UNOFFICIAL COPY 22 RS BR 378
Page 1 of 15
XXXX Jacketed
AN ACT relating to coverage for injectable epinephrine devices. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
SECTION 1. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 3
IS CREATED TO READ AS FOLLOWS: 4
(1) As used in this section, "injectable epinephrine device" has the same meaning as 5
in KRS 311.645. 6
(2) A health benefit plan issued or renewed on or after the effective date of this Act 7
shall provide coverage for injectable epinephrine devices for persons eighteen 8
(18) years of age and under. 9
(3) Coverage required by this section shall not be subject to copayments, 10
coinsurance, deductibles, or any other cost-sharing requirements. 11
Section 2. KRS 205.522 is amended to read as follows: 12
(1) The Department for Medicaid Services and any managed care organization 13
contracted to provide Medicaid benefits pursuant to this chapter shall comply with 14
the provisions of Section 1 of this Act and KRS 304.17A-167, 304.17A-235, 15
304.17A-257, 304.17A-259, 304.17A-515, 304.17A-580, 304.17A-600, 304.17A-16
603, 304.17A-607, and 304.17A-740 to 304.17A-743, as applicable. 17
(2) A managed care organization contracted to provide Medicaid benefits pursuant to 18
this chapter shall comply with the reporting requirements of KRS 304.17A-732. 19
Section 3. KRS 205.6485 is amended to read as follows: 20
(1) The Cabinet for Health and Family Services shall prepare a state child health plan 21
meeting the requirements of Title XXI of the Federal Social Security Act, for 22
submission to the Secretary of the United States Department of Health and Human 23
Services within such time as will permit the state to receive the maximum amounts 24
of federal matching funds available under Title XXI. The cabinet shall, by 25
administrative regulation promulgated in accordance with KRS Chapter 13A, 26
establish the following: 27 UNOFFICIAL COPY 22 RS BR 378
Page 2 of 15
XXXX Jacketed
(a) The eligibility criteria for children covered by the Kentucky Children's Health 1
Insurance Program. However, no person eligible for services under Title XIX 2
of the Social Security Act 42 U.S.C. 1396 to 1396v, as amended, shall be 3
eligible for services under the Kentucky Children's Health Insurance Program 4
except to the extent that Title XIX coverage is expanded by KRS 205.6481 to 5
205.6495 and KRS 304.17A-340; 6
(b) The schedule of benefits to be covered by the Kentucky Children's Health 7
Insurance Program, which shall include preventive services, vision services 8
including glasses, and dental services including at least sealants, extractions, 9
and fillings, and which shall be at least equivalent to one (1) of the following: 10
1. The standard Blue Cross/Blue Shield preferred provider option under the 11
Federal Employees Health Benefit Plan established by U.S.C. sec. 12
8903(1); 13
2. A mid-range health benefit coverage plan that is offered and generally 14
available to state employees; or 15
3. Health insurance coverage offered by a health maintenance organization 16
that has the largest insured commercial, non-Medicaid enrollment of 17
covered lives in the state; 18
(c) The premium contribution per family of health insurance coverage available 19
under the Kentucky Children's Health Insurance Program with provisions for 20
the payment of premium contributions by families of children eligible for 21
coverage by the program based upon a sliding scale relating to family income. 22
Premium contributions shall be based on a six (6) month period not to exceed: 23
1. Ten dollars ($10), to be paid by a family with income between one 24
hundred percent (100%) to one hundred thirty-three percent (133%) of 25
the federal poverty level; 26
2. Twenty dollars ($20), to be paid by a family with income between one 27 UNOFFICIAL COPY 22 RS BR 378
Page 3 of 15
XXXX Jacketed
hundred thirty-four percent (134%) to one hundred forty-nine percent 1
(149%) of the federal poverty level; and 2
3. One hundred twenty dollars ($120), to be paid by a family with income 3
between one hundred fifty percent (150%) to two hundred percent 4
(200%) of the federal poverty level, and which may be made on a partial 5
payment plan of twenty dollars ($20) per month or sixty dollars ($60) 6
per quarter; 7
(d) There shall be no copayments for services provided under the Kentucky 8
Children's Health Insurance Program; and 9
(e) The criteria for health services providers and insurers wishing to contract with 10
the Commonwealth to provide the children's health insurance coverage. 11
However, the cabinet shall provide, in any contracting process for the 12
preventive health insurance program, the opportunity for a public health 13
department to bid on preventive health services to eligible children within the 14
