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AN ACT relating to coverage for cancer detection. 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, "cancer screening, test, or procedure" means any 5
screening, test, or procedure performed for the purpose of detecting cancer, 6
including but not limited to lung, breast, cervical, prostate, and colorectal cancer, 7
that occurs prior to diagnosis. 8
(2) Except as provided in subsection (3) of this section: 9
(a) A health insurance policy, certificate, plan, or contract, including but not 10
limited to a health benefit plan, that provides medical or surgical benefits 11
with respect to cancer shall provide coverage for: 12
1. Any cancer screening, test, or procedure that is required under federal 13
law, including but not limited to 42 U.S.C. sec. 300gg-13, as amended; 14
and 15
2. Any other cancer screening, test, or procedure that is: 16
a. Consistent with nationally recognized clinical practice 17
guidelines; and 18
b. Ordered or prescribed by a health care provider legally 19
authorized to order or prescribe the cancer screening, test, or 20
procedure; and 21
(b) The coverage required under this subsection shall not be subject to: 22
1. Utilization management requirements, including prior authorization, 23
except for the purpose of determining that the cancer screening, test, 24
or procedure meets the requirements of paragraph (a)2.a. of this 25
subsection; or 26
2. Any deductible, coinsurance, copayment, or other cost-sharing 27 UNOFFICIAL COPY 24 RS BR 6
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requirement. 1
(3) (a) If the application of any requirement of subsection (2)(b)2. of this section 2
would be the sole cause of a health insurance policy's, certificate's, plan's, 3
or contract's failure to qualify as a Health Savings Account-qualified High 4
Deductible Health Plan under 26 U.S.C. sec. 223, as amended, then the 5
requirement shall not apply to that health insurance policy, certificate, plan, 6
or contract until the minimum deductible under 26 U.S.C. sec. 223, as 7
amended, is satisfied. 8
(b) If the application of any requirement of subsection (2) of this section to a 9
qualified health plan as defined in 42 U.S.C. sec. 18021(a)(1), as amended, 10
would result in a determination that the state must make payments to defray 11
the cost of the requirement under 42 U.S.C. sec. 18031(d)(3) and 45 C.F.R. 12
sec. 155.170, as amended, then the requirement shall not apply to the 13
qualified health plan until the cost defrayal requirement is no longer 14
applicable. 15
(4) (a) This section shall not be construed to limit coverage: 16
1. Provided under a health insurance policy, certificate, plan, or 17
contract; or 18
2. Required under any other law. 19
(b) In the case of a conflict between this section and any other law, this section 20
shall control unless application of this section would result in a reduction of 21
coverage or benefits for any insured. 22
Section 2. KRS 304.17C-125 (Effective January 1, 2025) is amended to read as 23
follows: 24
The following[KRS 304.17A-262] shall apply to limited health service benefit plans, 25
including any limited health service contract, as defined in KRS 304.38A-010: 26
(1) KRS 304.17A-262; and 27 UNOFFICIAL COPY 24 RS BR 6
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(2) Section 1 of this Act. 1
Section 3. KRS 205.522 (Effective January 1, 2024) is amended to read as 2
follows: 3
(1) With respect to the administration and provision of Medicaid benefits pursuant to 4
this chapter, the Department for Medicaid Services,[ and] any managed care 5
organization contracted to provide Medicaid benefits pursuant to this chapter, and 6
the state's medical assistance program shall be subject to, and comply with, the 7
following, as applicable:[provisions of ] 8
(a) KRS 304.17A-163;[, ] 9
(b) KRS 304.17A-1631;[, ] 10
(c) KRS 304.17A-167;[, ] 11
(d) KRS 304.17A-235;[, ] 12
(e) KRS 304.17A-257;[, ] 13
(f) KRS 304.17A-259;[, ] 14
(g) KRS 304.17A-263;[, ] 15
(h) KRS 304.17A-515;[, ] 16
(i) KRS 304.17A-580;[, ] 17
(j) KRS 304.17A-600, 304.17A-603, and 304.17A-607;[, and ] 18
(k) KRS 304.17A-740 to 304.17A-743; and[, as applicable] 19
(l) Section 1 of this Act. 20
(2) A managed care organization contracted to provide Medicaid benefits pursuant to 21
this chapter shall comply with the reporting requirements of KRS 304.17A-732. 22
Section 4. KRS 164.2871 (Effective January 1, 2025) is amended to read as 23
follows: 24
(1) The governing board of each state postsecondary educational institution is 25
authorized to purchase liability insurance for the protection of the individual 26
members of the governing board, faculty, and staff of such institutions from liability 27 UNOFFICIAL COPY 24 RS BR 6
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for acts and omissions committed in the course and scope of the individual's 1
employment or service. Each institution may purchase the type and amount of 2
liability coverage deemed to best serve the interest of such institution. 3
(2) All retirement annuity allowances accrued or accruing to any employee of a state 4
postsecondary educational institution through a retirement program sponsored by 5
the state postsecondary educational institution are hereby exempt from any state, 6
county, or municipal tax, and shall not be subject to execution, attachment, 7
garnishment, or any other process whatsoever, nor shall any assignment thereof be 8
