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AN ACT relating to coverage of mental health and substance use disorders. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
Section 1. KRS 304.17A-660 is amended to read as follows: 3
As used in KRS 304.17A-660 to 304.17A-665[304.17A-669], unless the context requires 4
otherwise: 5
(1) "Classification of benefits" means the classification of benefits set forth in 45 6
C.F.R. sec. 146.136(c)(2)(ii)(A); 7
(2) "FDA" means the United States Food and Drug Administration; 8
(3) (a) "Mental health and substance use disorder" means a mental health 9
condition or substance use disorder that falls under any of the diagnostic 10
categories listed in the most recent edition or version of: 11
1. The mental and behavioral disorders chapter of the World Health 12
Organization's International Statistical Classification of Diseases and 13
Related Health Problems; or 14
2. The American Psychiatric Association's Diagnostic and Statistical 15
Manual of Mental Disorders. 16
(b) Changes in terminology, organization, or classification of mental health 17
and substance use disorders in future versions of the World Health 18
Organization's International Statistical Classification of Diseases and 19
Related Health Problems or the American Psychiatric Association's 20
Diagnostic and Statistical Manual of Mental Disorders shall not affect the 21
conditions covered by this subsection if the condition is commonly 22
understood to be a mental health and substance use disorder by health care 23
practitioners practicing in relevant clinical specialties["Mental health 24
condition" means any condition or disorder that involves mental illness or 25
substance use disorder as defined in KRS 222.005 and that falls under any of 26
the diagnostic categories listed in the most recent version of the Diagnostic 27 UNOFFICIAL COPY 24 RS BR 1322
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and Statistical Manual of Mental Disorders or that is listed in the mental 1
disorders section of the most recent version of the International Classification 2
of Disease]; 3
(4)[(3)] "Nonquantitative treatment limitation" means any limitation that is not 4
expressed numerically but otherwise limits the scope or duration of benefits for 5
treatment; 6
(5)[(4)] "Terms or conditions" includes day or visit limits, episodes of care, any 7
lifetime or annual payment limits, deductibles, copayments, prescription coverage, 8
coinsurance, out-of-pocket limits, and any other cost-sharing requirements; and 9
(6)[(5)] "Treatment of a mental health and substance use disorder[mental health 10
condition]" includes but is not limited to any necessary outpatient, inpatient, 11
residential, partial hospitalization, day treatment, emergency detoxification, or crisis 12
stabilization services. 13
SECTION 2. A NEW SECTION OF KRS 304.17A-660 TO 304.17A-665 IS 14
CREATED TO READ AS FOLLOWS: 15
(1) As used in this section: 16
(a) "Generally accepted standards of mental health and substance use disorder 17
care": 18
1. Means standards of care and clinical practice that are generally 19
recognized by health care practitioners practicing in relevant clinical 20
specialties, including but not limited to: 21
a. Psychiatry; 22
b. Psychology; 23
c. Clinical sociology; 24
d. Addiction medicine and counseling; and 25
e. Behavioral health treatment; and 26
2. Includes but is not limited to: 27 UNOFFICIAL COPY 24 RS BR 1322
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a. Peer-reviewed scientific studies and medical literature; 1
b. Recommendations of nonprofit health care practitioner 2
professional associations and specialty associations, including 3
but not limited to: 4
i. Patient placement criteria; and 5
ii. Clinical practice guidelines; 6
c. Recommendations of federal government agencies; and 7
d. Drug-labeling approved by the FDA; 8
(b) "Health plan": 9
1. Means any health insurance policy, certificate, contract, or plan that 10
offers or provides hospital, medical, or surgical coverage in this state, 11
whether such coverage is by direct payment, reimbursement, or 12
otherwise; and 13
2. Includes but is not limited to: 14
a. Health benefit plans; and 15
b. Student health insurance offered by a Kentucky-licensed insurer 16
under written contract with a university or college whose 17
students it proposes to insure; 18
(c) "Medically necessary treatment of mental health and substance use 19
disorders" means a service or product addressing the specific needs of that 20
patient for the purpose of screening, preventing, diagnosing, managing, or 21
treating an illness, injury, condition, or its symptoms, including minimizing 22
the progression of an illness, injury, condition, or its symptoms, in a 23
manner that is: 24
1. In accordance with generally accepted standards of mental health and 25
substance use disorder care; 26
2. Clinically appropriate in terms of type, frequency, extent, site, and 27 UNOFFICIAL COPY 24 RS BR 1322
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duration; and 1
3. Not primarily for the: 2
a. Economic benefit of the insurer or purchaser; or 3
b. Convenience of the patient, treating physician, or other health 4
care practitioner; 5
(d) "Utilization review" has the same meaning as in KRS 304.17A-600; and 6
(e) "Utilization review criteria" means any criteria, standards, protocols, or 7
guidelines used to conduct a utilization review; 8
(2) Notwithstanding any other provision of law: 9
(a) All health plans shall provide coverage for medically necessary treatment of 10
mental health and substance use disorders; 11
(b) A health plan shall not limit benefits or coverage for chronic or pervasive 12
mental health and substance use disorders to short-term or acute treatment 13
at any level of placement; 14
(c) 1. All utilization review decisions concerning service intensity, level of 15
care placement, continued stay, and transfer or discharge of insureds 16
diagnosed with one (1) or more mental health and substance use 17
disorders shall comply with subparagraph 2.a. and b. of this 18
paragraph. 19
2. In conducting any utilization review of health care for the diagnosis, 20
prevention, or treatment of a mental health and substance use 21
disorder, an insurer or any person acting on the insurer's behalf: 22
a. Shall base any medical necessity determination or utilization 23
review criteria on generally accepted standards of mental health 24
and substance use disorder care; 25
b. Shall apply the criteria and guidelines set forth in the most 26
recent versions of the treatment criteria developed by the 27 UNOFFICIAL COPY 24 RS BR 1322
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nonprofit professional association for the relevant clinical 1
specialty; and 2
c. For any utilization review involving level of care placement 3
decisions or any other patient decisions that are within the scope 4
of the treatment criteria referenced in subdivision b. of this 5
subparagraph, shall not apply different, additional, conflicting, 6
or more restrictive utilization review criteria than the treatment 7
criteria referenced in subdivision b. of this subparagraph. 8
3. Nothing in subparagraph 2.c. of this paragraph shall be construed to 9
prohibit an insurer, or any person acting on the insurer's behalf, from 10
applying utilization review criteria for the diagnosis, prevention, or 11
treatment of a mental health and substance use disorder that: 12
a. Are outside the scope of the treatment criteria referenced in 13
subparagraph 2.b. of this paragraph if the criteria were 14
developed in accordance with subparagraph 2.a. of this 15
paragraph; or 16
b. Relate to advancements in technology or types of care that are 17
not covered in the most recent version of the criteria referenced 18
in subparagraph 2.b. of this paragraph if the criteria were 19