public health department's service area. A public health department shall not 15
be disqualified from bidding because the department does not currently offer 16
all the services required by paragraph (b) of this subsection. The criteria shall 17
be set forth in administrative regulations under KRS Chapter 13A and shall 18
maximize competition among the providers and insurers. The Cabinet for 19
Finance and Administration shall provide oversight over contracting policies 20
and procedures to assure that the number of applicants for contracts is 21
maximized. 22
(2) Within twelve (12) months of federal approval of the state's Title XXI child health 23
plan, the Cabinet for Health and Family Services shall assure that a KCHIP program 24
is available to all eligible children in all regions of the state. If necessary, in order to 25
meet this assurance, the cabinet shall institute its own program. 26
(3) KCHIP recipients shall have direct access without a referral from any gatekeeper 27 UNOFFICIAL COPY 22 RS BR 378
Page 4 of 15
XXXX Jacketed
primary care provider to dentists for covered primary dental services and to 1
optometrists and ophthalmologists for covered primary eye and vision services. 2
(4) The Kentucky Children's Health Insurance Program shall comply with Section 1 3
of this Act. 4
Section 4. KRS 18A.225 (Effective January 1, 2022) is amended to read as 5
follows: 6
(1) (a) The term "employee" for purposes of this section means: 7
1. Any person, including an elected public official, who is regularly 8
employed by any department, office, board, agency, or branch of state 9
government; or by a public postsecondary educational institution; or by 10
any city, urban-county, charter county, county, or consolidated local 11
government, whose legislative body has opted to participate in the state-12
sponsored health insurance program pursuant to KRS 79.080; and who 13
is either a contributing member to any one (1) of the retirement systems 14
administered by the state, including but not limited to the Kentucky 15
Retirement Systems, County Employees Retirement System, Kentucky 16
Teachers' Retirement System, the Legislators' Retirement Plan, or the 17
Judicial Retirement Plan; or is receiving a contractual contribution from 18
the state toward a retirement plan; or, in the case of a public 19
postsecondary education institution, is an individual participating in an 20
optional retirement plan authorized by KRS 161.567; or is eligible to 21
participate in a retirement plan established by an employer who ceases 22
participating in the Kentucky Employees Retirement System pursuant to 23
KRS 61.522 whose employees participated in the health insurance plans 24
administered by the Personnel Cabinet prior to the employer's effective 25
cessation date in the Kentucky Employees Retirement System; 26
2. Any certified or classified employee of a local board of education; 27 UNOFFICIAL COPY 22 RS BR 378
Page 5 of 15
XXXX Jacketed
3. Any elected member of a local board of education; 1
4. Any person who is a present or future recipient of a retirement 2
allowance from the Kentucky Retirement Systems, County Employees 3
Retirement System, Kentucky Teachers' Retirement System, the 4
Legislators' Retirement Plan, the Judicial Retirement Plan, or the 5
Kentucky Community and Technical College System's optional 6
retirement plan authorized by KRS 161.567, except that a person who is 7
receiving a retirement allowance and who is age sixty-five (65) or older 8
shall not be included, with the exception of persons covered under KRS 9
61.702(4)(c), unless he or she is actively employed pursuant to 10
subparagraph 1. of this paragraph; and 11
5. Any eligible dependents and beneficiaries of participating employees 12
and retirees who are entitled to participate in the state-sponsored health 13
insurance program; 14
(b) The term "health benefit plan" for the purposes of this section means a health 15
benefit plan as defined in KRS 304.17A-005; 16
(c) The term "insurer" for the purposes of this section means an insurer as defined 17
in KRS 304.17A-005; and 18
(d) The term "managed care plan" for the purposes of this section means a 19
managed care plan as defined in KRS 304.17A-500. 20
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 21
recommendation of the secretary of the Personnel Cabinet, shall procure, in 22
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 23
from one (1) or more insurers authorized to do business in this state, a group 24
health benefit plan that may include but not be limited to health maintenance 25
organization (HMO), preferred provider organization (PPO), point of service 26
(POS), and exclusive provider organization (EPO) benefit plans encompassing 27 UNOFFICIAL COPY 22 RS BR 378
