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AN ACT relating to contraceptives. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
SECTION 1. A NEW SECTION OF KRS CHAPTER 211 IS CREATED TO 3
READ AS FOLLOWS: 4
(1) As used in this section: 5
(a) "Contraception" means an action taken to prevent pregnancy, including 6
the use of contraceptives or fertility-awareness based methods and 7
sterilization procedures; and 8
(b) "Contraceptive" means any drug, device, or biological product intended for 9
use in the prevention of pregnancy, whether specifically intended to prevent 10
pregnancy or for other health needs, that is legally marketed under the 11
Federal Food, Drug, and Cosmetic Act, such as oral contraceptives, long-12
acting reversible contraceptives, emergency contraceptives, internal and 13
external condoms, injectables, vaginal barrier methods, transdermal 14
patches, and vaginal rings, or other contraceptives. 15
(2) Notwithstanding any other provision of law to the contrary, a person has a 16
statutory right to obtain contraceptives and to engage in contraception, and a 17
health care provider practicing in any place in the Commonwealth, including 18
institutions of higher education, has a corresponding right to provide 19
contraceptives, contraception, referrals, services, and information related to 20
contraception. 21
(3) The statutory rights specified in subsection (2) of this section shall not be limited 22
or otherwise infringed upon through any limitation or requirement that: 23
(a) Expressly, effectively, implicitly, or as implemented singles out: 24
1. The provision or sale of contraceptives, contraception, or information 25
related to contraception; 26
2. Health care providers who provide or dispense contraceptives, 27 UNOFFICIAL COPY 24 RS BR 478
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contraception, or information related to contraception; or 1
3. Facilities in which contraceptives, contraception, or information 2
related to contraception is provided or dispensed; or 3
(b) Impedes or prohibits the sale or access to contraceptives, contraception, or 4
information related to contraception. 5
(4) To defend against a claim that a limitation or requirement violates a health care 6
provider's or patient's rights under subsection (2) of this section, a party must 7
establish by clear and convincing evidence that: 8
(a) The limitation or requirement significantly advances access to 9
contraceptives, contraception, and information related to contraception; 10
and 11
(b) Access to contraceptives, contraception, and information related to 12
contraception or the health of patients cannot be advanced by a less 13
restrictive alternative measure or action. 14
(5) The Commonwealth or its localities shall not administer, implement, or enforce 15
any law, administrative regulation, or other provision having the force and effect 16
of law that conflicts with any provision of this section, notwithstanding any 17
provision of federal law, including the Religious Freedom Restoration Act of 18
1993, including: 19
(a) Prohibiting or restricting the sale, provision, or use of any contraceptives; 20
(b) Prohibiting or restricting any individual from aiding another individual in 21
voluntarily obtaining or using any contraceptives or contraception; or 22
(c) Exempting any contraceptives or contraception from any other generally 23
applicable law in a way that would make it more difficult to sell, provide, 24
obtain, or use such contraceptives or contraception, including over-the-25
counter sales. 26
(6) The Attorney General may commence a civil action on behalf of the 27 UNOFFICIAL COPY 24 RS BR 478
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Commonwealth against any locality that implements or enforces any limitation or 1
requirement that violates this section, or against any person who implements or 2
enforces any limitation or requirement that violates this section. The court shall 3
hold unlawful and set aside the limitation or requirement if it is in violation of 4
this section. 5
(7) The following private rights of action shall be available under this section: 6
(a) Any individual or entity, including any health care provider or patient, 7
adversely affected by an alleged violation of this section may commence a 8
civil action against the Commonwealth or any locality that implements or 9
enforces any limitation or requirement that violates this section or against 10
any person who implements or enforces any limitation or requirement that 11
violates this section; and 12
(b) A health care provider may commence an action for relief on its own 13
behalf, on behalf of the provider's staff, and on behalf of the provider's 14
patients who are or may be adversely affected by an alleged violation of this 15
section. 16
(8) In any action under this section, the court may award appropriate equitable 17
relief, including temporary, preliminary, or permanent injunctive relief. 18
(9) In any action under this section, the court shall award costs of litigation, as well 19
as reasonable attorney fees, to any prevailing plaintiff. A plaintiff shall not be 20
liable to a defendant for costs or attorney's fees in any nonfrivolous action under 21
this section. 22
(10) An action under this section shall be filed in Circuit Court. The Circuit Court 23
shall exercise jurisdiction without regard to whether the aggrieved party has 24
exhausted any administrative or other remedies that may be provided for by law. 25
(11) A locality that enforces or maintains any limitation or requirement that violates 26