developed in accordance with subparagraph 2.a. of this 20
subsection; and 21
(d) An insurer or any person acting on the insurer's behalf shall not: 22
1. Rescind or modify any prior authorization for mental health and 23
substance use disorder treatment after the treatment was provided in 24
good faith and pursuant to the prior authorization, for any reason, 25
including a: 26
a. Subsequent rescission, cancellation, or modification of the 27 UNOFFICIAL COPY 24 RS BR 1322
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health plan; and 1
b. Subsequent determination that the insurer, or person acting on 2
the insurer's behalf, did not make an accurate determination of 3
the insured's eligibility for coverage; or 4
2. Adopt, impose, or enforce terms in any health plan or practitioner 5
agreement, in writing or operation, that undermine, alter, or conflict 6
with this section. 7
Section 3. KRS 304.17A-661 is amended to read as follows: 8
(1) As used in this section, " Mental Health Parity and Addiction Equity Act" means 9
the Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. sec. 300gg-10
26, as amended, and any related federal regulations, as amended, including but 11
not limited to 45 C.F.R. secs. 146.136, 147.160, and 156.115(a)(3). 12
(2) Notwithstanding any other provision of law, the commissioner shall implement 13
and enforce the Mental Health Parity and Addiction Equity Act by doing, at a 14
minimum, the following: 15
(a) Proactively ensuring compliance by individual and group health plans, 16
including but not limited to enforcing the reporting requirements of 17
subsection (4) of this section; 18
(b) Evaluating all consumer or practitioner complaints regarding mental health 19
and substance use disorder benefits for possible parity violations; 20
(c) Performing parity compliance market conduct examinations of insurers, 21
including but not limited to review of: 22
1. Nonquantitative treatment limitations, including prior authorization 23
requirements, concurrent reviews, retrospective reviews, step therapy 24
protocols, network admission standards, reimbursement rates, 25
geographic restrictions, and any other nonquantitative treatment 26
limitations deemed relevant by the commissioner; 27 UNOFFICIAL COPY 24 RS BR 1322
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2. Denials of prior authorization, payment, or coverage; and 1
3. Other specific criteria as may be determined by the commissioner; and 2
(d) Promulgating any administrative regulations in accordance with KRS 3
Chapter 13A necessary to effectuate any provision of the Mental Health 4
Parity and Addiction Equity Act that relates to the business of insurance. 5
(3) Notwithstanding any other provision of law: 6
(a) 1. All[A] health benefit plans[plan issued or renewed on or after January 1, 7
2022,] that provide[provides] coverage for treatment of a mental health 8
and substance use disorder[condition] shall provide coverage of any 9
treatment of a mental health and substance use disorder [condition 10
]under terms or conditions that are no more restrictive than the terms or 11
conditions provided for treatment of a physical health condition. 12
2. Expenses for mental health and physical health conditions shall be 13
combined for purposes of meeting deductible and out-of-pocket limits 14
required under a health benefit plan. 15
3. A health benefit plan that does not otherwise provide for management of 16
care under the plan or that does not provide for the same degree of 17
management of care for all health or mental health and substance use 18
disorders[conditions] may provide coverage for treatment of mental 19
health and substance use disorder[conditions] through a managed care 20
organization; 21
(b) With respect to mental health and substance use disorder[condition] benefits 22
in any classification of benefits, a health benefit plan required to comply with 23
paragraph (a) of this subsection shall not impose: 24
1. A nonquantitative treatment limitation that does not apply to medical 25
and surgical benefits in the same classification; or[and] 26
2. Medical necessity criteria or a nonquantitative treatment limitation 27 UNOFFICIAL COPY 24 RS BR 1322
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unless, under the terms of the plan, as written and in operation, any 1
processes, strategies, evidentiary standards, or other factors used in 2
applying the criteria or limitation to mental health and substance use 3
disorder[condition] benefits in the classification are comparable to, and 4
are applied no more stringently than, the processes, strategies, 5
evidentiary standards, or other factors used in applying the criteria or 6
limitation to medical and surgical benefits in the same classification; and 7
(c) Paragraph (b) of this subsection shall be construed to require, at a minimum, 8
compliance with the requirements for nonquantitative treatment limitations set 9
forth in the Mental Health Parity and Addiction Equity Act[ of 2008, 42 10
U.S.C. sec. 300gg-26, as amended, and any related federal regulations, as 11
amended, including but not limited to 45 C.F.R. secs. 146.136, 147.160, and 12
156.115(a)(3)]. 13
(4)[(2)] Notwithstanding any other provision of law: 14
(a) An insurer that issues or renews a health benefit plan that is subject to the 15
provisions of this section shall submit an annual report to the commissioner 16
on or before April 1 of each year[ following January 1, 2022,] that contains 17
the following: 18
1. A description of the process used to develop or select the medical 19
necessity criteria for both mental health and substance use disorder 20
[condition] benefits and medical and surgical benefits; 21
2. Identification of all nonquantitative treatment limitations applicable to 22
benefits and services covered under the plan that are applied to both 23
mental health and substance use disorder[condition] benefits and 24
medical and surgical benefits within each classification of benefits; 25
3. The results of an analysis that demonstrates compliance with subsection 26
(3)[(1)](b) and (c) of this section for the medical necessity criteria 27 UNOFFICIAL COPY 24 RS BR 1322
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described in subparagraph 1. of this paragraph and for each 1
nonquantitative treatment limitation identified in subparagraph 2. of this 2
paragraph, as written and in operation. At a minimum, the results of the 3
analysis shall: 4
a. Identify the factors used to determine that a nonquantitative 5
treatment limitation will apply to a benefit, including factors that 6
were considered but rejected; 7
b. Identify and define the specific evidentiary standards used to 8
define the factors and any other evidence relied upon in designing 9
each nonquantitative treatment limitation; 10
c. Provide the comparative analyses, including the results of the 11
analyses, performed to determine that the processes and strategies: 12
i. Used to design each nonquantitative treatment limitation, as 13
written, and the as-written processes and strategies used to 14
apply the nonquantitative treatment limitation to mental 15
health and substance use disorder[condition] benefits are 16
comparable to, and are applied no more stringently than, the 17
processes and strategies used to design each nonquantitative 18
treatment limitation, as written, and the as-written processes 19
and strategies used to apply the nonquantitative treatment 20
limitation to medical and surgical benefits; and 21
ii. Used to apply each nonquantitative treatment limitation, in 22
operation, for mental health and substance use 23
disorder[condition] benefits are comparable to, and are 24
applied no more stringently than, the processes and strategies 25
used to apply each nonquantitative treatment limitation, in 26