Page 6 of 15
XXXX Jacketed
all or any class or classes of employees. With the exception of employers 1
governed by the provisions of KRS Chapters 16, 18A, and 151B, all 2
employers of any class of employees or former employees shall enter into a 3
contract with the Personnel Cabinet prior to including that group in the state 4
health insurance group. The contracts shall include but not be limited to 5
designating the entity responsible for filing any federal forms, adoption of 6
policies required for proper plan administration, acceptance of the contractual 7
provisions with health insurance carriers or third-party administrators, and 8
adoption of the payment and reimbursement methods necessary for efficient 9
administration of the health insurance program. Health insurance coverage 10
provided to state employees under this section shall, at a minimum, contain 11
the same benefits as provided under Kentucky Kare Standard as of January 1, 12
1994, and shall include a mail-order drug option as provided in subsection 13
(13) of this section. All employees and other persons for whom the health care 14
coverage is provided or made available shall annually be given an option to 15
elect health care coverage through a self-funded plan offered by the 16
Commonwealth or, if a self-funded plan is not available, from a list of 17
coverage options determined by the competitive bid process under the 18
provisions of KRS 45A.080, 45A.085, and 45A.090 and made available 19
during annual open enrollment. 20
(b) The policy or policies shall be approved by the commissioner of insurance and 21
may contain the provisions the commissioner of insurance approves, whether 22
or not otherwise permitted by the insurance laws. 23
(c) Any carrier bidding to offer health care coverage to employees shall agree to 24
provide coverage to all members of the state group, including active 25
employees and retirees and their eligible covered dependents and 26
beneficiaries, within the county or counties specified in its bid. Except as 27 UNOFFICIAL COPY 22 RS BR 378
Page 7 of 15
XXXX Jacketed
provided in subsection (20) of this section, any carrier bidding to offer health 1
care coverage to employees shall also agree to rate all employees as a single 2
entity, except for those retirees whose former employers insure their active 3
employees outside the state-sponsored health insurance program. 4
(d) Any carrier bidding to offer health care coverage to employees shall agree to 5
provide enrollment, claims, and utilization data to the Commonwealth in a 6
format specified by the Personnel Cabinet with the understanding that the data 7
shall be owned by the Commonwealth; to provide data in an electronic form 8
and within a time frame specified by the Personnel Cabinet; and to be subject 9
to penalties for noncompliance with data reporting requirements as specified 10
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 11
to protect the confidentiality of each individual employee; however, 12
confidentiality assertions shall not relieve a carrier from the requirement of 13
providing stipulated data to the Commonwealth. 14
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 15
for timely analysis of data received from carriers and, to the extent possible, 16
provide in the request-for-proposal specifics relating to data requirements, 17
electronic reporting, and penalties for noncompliance. The Commonwealth 18
shall own the enrollment, claims, and utilization data provided by each carrier 19
and shall develop methods to protect the confidentiality of the individual. The 20
Personnel Cabinet shall include in the October annual report submitted 21
pursuant to the provisions of KRS 18A.226 to the Governor, the General 22
Assembly, and the Chief Justice of the Supreme Court, an analysis of the 23
financial stability of the program, which shall include but not be limited to 24
loss ratios, methods of risk adjustment, measurements of carrier quality of 25
service, prescription coverage and cost management, and statutorily required 26
mandates. If state self-insurance was available as a carrier option, the report 27 UNOFFICIAL COPY 22 RS BR 378
Page 8 of 15
XXXX Jacketed
also shall provide a detailed financial analysis of the self-insurance fund 1
including but not limited to loss ratios, reserves, and reinsurance agreements. 2
(f) If any agency participating in the state-sponsored employee health insurance 3
program for its active employees terminates participation and there is a state 4
appropriation for the employer's contribution for active employees' health 5
insurance coverage, then neither the agency nor the employees shall receive 6
the state-funded contribution after termination from the state-sponsored 7
employee health insurance program. 8
