have access to the information used by the KHBE to determine his or her eligibility.

      (2) An appellant shall have access to his or her appeal record:

      (a) Upon written request;

      (b) At a place and time convenient to the appellant; and

      (c) Subject to all applicable federal and state laws regarding privacy, confidentiality, disclosure, and personally identifiable information.

      (3) The public shall have access to an appeal decision, subject to all applicable federal and state laws regarding privacy, confidentiality, disclosure, and personally identifiable information.

 

CARRIE BANAHAN      , Executive Director

AUDREY TAYSE HAYNES, Secretary

      APPROVED BY AGENCY: December 4, 2013

      FILED WITH LRC: December 17, 2013 at 2 p.m.

      CONTACT PERSON: Tricia Orme, tricia.orme@ky.gov, Office of Legal Services, 275 East Main Street 5 W-B, Frankfort, Kentucky 40621, phone (502) 564-7905, fax (502) 564-7573.

 

REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT

 

Contact Person: Carrie Banahan

      1. Provide a brief summary of:

      (a) What this administrative regulation does: This administrative regulation establishes the policies and procedures relating to appeals of eligibility determinations for KHBE participation and insurance affordability programs in accordance with 42 U.S.C. 18031 and 45 C.F.R. parts 155 and 156..

      (b) The necessity of this administrative regulation: This administrative regulation is necessary to develop the policies and procedures that will be used for an individual seeking to appeal a decision of the Kentucky Health Benefit Exchange regarding eligibility.

      (c) How this administrative regulation conforms to the content of the authorizing statutes: This administrative regulation is necessary so that individuals seeking to file an appeal of an eligibility determination issued by the Kentucky Health Benefit Exchange are informed of the steps necessary to file an appeal and the subsequent actions of the Cabinet related to the appeal.

      (d) How this administrative regulation currently assists or will assist in the effective administration of the statutes: This administrative regulation provides detailed information to individuals seeking to file an appeal of an eligibility determination issued by the Kentucky Health Benefit Exchange so that they may avail themselves of their rights to an appeal.

      2. If this is an amendment to an existing administrative regulation, provide a brief summary of:

      (a) How the amendment will change this existing administrative regulation: This is a new administrative regulation.

      (b) The necessity of the amendment to this administrative regulation: This is a new administrative regulation.

      (c) How the amendment conforms to the content of the authorizing statutes: This is a new administrative regulation.

      (d) How the amendment will assist in the effective administration of the statutes: This is a new administrative regulation.

      3. List the type and number of individuals, businesses, organizations, or state and local governments affected by this administrative regulation: This administrative regulation will affect approximately 500 individuals who may make an appeal of their determination of edibility issued by the Kentucky Health Benefit Exchange.

      4. Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:

      (a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment: Each individual seeking to file an appeal of a determination of eligibility issued by the Kentucky Health Benefit Exchange must file a request for an appeal pursuant to this administrative regulation.

      (b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3): There will be no cost to entities.

      (c) As a result of compliance, what benefits will accrue to the entities identified in question (3): This administrative regulation will benefit each individual that may request an appeal of an eligibility determination issued by the Kentucky Health Benefit Exchange by providing detailed instructions regarding the appeals process.

      5. Provide an estimate of how much it will cost the administrative body to   implement this administrative regulation:

      (a) Initially: No additional costs will be incurred to implement this administrative regulation.

      (b) On a continuing basis: No additional costs will be incurred.

      6. What is the source of the funding to be used for the implementation and enforcement of this administrative regulation: The source of funding to be used for the implementation and enforcement of this administrative regulation will be from Kentucky Office of Health Benefit Exchange existing budget. No new funding will be needed to implement the provisions of this regulation.

      7. Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new, or by the change if it is an amendment: No increase in fees or funding is necessary.

      8. State whether or not this administrative regulation established any fees or directly or indirectly increased any fees: This administrative regulation does not establish any fees and does not increase any fees either directly or indirectly.

      9. TIERING: Is tiering applied? Tiering was not appropriate in this administrative regulation because the administrative regulation applies equally to all those individuals or entities regulated by it.

 

FISCAL NOTE ON STATE OR LOCAL GOVERNMENT

 

      (1) What units, parts, or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation? This administrative regulation affects the Office of the Kentucky Health Benefit Exchange within the Cabinet for Health and Family Services.

      (2) Identify each state or federal statute or federal regulation that requires or authorizes the action taken by the administrative regulation. KRS 194A.050(1), 42 U.S.C. 18031, and 45 C.F.R. Part 155.

      (3) Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.

      (a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year? This administrative regulation will not generate any revenue.

      (b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years? This administrative regulation will not generate any revenue.

      (c) How much will it cost to administer this program for the first year? No additional costs will be incurred to implement this administrative regulation.

      (d) How much will it cost to administer this program for subsequent years? No additional costs will be incurred to implement this administrative regulation on a continuing basis.

      Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.

      Revenues (+/-):

      Expenditures (+/-):

      Other Explanation:

 

FEDERAL MANDATE ANALYSIS COMPARISON

 

      1.Federal statute or regulation constituting the federal mandate. 42 U.S.C. Section 18031 and 45 C.F.R. Parts 155 and 156.

      2. State compliance standards. KRS 194A.050(1) requires the secretary of the cabinet to promulgate administrative regulations necessary to protect, develop, and maintain the health, personal dignity, integrity, and sufficiency of the individual citizens of the Commonwealth; to operate the programs and fulfill the responsibilities vested in the cabinet, and to implement programs mandated by federal law or to qualify for the receipt of federal funds. This administrative regulation establishes the policies and procedures relating an appeal of a determination of eligibility issued by the Kentucky Health Benefit Exchange, pursuant to, and in accordance with 42 U.S.C. Section 18031 and 45 C.F.R. Parts 155 and 156.

      3. Minimum or uniform standards contained in the federal mandate. The Affordable Care Act establishes the creation of the American Health Benefit Exchange as identified in Section 1311(a) of the Affordable Care Act. The "Kentucky Health Benefit Exchange" (KHBE) is the Kentucky state-based exchange conditionally approved by HHS established by 45 C.F.R. 155.105 to offer a QHP in Kentucky beginning January 1, 2014. An Exchange must make develop policies and procedures related to individual appeals of eligibility determinations issued by KHBE.

      4. Will this administrative regulation impose stricter requirements, or additional or different responsibilities or requirements, than those required by the federal mandate? No.

      5. Justification for the imposition of the stricter standard, or additional or different responsibilities or requirements. This administrative regulation does not impose stricter requirements than those required by the federal mandate.