this section, or a government official, including any person who is permitted to 27 UNOFFICIAL COPY 24 RS BR 478
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implement or enforce any limitation or requirement that violates this section, 1
shall not be immune from an action challenging that limitation or requirement. 2
SECTION 2. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 3
IS CREATED TO READ AS FOLLOWS: 4
(1) As used in this section: 5
(a) "FDA" means the United States Food and Drug Administration; 6
(b) "Health benefit plan" has the same meaning as in KRS 304.17A-005, 7
except for purposes of this section, the term shall include student health 8
insurance offered by a Kentucky-licensed insurer under written contract 9
with a university or college whose students it proposes to insure; 10
(c) "Long-acting reversible contraception": 11
1. Means a contraception method that requires administration less than 12
once per month; and 13
2. Shall include: 14
a. An intrauterine device; and 15
b. A contraceptive implant; and 16
(d) "Religious employer" means an organization that is: 17
1. Organized and operates as a nonprofit entity; and 18
2. Referred to in 26 U.S.C. sec. 6033(a)(3)(A)(i) or (iii), as amended. 19
(2) Except as otherwise provided in subsection (3) or (5) of this section, a health 20
benefit plan shall provide coverage for the following: 21
(a) All FDA-approved contraceptive drugs, devices, and products, including: 22
1. Those prescribed: 23
a. By a covered person's provider; or 24
b. As otherwise authorized under state and federal law; 25
2. Over-the-counter contraceptive drugs, devices, and products; and 26
3. Those dispensed on-site at a provider's office, if available; 27 UNOFFICIAL COPY 24 RS BR 478
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(b) Voluntary sterilization procedures; 1
(c) Patient education and counseling on contraception; and 2
(d) Follow-up services related to drugs, devices, products, and procedures 3
covered under this section, including but not limited to: 4
1. Management of side effects; 5
2. Counseling for continued adherence; and 6
3. Device insertion and removal. 7
(3) For the coverage required under subsection (2)(a) of this section, the health 8
benefit plan shall: 9
(a) If the FDA has designated a therapeutic equivalent of an FDA-approved 10
prescription contraceptive drug, device, or product, cover either: 11
1. The original FDA-approved prescription contraceptive drug, device, or 12
product; or 13
2. At least one (1) therapeutic equivalent of the original FDA-approved 14
prescription contraceptive drug, device, or product; 15
(b) If a contraceptive drug, device, or product is deemed medically inadvisable 16
by the covered person's provider, defer to the determination and judgment 17
of the provider and provide coverage for an alternate prescribed FDA-18
approved contraceptive drug, device, or product; 19
(c) Provide coverage for the supply of contraceptives intended to last over a 20
twelve (12) month duration, which, at the discretion of the provider, may be 21
furnished or dispensed all at once or over the course of twelve (12) months; 22
(d) Reimburse a provider or dispensing entity per unit for furnishing or 23
dispensing an extended supply of contraceptives; 24
(e) Not deny the coverage required under this section because a covered person 25
changed contraceptive methods within a twelve (12) month period; and 26
(f) Not require a prescription to trigger the coverage of FDA-approved over-27 UNOFFICIAL COPY 24 RS BR 478
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the-counter contraceptive drugs, devices, and products. 1
(4) A health benefit plan subject to the coverage requirements of this section: 2
(a) Shall not impose a deductible, coinsurance, copayment, or any other cost-3
sharing requirement on the coverage, unless the health benefit plan is 4
offered as a qualifying high deductible health plan for a health savings 5
account, in which case the plan shall establish cost-sharing only at the 6
minimum level necessary to preserve the covered person's ability to claim 7
tax-exempt contributions and withdrawals from the person's health savings 8
account under 26 U.S.C. sec. 223, as amended; 9
(b) Except as otherwise authorized under this section, shall not impose any 10
restrictions or delays on the coverage; and 11
(c) Shall provide the same level of benefits to a covered person's covered 12
dependents as the plan provides to the covered person. 13
(5) (a) A religious employer may request a health benefit plan without coverage for 14
any FDA-approved drugs, devices, products, procedures, and services used 15
for contraceptive purposes that are contrary to the religious employer's 16
religious tenets. 17
(b) A religious employer that makes a request under paragraph (a) of this 18
subsection shall: 19
1. Be provided a health benefit plan without the contraceptive coverage; 20
and 21
2. Provide written notice to each prospective covered person, prior to the 22
covered person's enrollment in the health benefit plan, listing the 23
contraceptive drugs, devices, products, procedures, and services the 24
employer refused to cover for religious reasons. 25
(6) Nothing in this section shall be construed to: 26
(a) Exclude coverage for contraceptive drugs, devices, and products prescribed 27 UNOFFICIAL COPY 24 RS BR 478
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by a provider, acting within the provider's scope of practice, for reasons 1
other than contraceptive purposes, including but not limited to: 2
1. Decreasing the risk of ovarian cancer; 3