(g) Any funds in flexible spending accounts that remain after all reimbursements 9
have been processed shall be transferred to the credit of the state-sponsored 10
health insurance plan's appropriation account. 11
(h) Each entity participating in the state-sponsored health insurance program shall 12
provide an amount at least equal to the state contribution rate for the employer 13
portion of the health insurance premium. For any participating entity that used 14
the state payroll system, the employer contribution amount shall be equal to 15
but not greater than the state contribution rate. 16
(3) The premiums may be paid by the policyholder: 17
(a) Wholly from funds contributed by the employee, by payroll deduction or 18
otherwise; 19
(b) Wholly from funds contributed by any department, board, agency, public 20
postsecondary education institution, or branch of state, city, urban-county, 21
charter county, county, or consolidated local government; or 22
(c) Partly from each, except that any premium due for health care coverage or 23
dental coverage, if any, in excess of the premium amount contributed by any 24
department, board, agency, postsecondary education institution, or branch of 25
state, city, urban-county, charter county, county, or consolidated local 26
government for any other health care coverage shall be paid by the employee. 27 UNOFFICIAL COPY 22 RS BR 378
Page 9 of 15
XXXX Jacketed
(4) If an employee moves his or her place of residence or employment out of the service 1
area of an insurer offering a managed health care plan, under which he or she has 2
elected coverage, into either the service area of another managed health care plan or 3
into an area of the Commonwealth not within a managed health care plan service 4
area, the employee shall be given an option, at the time of the move or transfer, to 5
change his or her coverage to another health benefit plan. 6
(5) No payment of premium by any department, board, agency, public postsecondary 7
educational institution, or branch of state, city, urban-county, charter county, 8
county, or consolidated local government shall constitute compensation to an 9
insured employee for the purposes of any statute fixing or limiting the 10
compensation of such an employee. Any premium or other expense incurred by any 11
department, board, agency, public postsecondary educational institution, or branch 12
of state, city, urban-county, charter county, county, or consolidated local 13
government shall be considered a proper cost of administration. 14
(6) The policy or policies may contain the provisions with respect to the class or classes 15
of employees covered, amounts of insurance or coverage for designated classes or 16
groups of employees, policy options, terms of eligibility, and continuation of 17
insurance or coverage after retirement. 18
(7) Group rates under this section shall be made available to the disabled child of an 19
employee regardless of the child's age if the entire premium for the disabled child's 20
coverage is paid by the state employee. A child shall be considered disabled if he or 21
she has been determined to be eligible for federal Social Security disability benefits. 22
(8) The health care contract or contracts for employees shall be entered into for a period 23
of not less than one (1) year. 24
(9) The secretary shall appoint thirty-two (32) persons to an Advisory Committee of 25
State Health Insurance Subscribers to advise the secretary or the secretary's designee 26
regarding the state-sponsored health insurance program for employees. The 27 UNOFFICIAL COPY 22 RS BR 378
Page 10 of 15
XXXX Jacketed
secretary shall appoint, from a list of names submitted by appointing authorities, 1
members representing school districts from each of the seven (7) Supreme Court 2
districts, members representing state government from each of the seven (7) 3
Supreme Court districts, two (2) members representing retirees under age sixty-five 4
(65), one (1) member representing local health departments, two (2) members 5
representing the Kentucky Teachers' Retirement System, and three (3) members at 6
large. The secretary shall also appoint two (2) members from a list of five (5) names 7
submitted by the Kentucky Education Association, two (2) members from a list of 8
five (5) names submitted by the largest state employee organization of nonschool 9
state employees, two (2) members from a list of five (5) names submitted by the 10
Kentucky Association of Counties, two (2) members from a list of five (5) names 11
submitted by the Kentucky League of Cities, and two (2) members from a list of 12
names consisting of five (5) names submitted by each state employee organization 13
that has two thousand (2,000) or more members on state payroll deduction. The 14