operation, for medical and surgical benefits; and 27 UNOFFICIAL COPY 24 RS BR 1322
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d. Disclose the specific findings and conclusions reached by the 1
insurer that the results of the analyses performed under this 2
subparagraph indicate that the insurer is in compliance with 3
subsection (3)[(1)](b) and (c) of this section; and 4
4. Any additional information that may be prescribed by the commissioner 5
for use in determining compliance with the requirements of this section; 6
and[.] 7
(b) The annual report shall be submitted in a manner and format prescribed by the 8
commissioner through administrative regulation. 9
(5)[(3)] A group health benefit plan covering fewer than fifty-one (51) employees 10
that is not otherwise required to provide parity in mental health condition 11
benefits under federal law shall be exempt from the provisions of this 12
section. 13
(6) A willful violation of subsection (3) or (4) of this section shall constitute an act of 14
discrimination and shall be an unfair trade practice under this chapter. The remedies 15
provided under Subtitle 12 of this chapter shall apply to conduct in violation of this 16
section. 17
Section 4. KRS 304.17A-665 is amended to read as follows: 18
(1) Sixty (60) days[ prior to the regular session of the General Assembly in 2002, and 19
sixty (60) days] prior to each [subsequent ]even-numbered-year regular session of 20
the General Assembly, the commissioner shall submit a written report to the 21
Legislative Research Commission on the impact on health insurance costs of KRS 22
304.17A-660 to 304.17A-665[304.17A-669]. 23
(2) (a) By December 1 of each year, the commissioner shall submit a report 24
containing the following information to the Legislative Research 25
Commission for referral to the Interim Joint Committees on Health Services 26
and Banking and Insurance with regard to compliance with the Mental 27 UNOFFICIAL COPY 24 RS BR 1322
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Health Parity and Addiction Equity Act and Section 5 of this Act: 1
1. The methodology the commissioner is using to determine compliance; 2
2. A list, and summary of results, of market conduct examinations 3
conducted or completed during the preceding twelve (12) month 4
period; and 5
3. Any educational or corrective actions the commissioner has taken to 6
ensure compliance. 7
(b) The report required under paragraph (a) of this subsection shall be: 8
1. Written in nontechnical and readily understandable language; 9
2. Made available to the public by: 10
a. Posting the report on the department's website; and 11
b. Any other means the commissioner deems appropriate; and 12
3. Presented to the Interim Joint Committees on Health Services and 13
Banking and Insurance upon request. 14
SECTION 5. A NEW SECTION OF KRS 304.17A-660 TO 304.17A-665 IS 15
CREATED TO READ AS FOLLOWS: 16
(1) As used in this section, "health plan": 17
(a) Means any health insurance policy, certificate, contract, or plan that offers 18
or provides prescription drug coverage for the treatment of substance use 19
disorders in this state, whether such coverage is by direct payment, 20
reimbursement, or otherwise; and 21
(b) Includes but is not limited to: 22
1. Health benefit plans; and 23
2. Student health insurance offered by a Kentucky-licensed insurer 24
under written contract with a university or college whose students it 25
proposes to insure; 26
(2) Notwithstanding any other provision of law, with respect to prescription drugs 27 UNOFFICIAL COPY 24 RS BR 1322
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that are on the health plan's formulary, the health plan shall: 1
(a) For any prescription drug approved by the FDA for the treatment of 2
substance use disorders: 3
1. Not impose any prior authorization requirements; 4
2. Not impose any step therapy protocol, as defined in KRS 304.17A-163; 5
3. Place the drug on the lowest tier of the drug formulary used by the 6
health plan; and 7
4. Not exclude coverage for the drug or any associated counseling or 8
wraparound services based solely on the grounds that the drug, 9
counseling, or service was court-ordered; and 10
(b) Not refuse coverage for a drug based on whether the insured participates in 11
counseling or wraparound services. 12
SECTION 6. A NEW SECTION OF KRS 304.17A-660 TO 304.17A-665 IS 13
CREATED TO READ AS FOLLOWS: 14
Notwithstanding any other provision of law: 15
(1) Mental health and substance use disorder benefits shall be considered emergency 16
benefits for the purpose of classification of benefits under a health plan, as 17
defined in Section 2 of this Act, when treatment of a mental health and substance 18
use disorder is provided by any of the following mental health and substance use 19
disorder emergency practitioners: 20
(a) A crisis stabilization unit; 21
(b) A twenty-three (23) hour crisis relief center; 22
(c) An evaluation and treatment facility that: 23
1. Can provide, directly or by direct arrangement with other public or 24
private agencies, emergency evaluation and treatment, outpatient care, 25
and timely and appropriate inpatient care to persons suffering from a 26
mental disorder; and 27 UNOFFICIAL COPY 24 RS BR 1322
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2. Is licensed or certified as such under the laws of this state; 1
(d) An agency certified under the laws of this state to provide crisis services; 2
(e) An agency certified under the laws of this state to provide medically 3
managed or medically monitored withdrawal management services; or 4
(f) A mobile rapid response crisis team that is contracted with a behavioral 5
health administrative services organization to provide crisis response service 6
in the behavioral health administrative services organization's service area; 7
and 8
(2) When a mental health and substance use disorder is treated by a mental health 9
and substance use disorder emergency practitioner referenced in subsection (1) of 10
this section, the mental health and substance use disorder shall be considered an 11
emergency medical condition for purposes of this subtitle, including but not 12
limited to KRS 304.17A-580 and 304.17A-641. 13
SECTION 7. A NEW SECTION OF KRS 304.17A-660 TO 304.17A-665 IS 14
CREATED TO READ AS FOLLOWS: 15
(1) As used in this section: 16
(a) "Health plan": 17
1. Means any health insurance policy, certificate, contract, or plan that 18
offers or provides coverage in this state for both medical and surgical 19
benefits and mental health and substance use disorder benefits, 20
whether such coverage is by direct payment, reimbursement, or 21
otherwise; and 22
2. Includes but is not limited to: 23
a. Health benefit plans; and 24
b. Student health insurance offered by a Kentucky-licensed insurer 25
under written contract with a university or college whose 26
students it proposes to insure; 27 UNOFFICIAL COPY 24 RS BR 1322
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(b) "Mental health professional" means any of the following persons engaged 1
in providing mental health services: 2
1. A physician or psychiatrist licensed to practice medicine or osteopathy 3
under KRS Chapter 311; 4
2. A medical officer of the government of the United States; 5
3. A licensed psychologist, licensed psychological practitioner, certified 6
psychologist, or licensed psychological associate, licensed under KRS 7
Chapter 319; 8
4. A certified nurse practitioner or clinical nurse specialist with a 9
psychiatric or mental health population focus licensed to engage in 10
advanced practice registered nursing under KRS 314.042; 11
5. A licensed clinical social worker licensed under KRS 335.100 or a 12
certified social worker licensed under KRS 335.080; 13
6. A licensed marriage and family therapist licensed under KRS 335.330 14
or a marriage and family therapist associate holding a permit under 15