enforceable in any court. Except retirement benefits accrued or accruing to any 9
employee of a state postsecondary educational institution through a retirement 10
program sponsored by the state postsecondary educational institution on or after 11
January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 12
provided in KRS 141.010 and 141.0215. 13
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 14
members of governing boards, faculty and staff of institutions of higher education 15
in this state shall not be construed to be a waiver of sovereign immunity or any 16
other immunity or privilege. 17
(4) The governing board of each state postsecondary education institution is authorized 18
to provide a self-insured employer group health plan to its employees, which plan 19
shall: 20
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 21
(b) Except as provided in subsection (5) of this section, be exempt from 22
conformity with Subtitle 17A of KRS Chapter 304. 23
(5) A self-insured employer group health plan provided by the governing board of a 24
state postsecondary education institution to its employees shall comply with: 25
(a) KRS 304.17A-163 and 304.17A-1631; 26
(b) KRS 304.17A-265; 27 UNOFFICIAL COPY 24 RS BR 6
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(c) KRS 304.17A-261;[ and] 1
(d) KRS 304.17A-262; and 2
(e) Section 1 of this Act. 3
Section 5. KRS 18A.225 (Effective January 1, 2025) is amended to read as 4
follows: 5
(1) (a) The term "employee" for purposes of this section means: 6
1. Any person, including an elected public official, who is regularly 7
employed by any department, office, board, agency, or branch of state 8
government; or by a public postsecondary educational institution; or by 9
any city, urban-county, charter county, county, or consolidated local 10
government, whose legislative body has opted to participate in the state-11
sponsored health insurance program pursuant to KRS 79.080; and who 12
is either a contributing member to any one (1) of the retirement systems 13
administered by the state, including but not limited to the Kentucky 14
Retirement Systems, County Employees Retirement System, Kentucky 15
Teachers' Retirement System, the Legislators' Retirement Plan, or the 16
Judicial Retirement Plan; or is receiving a contractual contribution from 17
the state toward a retirement plan; or, in the case of a public 18
postsecondary education institution, is an individual participating in an 19
optional retirement plan authorized by KRS 161.567; or is eligible to 20
participate in a retirement plan established by an employer who ceases 21
participating in the Kentucky Employees Retirement System pursuant to 22
KRS 61.522 whose employees participated in the health insurance plans 23
administered by the Personnel Cabinet prior to the employer's effective 24
cessation date in the Kentucky Employees Retirement System; 25
2. Any certified or classified employee of a local board of education or a 26
public charter school as defined in KRS 160.1590; 27 UNOFFICIAL COPY 24 RS BR 6
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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(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 10
employed pursuant to 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 27 UNOFFICIAL COPY 24 RS BR 6
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encompassing all or any class or classes of employees. With the exception of 1
employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 2
all employers of any class of employees or former employees shall enter into 3
a 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 21
and may contain the provisions the commissioner of insurance approves, 22
whether 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 24 RS BR 6
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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 and as 4
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 5
(d) Any carrier bidding to offer health care coverage to employees shall agree to 6
provide enrollment, claims, and utilization data to the Commonwealth in a 7
format specified by the Personnel Cabinet with the understanding that the data 8
shall be owned by the Commonwealth; to provide data in an electronic form 9
and within a time frame specified by the Personnel Cabinet; and to be subject 10
to penalties for noncompliance with data reporting requirements as specified 11
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 12
to protect the confidentiality of each individual employee; however, 13
confidentiality assertions shall not relieve a carrier from the requirement of 14
providing stipulated data to the Commonwealth. 15
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 16
for timely analysis of data received from carriers and, to the extent possible, 17
provide in the request-for-proposal specifics relating to data requirements, 18
electronic reporting, and penalties for noncompliance. The Commonwealth 19
shall own the enrollment, claims, and utilization data provided by each carrier 20
and shall develop methods to protect the confidentiality of the individual. The 21
Personnel Cabinet shall include in the October annual report submitted 22
pursuant to the provisions of KRS 18A.226 to the Governor, the General 23
Assembly, and the Chief Justice of the Supreme Court, an analysis of the 24