advisory committee shall be appointed in January of each year and shall meet 15
quarterly. 16
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 17
provided to employees pursuant to this section shall not provide coverage for 18
obtaining or performing an abortion, nor shall any state funds be used for the 19
purpose of obtaining or performing an abortion on behalf of employees or their 20
dependents. 21
(11) Interruption of an established treatment regime with maintenance drugs shall be 22
grounds for an insured to appeal a formulary change through the established appeal 23
procedures approved by the Department of Insurance, if the physician supervising 24
the treatment certifies that the change is not in the best interests of the patient. 25
(12) Any employee who is eligible for and elects to participate in the state health 26
insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 27 UNOFFICIAL COPY 22 RS BR 378
Page 11 of 15
XXXX Jacketed
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 1
state health insurance contribution toward health care coverage as a result of any 2
other employment for which there is a public employer contribution. This does not 3
preclude a retiree and an active employee spouse from using both contributions to 4
the extent needed for purchase of one (1) state sponsored health insurance policy for 5
that plan year. 6
(13) (a) The policies of health insurance coverage procured under subsection (2) of 7
this section shall include a mail-order drug option for maintenance drugs for 8
state employees. Maintenance drugs may be dispensed by mail order in 9
accordance with Kentucky law. 10
(b) A health insurer shall not discriminate against any retail pharmacy located 11
within the geographic coverage area of the health benefit plan and that meets 12
the terms and conditions for participation established by the insurer, including 13
price, dispensing fee, and copay requirements of a mail-order option. The 14
retail pharmacy shall not be required to dispense by mail. 15
(c) The mail-order option shall not permit the dispensing of a controlled 16
substance classified in Schedule II. 17
(14) The policy or policies provided to state employees or their dependents pursuant to 18
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 19
aid-related services for insured individuals under eighteen (18) years of age, subject 20
to a cap of one thousand four hundred dollars ($1,400) every thirty-six (36) months 21
pursuant to KRS 304.17A-132. 22
(15) Any policy provided to state employees or their dependents pursuant to this section 23
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 24
consistent with KRS 304.17A-142. 25
(16) Any policy provided to state employees or their dependents pursuant to this section 26
shall provide coverage for obtaining amino acid-based elemental formula pursuant 27 UNOFFICIAL COPY 22 RS BR 378
Page 12 of 15
XXXX Jacketed
to KRS 304.17A-258. 1
(17) If a state employee's residence and place of employment are in the same county, and 2
if the hospital located within that county does not offer surgical services, intensive 3
care services, obstetrical services, level II neonatal services, diagnostic cardiac 4
catheterization services, and magnetic resonance imaging services, the employee 5
may select a plan available in a contiguous county that does provide those services, 6
and the state contribution for the plan shall be the amount available in the county 7
where the plan selected is located. 8
(18) If a state employee's residence and place of employment are each located in counties 9
in which the hospitals do not offer surgical services, intensive care services, 10
obstetrical services, level II neonatal services, diagnostic cardiac catheterization 11
services, and magnetic resonance imaging services, the employee may select a plan 12
available in a county contiguous to the county of residence that does provide those 13
services, and the state contribution for the plan shall be the amount available in the 14
county where the plan selected is located. 15
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 16
in the best interests of the state group to allow any carrier bidding to offer health 17
care coverage under this section to submit bids that may vary county by county or 18
by larger geographic areas. 19
(20) Notwithstanding any other provision of this section, the bid for proposals for health 20
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 21
the statewide rating structure provided in calendar year 2003 and a bid scenario that 22
allows for a regional rating structure that allows carriers to submit bids that may 23
vary by region for a given product offering as described in this subsection: 24
