Request By:
State Senator Julie Rose Denton
Opinion
Opinion By: Albert B. Chandler III, Attorney General; Ryan Halloran, Assistant Attorney General
Opinion of the Attorney General
Senator Julie Rose Denton has requested the opinion of this office as to whether the state Medicaid program can require a co-payment for a covered service rendered by an optometrist, but not for the same service if rendered by an ophthalmologist. In the opinion of this office the answer is no. Because we think the resolution of the question is clear under state statute we will not conduct an analysis of federal law or of whether the federal and state constitutions are implicated.
KRS 205.6312(6) authorizes the Cabinet for Health Services to institute co-payments for medical services provided under the Medicaid Program. The Cabinet has done so by Administrative Regulation 907 KAR 1:604E. That regulation provides a co-payment of two dollars ( $ 2.00) for covered medical services provided by an optometrist and a general ophthalmological service provided by a physician. 907 KAR 1:604E(2)(b) and (c). Optometric services are specifically included in the Medicaid Program to the extent those services are covered in the ophthalmologist portion of the program and the optometrist is licensed to perform them. KRS 205.560(1)(e). The statute places ophthalmological services covered under the Medicaid Program, to the extent an optometrist is licensed to perform them, on an equal basis, whether delivered by an ophthalmologist or an optometrist. The regulation implementing the co-payments requires a co-payment for both ophthalmological services provided by an optometrist and general ophthalmological services provided by a physician. See administrative regulation 907 KAR 1:604E(2). Hence, any interpretation of the regulation that requires a co-payment for ophthalmological services rendered by an optometrist, but not for an ophthalmologist, in our opinion, violates KRS 205.560(1)(e) and the regulation. See Hawley Coal Co. v. Bruce, 252 Ky. 455, 67 S.W.2d 703, 705 (1934) ("When language is clear and unambiguous, it will be held to mean what it plainly expresses").