financial stability of the program, which shall include but not be limited to 25
loss ratios, methods of risk adjustment, measurements of carrier quality of 26
service, prescription coverage and cost management, and statutorily required 27 UNOFFICIAL COPY 24 RS BR 6
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mandates. If state self-insurance was available as a carrier option, the report 1
also shall provide a detailed financial analysis of the self-insurance fund 2
including but not limited to loss ratios, reserves, and reinsurance agreements. 3
(f) If any agency participating in the state-sponsored employee health insurance 4
program for its active employees terminates participation and there is a state 5
appropriation for the employer's contribution for active employees' health 6
insurance coverage, then neither the agency nor the employees shall receive 7
the state-funded contribution after termination from the state-sponsored 8
employee health insurance program. 9
(g) Any funds in flexible spending accounts that remain after all reimbursements 10
have been processed shall be transferred to the credit of the state-sponsored 11
health insurance plan's appropriation account. 12
(h) Each entity participating in the state-sponsored health insurance program shall 13
provide an amount at least equal to the state contribution rate for the employer 14
portion of the health insurance premium. For any participating entity that used 15
the state payroll system, the employer contribution amount shall be equal to 16
but not greater than the state contribution rate. 17
(3) The premiums may be paid by the policyholder: 18
(a) Wholly from funds contributed by the employee, by payroll deduction or 19
otherwise; 20
(b) Wholly from funds contributed by any department, board, agency, public 21
postsecondary education institution, or branch of state, city, urban-county, 22
charter county, county, or consolidated local government; or 23
(c) Partly from each, except that any premium due for health care coverage or 24
dental coverage, if any, in excess of the premium amount contributed by any 25
department, board, agency, postsecondary education institution, or branch of 26
state, city, urban-county, charter county, county, or consolidated local 27 UNOFFICIAL COPY 24 RS BR 6
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government for any other health care coverage shall be paid by the employee. 1
(4) If an employee moves his or her place of residence or employment out of the 2
service area of an insurer offering a managed health care plan, under which he or 3
she has elected coverage, into either the service area of another managed health care 4
plan or into an area of the Commonwealth not within a managed health care plan 5
service area, the employee shall be given an option, at the time of the move or 6
transfer, to change his or her coverage to another health benefit plan. 7
(5) No payment of premium by any department, board, agency, public postsecondary 8
educational institution, or branch of state, city, urban-county, charter county, 9
county, or consolidated local government shall constitute compensation to an 10
insured employee for the purposes of any statute fixing or limiting the 11
compensation of such an employee. Any premium or other expense incurred by any 12
department, board, agency, public postsecondary educational institution, or branch 13
of state, city, urban-county, charter county, county, or consolidated local 14
government shall be considered a proper cost of administration. 15
(6) The policy or policies may contain the provisions with respect to the class or classes 16
of employees covered, amounts of insurance or coverage for designated classes or 17
groups of employees, policy options, terms of eligibility, and continuation of 18
insurance or coverage after retirement. 19
(7) Group rates under this section shall be made available to the disabled child of an 20
employee regardless of the child's age if the entire premium for the disabled child's 21
coverage is paid by the state employee. A child shall be considered disabled if he or 22
she has been determined to be eligible for federal Social Security disability benefits. 23
(8) The health care contract or contracts for employees shall be entered into for a 24
period of not less than one (1) year. 25
(9) The secretary shall appoint thirty-two (32) persons to an Advisory Committee of 26
State Health Insurance Subscribers to advise the secretary or the secretary's 27 UNOFFICIAL COPY 24 RS BR 6
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designee regarding the state-sponsored health insurance program for employees. 1
The secretary shall appoint, from a list of names submitted by appointing 2
authorities, members representing school districts from each of the seven (7) 3
Supreme Court districts, members representing state government from each of the 4
seven (7) Supreme Court districts, two (2) members representing retirees under age 5
sixty-five (65), one (1) member representing local health departments, two (2) 6
members representing the Kentucky Teachers' Retirement System, and three (3) 7
members at large. The secretary shall also appoint two (2) members from a list of 8
five (5) names submitted by the Kentucky Education Association, two (2) members 9
from a list of five (5) names submitted by the largest state employee organization of 10
nonschool state employees, two (2) members from a list of five (5) names submitted 11
