Summary — SJR 26 (Acts Ch. 23) — Pharmacist Payment Parity Report
Status and timeline
- Type: Joint Resolution (directive/report), enacted as Acts Chapter 23.
- Introduced: November 22, 2024.
- Passed: Senate (Feb. 14, 2025, 34–0); House (Mar. 12, 2025, 93–0).
- Signed / Enacted: March 2025 (Acts Ch. 23).
- Report deadline: Department for Medicaid Services (DMS) must deliver the report to the Legislative Research Commission (LRC) — for referral to the Interim Joint Committee on Appropriations & Revenue and the Interim Joint Committee on Health Services — no later than August 1, 2025.
Purpose and context
- Purpose: Direct DMS to analyze the fiscal, operational, and access-to-care implications of requiring Kentucky Medicaid and KCHIP to provide the same coverage and reimbursement for pharmacist‑provided clinical services that private insurers were required to provide under 2021’s House Bill 48 (KRS 304.12‑237). HB 48 mandated private insurers reimburse pharmacists for clinical services at parity with other nonphysician practitioners, but it did not apply to Medicaid or KCHIP.
Key required elements of the DMS report (minimum)
1. Detailed summary of changes necessary for Medicaid/KCHIP (including contracted managed care organizations) to comply with KRS 304.12‑237, covering:
- Administrative and technology updates,
- Provider onboarding/credentialing of pharmacists,
- Estimated costs of required changes.
2. Comprehensive list of clinical services and related CPT codes that pharmacists would bill, current reimbursement rates for physicians and nonphysician providers, and counts of those CPT codes billed in 2023–2024.
3. Analysis of expected effects on Medicaid/KCHIP claims and expenditures, including:
- Changes in claim volume,
- Potential offsets (claims shifting between providers/sites),
- Annual expenditure impacts across fee‑for‑service and managed‑care capitation.
4. Review of fiscal outcomes in other states with similar policies (if data available).
5. Summary of HB 48’s observed effects on private insurers (premiums and claims).
6. Analysis of impacts on access to care and health outcomes — with emphasis on rural and underserved communities.
7. Detailed implementation timeline, including any federal approvals (e.g., CMS) required.
Data and interagency coordination
- If DMS lacks necessary private‑insurer data, it must request available information from the Department of Insurance.
- DMS must contact Medicaid agencies in other states with similar policies to obtain comparative data where relevant.
Who is affected
- Directly: Department for Medicaid Services, managed care organizations contracting with Medicaid, pharmacists (as potential billable providers), Medicaid and KCHIP beneficiaries.
- Indirectly: other providers (physicians, APRNs, PAs), state budget/appropriations committees, taxpayers, and private insurers (for comparative analysis).
Practical effect
- SJR 26 does not change coverage or payment rules itself; it mandates a data‑driven report to inform possible legislative or administrative action to extend pharmacist payment parity to Medicaid/KCHIP. The report is intended to quantify operational needs, costs, and impacts on access and outcomes to support future policy decisions.