KRS 335.332; 16
7. A licensed professional clinical counselor or licensed professional 17
counselor associate, licensed under KRS 335.500 to 335.599; 18
8. A licensed professional art therapist licensed under KRS 309.133 or a 19
professional art therapist associate licensed under KRS 309.134; 20
9. A Kentucky licensed pastoral counselor licensed under KRS 335.600 21
to 335.699; 22
10. A licensed clinical alcohol and drug counselor, licensed clinical 23
alcohol and drug counselor associate, or certified alcohol and drug 24
counselor, licensed or certified under KRS 309.080 to 309.089; or 25
11. A physician assistant licensed under KRS 311.840 to 311.862 who 26
meets the criteria for being a qualified mental health professional 27 UNOFFICIAL COPY 24 RS BR 1322
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under KRS 202A.011(12)(h); and 1
(c) "Mental health wellness examination" includes but is not limited to: 2
1. A behavioral health screening; 3
2. Education and consultation on healthy lifestyle changes; 4
3. Referrals to ongoing treatment, mental health services, and other 5
supports; and 6
4. Discussion of potential options for medication. 7
(2) To the extent permitted by federal law, all health plans shall provide coverage for 8
an annual comprehensive mental health wellness examination that is performed: 9
(a) By a mental health professional; and 10
(b) In accordance with nationally recognized clinical practice guidelines. 11
(3) The coverage required by this section shall: 12
(a) Include coverage for both in-person and telehealth examinations; 13
(b) Be no less extensive than the coverage provided for medical and surgical 14
benefits; 15
(c) Comply with the Mental Health Parity and Addiction Equity Act; and 16
(d) Not be subject to copayments, coinsurance, deductibles, or any other cost-17
sharing requirements. 18
SECTION 8. A NEW SECTION OF SUBTITLE 99 OF KRS CHAPTER 304 19
IS CREATED TO READ AS FOLLOWS: 20
(1) If the commissioner determines that an insurer, or any person acting on the 21
insurer's behalf, has violated Section 2 of this Act, the commissioner may, after 22
notice and hearing, by order assess a civil penalty for each violation, not to 23
exceed: 24
(a) Except as provided in paragraph (b) of this subsection, five thousand 25
dollars ($5,000); or 26
(b) Ten thousand dollars ($10,000) for a willful violation. 27 UNOFFICIAL COPY 24 RS BR 1322
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(2) (a) If the commissioner determines that an insurer has violated subsection (2) 1
of Section 3 of this Act, or any administrative regulation promulgated 2
thereunder, the commissioner may, after notice and hearing, by order, 3
assess a civil penalty for each violation not to exceed: 4
1. Except as provided in paragraph (b) of this subsection, five thousand 5
dollars ($5,000); or 6
2. Ten thousand dollars ($10,000) for a willful violation. 7
(b) The penalties provided under this subsection shall be cumulative to any 8
other penalties provided under this chapter. 9
Section 9. KRS 304.17A-265 is amended to read as follows: 10
(1) As used in this section: 11
(a) "Health insurance policy": 12
1. Includes any health insurance policy, certificate, plan, or contract or 13
managed care plan, as defined in KRS 304.17A-500, regardless of 14
whether the policy, certificate, plan, or contract was issued or delivered 15
in this state; and 16
2. Does not include Medicare or Medicaid benefits; 17
(b) "Insurer": 18
1. Means any domestic, foreign, or alien insurer, self-insurer, self-insured 19
plan, or self-insured group; and 20
2. Includes any domestic, foreign, or alien: 21
a. Health maintenance organization; 22
b. Limited health service organization; 23
c. Provider-sponsored integrated health delivery network; and 24
d. Nonprofit hospital, medical-surgical, dental, and health service 25
corporation; and 26
(c) "Substance abuse or mental health facility" means a structurally distinct 27 UNOFFICIAL COPY 24 RS BR 1322
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public or private health care establishment, institution, or facility located and 1
licensed in this state that is primarily constituted, staffed, and equipped to 2
deliver substance abuse or mental health treatment services, or both substance 3
abuse and mental health treatment services, to the general public. 4
(2) To the extent permitted under federal law, an insurer or its agent: 5
(a) Shall not prohibit or restrict, except as provided in paragraph (b) of this 6
subsection, an insured under a health insurance policy from making a written 7
assignment of any substance abuse or mental health treatment benefits 8
available under the policy to a substance abuse or mental health facility; and 9
(b) May require a substance abuse or mental health facility that receives a written 10
assignment of benefits from an insured to: 11
1. Provide the following information to the insured prior to performing a 12
health care service associated with the benefits: 13
a. A statement informing the insured that the facility, as applicable: 14
i. Is an out-of-network provider; 15
ii. May charge the insured for services not covered under the 16
health insurance policy; and 17
iii. May charge the insured the balance of any bill for services 18
that are covered under the health insurance policy; 19
b. A schedule of all applicable charges for the services that the 20
facility may provide to the insured; 21
c. Any terms of payment that may apply to the insured; and 22
d. Whether interest will apply to, and the amount of interest that will 23
be charged against, any payment owed by the insured to the 24
facility; 25
2. Submit claims associated with the benefits within ninety (90) days of the 26
date of service; 27 UNOFFICIAL COPY 24 RS BR 1322
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3. Maintain records of claims associated with the benefits; 1
4. Respond to any inquiry regarding the benefits from an investigative unit 2
established under KRS 304.47-080 or other similar unit; and 3
5. Make a good-faith effort to abide by the standards of care set forth by 4
the following, as applicable: 5
a. The American Society of Addiction Medicine; 6
b. The American Association for Community Psychiatry's Level of 7
Care Utilization System (LOCUS); or 8
c. The American Association for Community Psychiatry's and the 9
American Academy of Child and Adolescent Psychiatry's Child 10
and Adolescent Level of Care/Service Intensity Utilization System 11
(CALOCUS-CASII). 12
(3) For an assignment of benefits made in accordance with this section: 13
(a) The assignment shall: 14
1. Be valid as of the effective date contained in the assignment; and 15
2. Remain in effect until the earlier of the following: 16
a. The date the insured is discharged from the care of the substance 17
abuse or mental health facility; or 18
b. The date the substance abuse or mental health facility receives 19
written notice of the insured's termination of the assignment; and 20
(b) Upon notice of the assignment, the insurer shall make payments directly to the 21
substance abuse or mental health facility for all services rendered by the 22
facility to the insured for the duration of the assignment. 23
(4) This section shall not be construed to: 24
(a) Provide a coverage or benefit that is not otherwise available under the health 25
insurance policy; 26
(b) Prohibit an insurer from enforcing any terms or conditions of the health 27 UNOFFICIAL COPY 24 RS BR 1322
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insurance policy that are not in conflict with this section; 1
(c) Relieve an insured from the contractual obligation to pay deductibles, 2
copayments, or coinsurance; 3
(d) Permit a substance abuse or mental health facility to waive deductibles, 4
copayments, or coinsurance by the notice of assignment; or 5