by the Kentucky Association of Counties, two (2) members from a list of five (5) 12
names submitted by the Kentucky League of Cities, and two (2) members from a 13
list of names consisting of five (5) names submitted by each state employee 14
organization that has two thousand (2,000) or more members on state payroll 15
deduction. The advisory committee shall be appointed in January of each year and 16
shall meet quarterly. 17
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 18
provided to employees pursuant to this section shall not provide coverage for 19
obtaining or performing an abortion, nor shall any state funds be used for the 20
purpose of obtaining or performing an abortion on behalf of employees or their 21
dependents. 22
(11) Interruption of an established treatment regime with maintenance drugs shall be 23
grounds for an insured to appeal a formulary change through the established appeal 24
procedures approved by the Department of Insurance, if the physician supervising 25
the treatment certifies that the change is not in the best interests of the patient. 26
(12) Any employee who is eligible for and elects to participate in the state health 27 UNOFFICIAL COPY 24 RS BR 6
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insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 1
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 2
state health insurance contribution toward health care coverage as a result of any 3
other employment for which there is a public employer contribution. This does not 4
preclude a retiree and an active employee spouse from using both contributions to 5
the extent needed for purchase of one (1) state sponsored health insurance policy 6
for that plan year. 7
(13) (a) The policies of health insurance coverage procured under subsection (2) of 8
this section shall include a mail-order drug option for maintenance drugs for 9
state employees. Maintenance drugs may be dispensed by mail order in 10
accordance with Kentucky law. 11
(b) A health insurer shall not discriminate against any retail pharmacy located 12
within the geographic coverage area of the health benefit plan and that meets 13
the terms and conditions for participation established by the insurer, including 14
price, dispensing fee, and copay requirements of a mail-order option. The 15
retail pharmacy shall not be required to dispense by mail. 16
(c) The mail-order option shall not permit the dispensing of a controlled 17
substance classified in Schedule II. 18
(14) The policy or policies provided to state employees or their dependents pursuant to 19
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 20
aid-related services for insured individuals under eighteen (18) years of age, subject 21
to a cap of one thousand four hundred dollars ($1,400) every thirty-six (36) months 22
pursuant to KRS 304.17A-132. 23
(15) Any policy provided to state employees or their dependents pursuant to this section 24
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 25
consistent with KRS 304.17A-142. 26
(16) Any policy provided to state employees or their dependents pursuant to this section 27 UNOFFICIAL COPY 24 RS BR 6
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shall provide coverage for obtaining amino acid-based elemental formula pursuant 1
to KRS 304.17A-258. 2
(17) If a state employee's residence and place of employment are in the same county, 3
and if the hospital located within that county does not offer surgical services, 4
intensive care services, obstetrical services, level II neonatal services, diagnostic 5
cardiac catheterization services, and magnetic resonance imaging services, the 6
employee may select a plan available in a contiguous county that does provide 7
those services, and the state contribution for the plan shall be the amount available 8
in the county where the plan selected is located. 9
(18) If a state employee's residence and place of employment are each located in 10
counties in which the hospitals do not offer surgical services, intensive care 11
services, obstetrical services, level II neonatal services, diagnostic cardiac 12
catheterization services, and magnetic resonance imaging services, the employee 13
may select a plan available in a county contiguous to the county of residence that 14
does provide those services, and the state contribution for the plan shall be the 15
amount available in the county where the plan selected is located. 16
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 17
in the best interests of the state group to allow any carrier bidding to offer health 18
care coverage under this section to submit bids that may vary county by county or 19
by larger geographic areas. 20
(20) Notwithstanding any other provision of this section, the bid for proposals for health 21
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 22
the statewide rating structure provided in calendar year 2003 and a bid scenario that 23
allows for a regional rating structure that allows carriers to submit bids that may 24
vary by region for a given product offering as described in this subsection: 25
(a) The regional rating bid scenario shall not include a request for bid on a 26
statewide option; 27 UNOFFICIAL COPY 24 RS BR 6
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(b) The Personnel Cabinet shall divide the state into geographical regions which 1
shall be the same as the partnership regions designated by the Department for 2