(a) The regional rating bid scenario shall not include a request for bid on a 25
statewide option; 26
(b) The Personnel Cabinet shall divide the state into geographical regions which 27 UNOFFICIAL COPY 22 RS BR 378
Page 13 of 15
XXXX Jacketed
shall be the same as the partnership regions designated by the Department for 1
Medicaid Services for purposes of the Kentucky Health Care Partnership 2
Program established pursuant to 907 KAR 1:705; 3
(c) The request for proposal shall require a carrier's bid to include every county 4
within the region or regions for which the bid is submitted and include but not 5
be restricted to a preferred provider organization (PPO) option; 6
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 7
carrier all of the counties included in its bid within the region. If the Personnel 8
Cabinet deems the bids submitted in accordance with this subsection to be in 9
the best interests of state employees in a region, the cabinet may award the 10
contract for that region to no more than two (2) carriers; and 11
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 12
other requirements or criteria in the request for proposal. 13
(21) Any fully insured health benefit plan or self-insured plan issued or renewed on or 14
after July 12, 2006, to public employees pursuant to this section which provides 15
coverage for services rendered by a physician or osteopath duly licensed under KRS 16
Chapter 311 that are within the scope of practice of an optometrist duly licensed 17
under the provisions of KRS Chapter 320 shall provide the same payment of 18
coverage to optometrists as allowed for those services rendered by physicians or 19
osteopaths. 20
(22) Any fully insured health benefit plan or self-insured plan issued or renewed[ on or 21
after June 29, 2021,] to public employees pursuant to this section shall comply with: 22
(a) KRS 304.12-237; 23
(b) KRS 304.17A-270 and 304.17A-525; 24
(c) KRS 304.17A-600 to 304.17A-633; 25
(d) KRS 205.593; 26
(e) KRS 304.17A-700 to 304.17A-730; 27 UNOFFICIAL COPY 22 RS BR 378
Page 14 of 15
XXXX Jacketed
(f) KRS 304.14-135; 1
(g) KRS 304.17A-580 and 304.17A-641; 2
(h) KRS 304.99-123; 3
(i) KRS 304.17A-138;[ and] 4
(j) KRS 304.17A-148; 5
(k) Section 1 of this Act; and 6
(l) Administrative regulations promulgated pursuant to statutes listed in this 7
subsection. 8
[(23) Any fully insured health benefit plan or self-insured plan issued or renewed on or 9
after January 1, 2022, to public employees pursuant to this section shall comply 10
with KRS 304.17A-148.] 11
Section 5. KRS 164.2871 is amended to read as follows: 12
(1) The governing board of each state postsecondary educational institution is 13
authorized to purchase liability insurance for the protection of the individual 14
members of the governing board, faculty, and staff of such institutions from liability 15
for acts and omissions committed in the course and scope of the individual's 16
employment or service. Each institution may purchase the type and amount of 17
liability coverage deemed to best serve the interest of such institution. 18
(2) All retirement annuity allowances accrued or accruing to any employee of a state 19
postsecondary educational institution through a retirement program sponsored by 20
the state postsecondary educational institution are hereby exempt from any state, 21
county, or municipal tax, and shall not be subject to execution, attachment, 22
garnishment, or any other process whatsoever, nor shall any assignment thereof be 23
enforceable in any court. Except retirement benefits accrued or accruing to any 24
employee of a state postsecondary educational institution through a retirement 25
program sponsored by the state postsecondary educational institution on or after 26
January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 27 UNOFFICIAL COPY 22 RS BR 378
Page 15 of 15
XXXX Jacketed
provided in KRS 141.010 and 141.0215. 1
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 2
members of governing boards, faculty and staff of institutions of higher education in 3
this state shall not be construed to be a waiver of sovereign immunity or any other 4
immunity or privilege. 5
(4) The governing board of each state postsecondary education institution is authorized 6
to provide a self-insured employer group health plan to its employees, which plan 7
shall: 8
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and[ shall] 9
(b) Except as provided in subsection (5) of this section, be exempt from 10
conformity with Subtitle 17A of KRS Chapter 304. 11
(5) A self-insured employer group health plan provided by the governing board of a 12
state postsecondary education institution to its employees shall comply with 13
Section 1 of this Act. 14
Section 6. This Act takes effect on January 1, 2023. 15