(e) Violate: 6
1. 29 U.S.C. sec. 1185a, as amended; or 7
2. KRS 304.17A-660 to 304.17A-665[304.17A-669]. 8
Section 10. KRS 164.2871 (Effective January 1, 2025) is amended to read as 9
follows: 10
(1) The governing board of each state postsecondary educational institution is 11
authorized to purchase liability insurance for the protection of the individual 12
members of the governing board, faculty, and staff of such institutions from liability 13
for acts and omissions committed in the course and scope of the individual's 14
employment or service. Each institution may purchase the type and amount of 15
liability coverage deemed to best serve the interest of such institution. 16
(2) All retirement annuity allowances accrued or accruing to any employee of a state 17
postsecondary educational institution through a retirement program sponsored by 18
the state postsecondary educational institution are hereby exempt from any state, 19
county, or municipal tax, and shall not be subject to execution, attachment, 20
garnishment, or any other process whatsoever, nor shall any assignment thereof be 21
enforceable in any court. Except retirement benefits accrued or accruing to any 22
employee of a state postsecondary educational institution through a retirement 23
program sponsored by the state postsecondary educational institution on or after 24
January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 25
provided in KRS 141.010 and 141.0215. 26
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 27 UNOFFICIAL COPY 24 RS BR 1322
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members of governing boards, faculty and staff of institutions of higher education 1
in this state shall not be construed to be a waiver of sovereign immunity or any 2
other immunity or privilege. 3
(4) The governing board of each state postsecondary education institution is authorized 4
to provide a self-insured employer group health plan to its employees, which plan 5
shall: 6
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 7
(b) Except as provided in subsection (5) of this section, be exempt from 8
conformity with Subtitle 17A of KRS Chapter 304. 9
(5) A self-insured employer group health plan provided by the governing board of a 10
state postsecondary education institution to its employees shall comply with: 11
(a) KRS 304.17A-163 and 304.17A-1631; 12
(b) KRS 304.17A-265; 13
(c) KRS 304.17A-261;[ and] 14
(d) KRS 304.17A-262; and 15
(e) Sections 2, 5, 6, and 7 of this Act. 16
Section 11. KRS 205.522 is amended to read as follows: 17
(1) With respect to the administration and provision of Medicaid benefits pursuant to 18
this chapter, the Department for Medicaid Services,[ and] any managed care 19
organization contracted to provide Medicaid benefits pursuant to this chapter, and 20
the state's medical assistance program shall be subject to, and comply with, the 21
following, as applicable:[provisions of] 22
(a) KRS 304.17A-163;[,] 23
(b) KRS 304.17A-1631;[,] 24
(c) KRS 304.17A-167;[,] 25
(d) KRS 304.17A-235;[,] 26
(e) KRS 304.17A-257;[,] 27 UNOFFICIAL COPY 24 RS BR 1322
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(f) KRS 304.17A-259;[,] 1
(g) KRS 304.17A-263;[,] 2
(h) KRS 304.17A-515;[,] 3
(i) KRS 304.17A-580;[,] 4
(j) KRS 304.17A-600, 304.17A-603, and 304.17A-607;[, and] 5
(k) KRS 304.17A-740 to 304.17A-743; and[, as applicable] 6
(l) Sections 2, 5, 6, and 7 of this Act. 7
(2) A managed care organization contracted to provide Medicaid benefits pursuant to 8
this chapter shall comply with the reporting requirements of KRS 304.17A-732. 9
Section 12. KRS 205.6485 is amended to read as follows: 10
(1) As used in this section, "KCHIP" means the Kentucky Children's Health 11
Insurance Program. 12
(2) The Cabinet for Health and Family Services shall: 13
(a) Prepare a state child health plan, known as KCHIP, meeting the requirements 14
of Title XXI of the Federal Social Security Act, for submission to the 15
Secretary of the United States Department of Health and Human Services 16
within such time as will permit the state to receive the maximum amounts of 17
federal matching funds available under Title XXI; and[. The cabinet shall, ] 18
(b) By administrative regulation promulgated in accordance with KRS Chapter 19
13A, establish the following: 20
1.[(a)] The eligibility criteria for children covered by KCHIP, which 21
shall include a provision that[the Kentucky Children's Health Insurance 22
Program. However,] no person eligible for services under Title XIX of 23
the Social Security Act, 42 U.S.C. secs. 1396 to 1396v, as amended, 24
shall be eligible for services under KCHIP,[the Kentucky Children's 25
Health Insurance Program] except to the extent that Title XIX coverage 26
is expanded by KRS 205.6481 to 205.6495 and KRS 304.17A-340; 27 UNOFFICIAL COPY 24 RS BR 1322
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2.[(b)] The schedule of benefits to be covered by KCHIP [the Kentucky 1
Children's Health Insurance Program], which shall:[ include preventive 2
services, vision services including glasses, and dental services including 3
at least sealants, extractions, and fillings, and which shall ] 4
a. Be at least equivalent to one (1) of the following: 5
i.[1.] The standard Blue Cross/Blue Shield preferred provider 6
option under the Federal Employees Health Benefit Plan 7
established by 5 U.S.C. sec. 8903(1); 8
ii.[2.] A mid-range health benefit coverage plan that is offered and 9
generally available to state employees; or 10
iii.[3.] Health insurance coverage offered by a health 11
maintenance organization that has the largest insured 12
commercial, non-Medicaid enrollment of covered lives in the 13
state; 14
and 15
b. Comply with subsection (6) of this section; 16
3.[(c)] The premium contribution per family for[of] health insurance 17
coverage available under KCHIP, which[the Kentucky Children's 18
Health Insurance Program with provisions for the payment of premium 19
contributions by families of children eligible for coverage by the 20
program based upon a sliding scale relating to family income. Premium 21
contributions] shall be based: 22
a. On a six (6) month period; and 23
b. Upon a sliding scale relating to family income not to exceed: 24
i.[1.] Ten dollars ($10), to be paid by a family with income 25
between one hundred percent (100%) to one hundred thirty-26
three percent (133%) of the federal poverty level; 27 UNOFFICIAL COPY 24 RS BR 1322
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ii.[2.] Twenty dollars ($20), to be paid by a family with income 1
between one hundred thirty-four percent (134%) to one 2
hundred forty-nine percent (149%) of the federal poverty 3
level; and 4
iii.[3.] One hundred twenty dollars ($120), to be paid by a 5
family with income between one hundred fifty percent 6
(150%) to two hundred percent (200%) of the federal 7
poverty level, and which may be made on a partial payment 8
plan of twenty dollars ($20) per month or sixty dollars ($60) 9
per quarter; 10
4.[(d)] There shall be no copayments for services provided under 11
KCHIP[the Kentucky Children's Health Insurance Program]; and 12
5. a.[(e)] The criteria for health services providers and insurers 13
wishing to contract with the Commonwealth to provide [the 14
children's health insurance ]coverage under KCHIP. 15
b. [However, ]The cabinet shall provide, in any contracting process 16
for coverage of[the ]preventive services[health insurance 17
program], the opportunity for a public health department to bid on 18
preventive health services to eligible children within the public 19
health department's service area. A public health department shall 20
not be disqualified from bidding because the department does not 21
currently offer all the services required by [paragraph (b) of ]this 22
section[subsection]. The criteria shall be set forth in administrative 23