Medicaid Services for purposes of the Kentucky Health Care Partnership 3
Program established pursuant to 907 KAR 1:705; 4
(c) The request for proposal shall require a carrier's bid to include every county 5
within the region or regions for which the bid is submitted and include but not 6
be restricted to a preferred provider organization (PPO) option; 7
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 8
carrier all of the counties included in its bid within the region. If the Personnel 9
Cabinet deems the bids submitted in accordance with this subsection to be in 10
the best interests of state employees in a region, the cabinet may award the 11
contract for that region to no more than two (2) carriers; and 12
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 13
other requirements or criteria in the request for proposal. 14
(21) Any fully insured health benefit plan or self-insured plan issued or renewed on or 15
after July 12, 2006, to public employees pursuant to this section which provides 16
coverage for services rendered by a physician or osteopath duly licensed under KRS 17
Chapter 311 that are within the scope of practice of an optometrist duly licensed 18
under the provisions of KRS Chapter 320 shall provide the same payment of 19
coverage to optometrists as allowed for those services rendered by physicians or 20
osteopaths. 21
(22) Any fully insured health benefit plan or self-insured plan issued or renewed to 22
public employees pursuant to this section shall comply with: 23
(a) KRS 304.12-237; 24
(b) KRS 304.17A-270 and 304.17A-525; 25
(c) KRS 304.17A-600 to 304.17A-633; 26
(d) KRS 205.593; 27 UNOFFICIAL COPY 24 RS BR 6
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(e) KRS 304.17A-700 to 304.17A-730; 1
(f) KRS 304.14-135; 2
(g) KRS 304.17A-580 and 304.17A-641; 3
(h) KRS 304.99-123; 4
(i) KRS 304.17A-138; 5
(j) KRS 304.17A-148; 6
(k) KRS 304.17A-163 and 304.17A-1631; 7
(l) KRS 304.17A-265; 8
(m) KRS 304.17A-261; 9
(n) KRS 304.17A-262;[ and] 10
(o) Section 1 of this Act; and 11
(p) Administrative regulations promulgated pursuant to statutes listed in this 12
subsection. 13
Section 6. Sections 1, 2, 4, and 5 of this Act apply to policies, certificates, 14
plans, or contracts issued or renewed on or after January 1, 2025. 15
Section 7. (1) For purposes of 45 C.F.R. sec. 156.115, the benefits required 16
under subsection (2)(a)1. of Section 1 of this Act are intended to be, and shall be 17
considered, substantially equal to the benefits required under the state's EHB-benchmark 18
plan. 19
(2) For purposes of 45 C.F.R. sec. 155.170, the benefits required under subsection 20
(2)(a)1. of Section 1 of this Act are intended to be, and shall be considered by the state as, 21
"a benefit required by State action . . . for purposes of compliance with Federal 22
requirements," and thus, the state shall not consider or identify the benefits required 23
under subsection (2)(a)1. of Section 1 of this Act as being in addition to the essential 24
health benefits required under federal law. 25
(3) The "Federal requirements" referred to in subsection (2) of this section 26
include the requirement to provide coverage for preventive health services under 42 27 UNOFFICIAL COPY 24 RS BR 6
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U.S.C. sec. 300gg-13. 1
(4) The commissioner of insurance and any other state official or state agency 2
shall: 3
(a) Comply with the requirements of this section; and 4
(b) Not take any action that is in violation of or in conflict with this section. 5
Section 8. Notwithstanding KRS 194A.099: 6
(1) Within 90 days of the effective date of this section and subject to Section 7 of 7
this Act, the Department of Insurance shall identify, in accordance with 45 C.F.R. sec. 8
155.170(a)(3), whether the application of any requirement of subsection (2) of Section 1 9
of this Act to a qualified health plan (QHP) is in addition to the essential health benefits 10
required under federal law. 11
(2) If it is determined that the application of any requirement of subsection (2) of 12
Section 1 of this Act to a QHP is in addition to the essential health benefits required 13
under federal law, then the department shall, within 180 days of the effective date of this 14
section, apply for a waiver under 42 U.S.C. sec. 18052, as amended, or any other 15
applicable federal law of all or any of the cost defrayal requirements under 42 U.S.C. sec. 16
18031(d)(3) and 45 C.F.R. sec. 155.170, as amended. 17
(3) The application required under subsection (2) of this section: 18
(a) Shall comply with the requirements of federal law for obtaining a waiver; and 19
(b) May propose changes to the state's EHB-benchmark plan, as defined in 45 20
C.F.R. sec. 156.20, that are not in conflict with existing state law. 21
Section 9. If the Cabinet for Health and Family Services determines that a 22
waiver or other authorization from a federal agency is necessary to implement Section 3 23
of this Act for any reason, including the loss of federal funds, the cabinet shall, within 90 24
days of the effective date of this section, request the waiver or authorization, and may 25
only delay implementation of those provisions for which a waiver or authorization was 26
deemed necessary until the waiver or authorization is granted. 27 UNOFFICIAL COPY 24 RS BR 6
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Section 10. Sections 1 to 6 of this Act take effect January 1, 2025. 1