regulations under KRS Chapter 13A and shall maximize 24
competition among the providers and insurers. The [Cabinet for 25
]Finance and Administration Cabinet shall provide oversight over 26
contracting policies and procedures to assure that the number of 27 UNOFFICIAL COPY 24 RS BR 1322
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applicants for contracts is maximized. 1
(3)[(2)] Within twelve (12) months of federal approval of the state's Title XXI child 2
health plan, the Cabinet for Health and Family Services shall assure that a KCHIP 3
program is available to all eligible children in all regions of the state. If necessary, 4
in order to meet this assurance, the cabinet shall institute its own program. 5
(4)[(3)] KCHIP recipients shall have direct access without a referral from any 6
gatekeeper primary care provider to dentists for covered primary dental services 7
and to optometrists and ophthalmologists for covered primary eye and vision 8
services. 9
(5)[(4)] KCHIP[The Kentucky Children's Health Insurance Plan] shall comply with: 10
(a) KRS 304.17A-163 and 304.17A-1631; and 11
(b) Section 6 of this Act. 12
(6) The schedule of benefits required under subsection (2)(b)2. of this section shall 13
include: 14
(a) Preventive services; 15
(b) Vision services, including glasses; 16
(c) Dental services, including sealants, extractions, and fillings; and 17
(d) The coverage required under Sections 2, 5, and 7 of this Act. 18
Section 13. KRS 18A.225 (Effective January 1, 2025) is amended to read as 19
follows: 20
(1) (a) The term "employee" for purposes of this section means: 21
1. Any person, including an elected public official, who is regularly 22
employed by any department, office, board, agency, or branch of state 23
government; or by a public postsecondary educational institution; or by 24
any city, urban-county, charter county, county, or consolidated local 25
government, whose legislative body has opted to participate in the state-26
sponsored health insurance program pursuant to KRS 79.080; and who 27 UNOFFICIAL COPY 24 RS BR 1322
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is either a contributing member to any one (1) of the retirement systems 1
administered by the state, including but not limited to the Kentucky 2
Retirement Systems, County Employees Retirement System, Kentucky 3
Teachers' Retirement System, the Legislators' Retirement Plan, or the 4
Judicial Retirement Plan; or is receiving a contractual contribution from 5
the state toward a retirement plan; or, in the case of a public 6
postsecondary education institution, is an individual participating in an 7
optional retirement plan authorized by KRS 161.567; or is eligible to 8
participate in a retirement plan established by an employer who ceases 9
participating in the Kentucky Employees Retirement System pursuant to 10
KRS 61.522 whose employees participated in the health insurance plans 11
administered by the Personnel Cabinet prior to the employer's effective 12
cessation date in the Kentucky Employees Retirement System; 13
2. Any certified or classified employee of a local board of education or a 14
public charter school as defined in KRS 160.1590; 15
3. Any elected member of a local board of education; 16
4. Any person who is a present or future recipient of a retirement 17
allowance from the Kentucky Retirement Systems, County Employees 18
Retirement System, Kentucky Teachers' Retirement System, the 19
Legislators' Retirement Plan, the Judicial Retirement Plan, or the 20
Kentucky Community and Technical College System's optional 21
retirement plan authorized by KRS 161.567, except that a person who is 22
receiving a retirement allowance and who is age sixty-five (65) or older 23
shall not be included, with the exception of persons covered under KRS 24
61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 25
employed pursuant to subparagraph 1. of this paragraph; and 26
5. Any eligible dependents and beneficiaries of participating employees 27 UNOFFICIAL COPY 24 RS BR 1322
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and retirees who are entitled to participate in the state-sponsored health 1
insurance program; 2
(b) The term "health benefit plan" for the purposes of this section means a health 3
benefit plan as defined in KRS 304.17A-005; 4
(c) The term "insurer" for the purposes of this section means an insurer as defined 5
in KRS 304.17A-005; and 6
(d) The term "managed care plan" for the purposes of this section means a 7
managed care plan as defined in KRS 304.17A-500. 8
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 9
recommendation of the secretary of the Personnel Cabinet, shall procure, in 10
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 11
from one (1) or more insurers authorized to do business in this state, a group 12
health benefit plan that may include but not be limited to health maintenance 13
organization (HMO), preferred provider organization (PPO), point of service 14
(POS), and exclusive provider organization (EPO) benefit plans 15
encompassing all or any class or classes of employees. With the exception of 16
employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 17
all employers of any class of employees or former employees shall enter into 18
a contract with the Personnel Cabinet prior to including that group in the state 19
health insurance group. The contracts shall include but not be limited to 20
designating the entity responsible for filing any federal forms, adoption of 21
policies required for proper plan administration, acceptance of the contractual 22
provisions with health insurance carriers or third-party administrators, and 23
adoption of the payment and reimbursement methods necessary for efficient 24
administration of the health insurance program. Health insurance coverage 25
provided to state employees under this section shall, at a minimum, contain 26
the same benefits as provided under Kentucky Kare Standard as of January 1, 27 UNOFFICIAL COPY 24 RS BR 1322
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1994, and shall include a mail-order drug option as provided in subsection 1
(13) of this section. All employees and other persons for whom the health care 2
coverage is provided or made available shall annually be given an option to 3
elect health care coverage through a self-funded plan offered by the 4
Commonwealth or, if a self-funded plan is not available, from a list of 5
coverage options determined by the competitive bid process under the 6
provisions of KRS 45A.080, 45A.085, and 45A.090 and made available 7
during annual open enrollment. 8
(b) The policy or policies shall be approved by the commissioner of insurance 9
and may contain the provisions the commissioner of insurance approves, 10
whether or not otherwise permitted by the insurance laws. 11
(c) Any carrier bidding to offer health care coverage to employees shall agree to 12
provide coverage to all members of the state group, including active 13
employees and retirees and their eligible covered dependents and 14
beneficiaries, within the county or counties specified in its bid. Except as 15
provided in subsection (20) of this section, any carrier bidding to offer health 16
care coverage to employees shall also agree to rate all employees as a single 17
entity, except for those retirees whose former employers insure their active 18
employees outside the state-sponsored health insurance program and as 19
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 20
(d) Any carrier bidding to offer health care coverage to employees shall agree to 21
provide enrollment, claims, and utilization data to the Commonwealth in a 22
format specified by the Personnel Cabinet with the understanding that the data 23
shall be owned by the Commonwealth; to provide data in an electronic form 24
and within a time frame specified by the Personnel Cabinet; and to be subject 25
to penalties for noncompliance with data reporting requirements as specified 26
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 27 UNOFFICIAL COPY 24 RS BR 1322
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to protect the confidentiality of each individual employee; however, 1
confidentiality assertions shall not relieve a carrier from the requirement of 2
providing stipulated data to the Commonwealth. 3
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 4
for timely analysis of data received from carriers and, to the extent possible, 5
provide in the request-for-proposal specifics relating to data requirements, 6
electronic reporting, and penalties for noncompliance. The Commonwealth 7
shall own the enrollment, claims, and utilization data provided by each carrier 8
and shall develop methods to protect the confidentiality of the individual. The 9
Personnel Cabinet shall include in the October annual report submitted 10
pursuant to the provisions of KRS 18A.226 to the Governor, the General 11
Assembly, and the Chief Justice of the Supreme Court, an analysis of the 12
financial stability of the program, which shall include but not be limited to 13
loss ratios, methods of risk adjustment, measurements of carrier quality of 14
service, prescription coverage and cost management, and statutorily required 15
mandates. If state self-insurance was available as a carrier option, the report 16
also shall provide a detailed financial analysis of the self-insurance fund 17
including but not limited to loss ratios, reserves, and reinsurance agreements. 18
(f) If any agency participating in the state-sponsored employee health insurance 19
program for its active employees terminates participation and there is a state 20
appropriation for the employer's contribution for active employees' health 21
insurance coverage, then neither the agency nor the employees shall receive 22
the state-funded contribution after termination from the state-sponsored 23
employee health insurance program. 24
(g) Any funds in flexible spending accounts that remain after all reimbursements 25
have been processed shall be transferred to the credit of the state-sponsored 26
health insurance plan's appropriation account. 27 UNOFFICIAL COPY 24 RS BR 1322
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(h) Each entity participating in the state-sponsored health insurance program shall 1
provide an amount at least equal to the state contribution rate for the employer 2
portion of the health insurance premium. For any participating entity that used 3
the state payroll system, the employer contribution amount shall be equal to 4
but not greater than the state contribution rate. 5
(3) The premiums may be paid by the policyholder: 6
(a) Wholly from funds contributed by the employee, by payroll deduction or 7
otherwise; 8
(b) Wholly from funds contributed by any department, board, agency, public 9
postsecondary education institution, or branch of state, city, urban-county, 10
charter county, county, or consolidated local government; or 11
(c) Partly from each, except that any premium due for health care coverage or 12
dental coverage, if any, in excess of the premium amount contributed by any 13
department, board, agency, postsecondary education institution, or branch of 14
state, city, urban-county, charter county, county, or consolidated local 15
government for any other health care coverage shall be paid by the employee. 16
(4) If an employee moves his or her place of residence or employment out of the 17
service area of an insurer offering a managed health care plan, under which he or 18
she has elected coverage, into either the service area of another managed health care 19
plan or into an area of the Commonwealth not within a managed health care plan 20
service area, the employee shall be given an option, at the time of the move or 21
transfer, to change his or her coverage to another health benefit plan. 22
(5) No payment of premium by any department, board, agency, public postsecondary 23
educational institution, or branch of state, city, urban-county, charter county, 24
county, or consolidated local government shall constitute compensation to an 25
insured employee for the purposes of any statute fixing or limiting the 26
compensation of such an employee. Any premium or other expense incurred by any 27 UNOFFICIAL COPY 24 RS BR 1322
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department, board, agency, public postsecondary educational institution, or branch 1
of state, city, urban-county, charter county, county, or consolidated local 2
government shall be considered a proper cost of administration. 3
(6) The policy or policies may contain the provisions with respect to the class or classes 4
of employees covered, amounts of insurance or coverage for designated classes or 5
groups of employees, policy options, terms of eligibility, and continuation of 6
insurance or coverage after retirement. 7
(7) Group rates under this section shall be made available to the disabled child of an 8
employee regardless of the child's age if the entire premium for the disabled child's 9
coverage is paid by the state employee. A child shall be considered disabled if he or 10
she has been determined to be eligible for federal Social Security disability benefits. 11
(8) The health care contract or contracts for employees shall be entered into for a 12
period of not less than one (1) year. 13
(9) The secretary shall appoint thirty-two (32) persons to an Advisory Committee of 14
State Health Insurance Subscribers to advise the secretary or the secretary's 15
designee regarding the state-sponsored health insurance program for employees. 16
The secretary shall appoint, from a list of names submitted by appointing 17
authorities, members representing school districts from each of the seven (7) 18
Supreme Court districts, members representing state government from each of the 19
seven (7) Supreme Court districts, two (2) members representing retirees under age 20
sixty-five (65), one (1) member representing local health departments, two (2) 21
members representing the Kentucky Teachers' Retirement System, and three (3) 22
members at large. The secretary shall also appoint two (2) members from a list of 23
five (5) names submitted by the Kentucky Education Association, two (2) members 24
from a list of five (5) names submitted by the largest state employee organization of 25
nonschool state employees, two (2) members from a list of five (5) names submitted 26
by the Kentucky Association of Counties, two (2) members from a list of five (5) 27 UNOFFICIAL COPY 24 RS BR 1322
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names submitted by the Kentucky League of Cities, and two (2) members from a 1
list of names consisting of five (5) names submitted by each state employee 2
organization that has two thousand (2,000) or more members on state payroll 3
deduction. The advisory committee shall be appointed in January of each year and 4
shall meet quarterly. 5
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 6
provided to employees pursuant to this section shall not provide coverage for 7
obtaining or performing an abortion, nor shall any state funds be used for the 8
purpose of obtaining or performing an abortion on behalf of employees or their 9
dependents. 10
(11) Interruption of an established treatment regime with maintenance drugs shall be 11
grounds for an insured to appeal a formulary change through the established appeal 12
procedures approved by the Department of Insurance, if the physician supervising 13
the treatment certifies that the change is not in the best interests of the patient. 14
(12) Any employee who is eligible for and elects to participate in the state health 15
insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 16
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 17
state health insurance contribution toward health care coverage as a result of any 18
other employment for which there is a public employer contribution. This does not 19
preclude a retiree and an active employee spouse from using both contributions to 20
the extent needed for purchase of one (1) state sponsored health insurance policy 21
for that plan year. 22
(13) (a) The policies of health insurance coverage procured under subsection (2) of 23
this section shall include a mail-order drug option for maintenance drugs for 24
state employees. Maintenance drugs may be dispensed by mail order in 25
accordance with Kentucky law. 26
(b) A health insurer shall not discriminate against any retail pharmacy located 27 UNOFFICIAL COPY 24 RS BR 1322
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within the geographic coverage area of the health benefit plan and that meets 1
the terms and conditions for participation established by the insurer, including 2
price, dispensing fee, and copay requirements of a mail-order option. The 3
retail pharmacy shall not be required to dispense by mail. 4
(c) The mail-order option shall not permit the dispensing of a controlled 5
substance classified in Schedule II. 6
(14) The policy or policies provided to state employees or their dependents pursuant to 7
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 8
aid-related services for insured individuals under eighteen (18) years of age, subject 9
to a cap of one thousand four hundred dollars ($1,400) every thirty-six (36) months 10
pursuant to KRS 304.17A-132. 11
(15) Any policy provided to state employees or their dependents pursuant to this section 12
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 13
consistent with KRS 304.17A-142. 14
(16) Any policy provided to state employees or their dependents pursuant to this section 15
shall provide coverage for obtaining amino acid-based elemental formula pursuant 16
to KRS 304.17A-258. 17
(17) If a state employee's residence and place of employment are in the same county, 18
and if the hospital located within that county does not offer surgical services, 19
intensive care services, obstetrical services, level II neonatal services, diagnostic 20
cardiac catheterization services, and magnetic resonance imaging services, the 21
employee may select a plan available in a contiguous county that does provide 22
those services, and the state contribution for the plan shall be the amount available 23
in the county where the plan selected is located. 24
(18) If a state employee's residence and place of employment are each located in 25
counties in which the hospitals do not offer surgical services, intensive care 26
services, obstetrical services, level II neonatal services, diagnostic cardiac 27 UNOFFICIAL COPY 24 RS BR 1322
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catheterization services, and magnetic resonance imaging services, the employee 1
may select a plan available in a county contiguous to the county of residence that 2
does provide those services, and the state contribution for the plan shall be the 3
amount available in the county where the plan selected is located. 4
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 5
in the best interests of the state group to allow any carrier bidding to offer health 6
care coverage under this section to submit bids that may vary county by county or 7
by larger geographic areas. 8
(20) Notwithstanding any other provision of this section, the bid for proposals for health 9
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 10
the statewide rating structure provided in calendar year 2003 and a bid scenario that 11
allows for a regional rating structure that allows carriers to submit bids that may 12
vary by region for a given product offering as described in this subsection: 13
(a) The regional rating bid scenario shall not include a request for bid on a 14
statewide option; 15
(b) The Personnel Cabinet shall divide the state into geographical regions which 16
shall be the same as the partnership regions designated by the Department for 17
Medicaid Services for purposes of the Kentucky Health Care Partnership 18
Program established pursuant to 907 KAR 1:705; 19
(c) The request for proposal shall require a carrier's bid to include every county 20
within the region or regions for which the bid is submitted and include but not 21
be restricted to a preferred provider organization (PPO) option; 22
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 23
carrier all of the counties included in its bid within the region. If the Personnel 24
Cabinet deems the bids submitted in accordance with this subsection to be in 25
the best interests of state employees in a region, the cabinet may award the 26
contract for that region to no more than two (2) carriers; and 27 UNOFFICIAL COPY 24 RS BR 1322
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(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 1
other requirements or criteria in the request for proposal. 2
(21) Any fully insured health benefit plan or self-insured plan issued or renewed on or 3
after July 12, 2006, to public employees pursuant to this section which provides 4
coverage for services rendered by a physician or osteopath duly licensed under KRS 5
Chapter 311 that are within the scope of practice of an optometrist duly licensed 6
under the provisions of KRS Chapter 320 shall provide the same payment of 7
coverage to optometrists as allowed for those services rendered by physicians or 8
osteopaths. 9
(22) Any fully insured health benefit plan or self-insured plan issued or renewed to 10
public employees pursuant to this section shall comply with: 11
(a) KRS 304.12-237; 12
(b) KRS 304.17A-270 and 304.17A-525; 13
(c) KRS 304.17A-600 to 304.17A-633; 14
(d) KRS 205.593; 15
(e) KRS 304.17A-700 to 304.17A-730; 16
(f) KRS 304.14-135; 17
(g) KRS 304.17A-580 and 304.17A-641; 18
(h) KRS 304.99-123; 19
(i) KRS 304.17A-138; 20
(j) KRS 304.17A-148; 21
(k) KRS 304.17A-163 and 304.17A-1631; 22
(l) KRS 304.17A-265; 23
(m) KRS 304.17A-261; 24
(n) KRS 304.17A-262;[ and] 25
(o) Sections 2, 5, 6, and 7 of this Act; and 26
(p) Administrative regulations promulgated pursuant to statutes listed in this 27 UNOFFICIAL COPY 24 RS BR 1322
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subsection. 1
Section 14. The following KRS section is repealed: 2
304.17A-669 KRS 304.17A-660 to 304.17A-669 not to be construed as mandating 3
coverage for mental health conditions -- Exemption from KRS 304.17A-660 to 4
304.17A-669. 5
Section 15. Sections 2, 5, 6, and 7 of this Act apply to health plans issued or 6
renewed on or after January 1, 2026. 7
Section 16. If the state would, or would likely, be required to make payments to 8
defray the cost of any requirement of this Act, as provided under 42 U.S.C. sec. 9
18031(d)(3) and 45 C.F.R. sec. 155.170, as amended, then the Department of Insurance 10
shall, within 90 days of the effective date of this section, apply for a waiver under 42 11
U.S.C. sec. 18052, as amended, or any other applicable federal law of all or any of the 12
cost defrayal requirements. 13
Section 17. If the Cabinet for Health and Family Services determines that a 14
waiver or any other authorization from a federal agency is necessary to implement 15
Section 11 or 12 of this Act for any reason, including the loss of federal funds, the 16
cabinet shall, within 90 days after the effective date of this section, request the waiver or 17
authorization, and may only delay implementation of those provisions for which a waiver 18
or authorization was deemed necessary until the waiver or authorization is granted. 19
Section 18. Sections 1 to 15 of this Act take effect January 1, 2026. 20