2. Eliminating symptoms of menopause; or 4
3. Contraception that is necessary to preserve the life of the covered 5
person; or 6
(b) Require a health benefit plan to cover experimental or investigational 7
treatments. 8
(7) A health benefit plan shall provide coverage for long-acting reversible 9
contraception administered during a postpartum hospital stay. 10
Section 3. KRS 164.2871 (Effective January 1, 2025) is amended to read as 11
follows: 12
(1) The governing board of each state postsecondary educational institution is 13
authorized to purchase liability insurance for the protection of the individual 14
members of the governing board, faculty, and staff of such institutions from liability 15
for acts and omissions committed in the course and scope of the individual's 16
employment or service. Each institution may purchase the type and amount of 17
liability coverage deemed to best serve the interest of such institution. 18
(2) All retirement annuity allowances accrued or accruing to any employee of a state 19
postsecondary educational institution through a retirement program sponsored by 20
the state postsecondary educational institution are hereby exempt from any state, 21
county, or municipal tax, and shall not be subject to execution, attachment, 22
garnishment, or any other process whatsoever, nor shall any assignment thereof be 23
enforceable in any court. Except retirement benefits accrued or accruing to any 24
employee of a state postsecondary educational institution through a retirement 25
program sponsored by the state postsecondary educational institution on or after 26
January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 27 UNOFFICIAL COPY 24 RS BR 478
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provided in KRS 141.010 and 141.0215. 1
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 2
members of governing boards, faculty and staff of institutions of higher education 3
in this state shall not be construed to be a waiver of sovereign immunity or any 4
other immunity or privilege. 5
(4) The governing board of each state postsecondary education institution is authorized 6
to provide a self-insured employer group health plan to its employees, which plan 7
shall: 8
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 9
(b) Except as provided in subsection (5) of this section, be exempt from 10
conformity with Subtitle 17A of KRS Chapter 304. 11
(5) A self-insured employer group health plan provided by the governing board of a 12
state postsecondary education institution to its employees shall comply with: 13
(a) KRS 304.17A-163 and 304.17A-1631; 14
(b) KRS 304.17A-265; 15
(c) KRS 304.17A-261; [and] 16
(d) KRS 304.17A-262; 17
(e) Section 2 of this Act; and 18
(f) Section 8 of this Act. 19
Section 4. KRS 205.522 is amended to read as follows: 20
(1) The Department for Medicaid Services and any managed care organization 21
contracted to provide Medicaid benefits pursuant to this chapter shall comply with 22
the provisions of Sections 2 and 8 of this Act, KRS 304.17A-163, 304.17A-1631, 23
304.17A-167, 304.17A-235, 304.17A-257, 304.17A-259, 304.17A-263, 304.17A-24
515, 304.17A-580, 304.17A-600, 304.17A-603, 304.17A-607, and 304.17A-740 to 25
304.17A-743, as applicable. 26
(2) A managed care organization contracted to provide Medicaid benefits pursuant to 27 UNOFFICIAL COPY 24 RS BR 478
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this chapter shall comply with the reporting requirements of KRS 304.17A-732. 1
Section 5. KRS 205.6485 is amended to read as follows: 2
(1) The Cabinet for Health and Family Services shall prepare a state child health plan 3
meeting the requirements of Title XXI of the Federal Social Security Act, for 4
submission to the Secretary of the United States Department of Health and Human 5
Services within such time as will permit the state to receive the maximum amounts 6
of federal matching funds available under Title XXI. The cabinet shall, by 7
administrative regulation promulgated in accordance with KRS Chapter 13A, 8
establish the following: 9
(a) The eligibility criteria for children covered by the Kentucky Children's Health 10
Insurance Program. However, no person eligible for services under Title XIX 11
of the Social Security Act 42 U.S.C. secs. 1396 to 1396v, as amended, shall 12
be eligible for services under the Kentucky Children's Health Insurance 13
Program except to the extent that Title XIX coverage is expanded by KRS 14
205.6481 to 205.6495 and KRS 304.17A-340; 15
(b) The schedule of benefits to be covered by the Kentucky Children's Health 16
Insurance Program, which shall include preventive services, vision services 17
including glasses, and dental services including at least sealants, extractions, 18
and fillings, and which shall be at least equivalent to one (1) of the following: 19
1. The standard Blue Cross/Blue Shield preferred provider option under 20
the Federal Employees Health Benefit Plan established by U.S.C. sec. 21
8903(1); 22
2. A mid-range health benefit coverage plan that is offered and generally 23
available to state employees; or 24
3. Health insurance coverage offered by a health maintenance organization 25
that has the largest insured commercial, non-Medicaid enrollment of 26
covered lives in the state; 27 UNOFFICIAL COPY 24 RS BR 478
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(c) The premium contribution per family of health insurance coverage available 1
under the Kentucky Children's Health Insurance Program with provisions for 2
the payment of premium contributions by families of children eligible for 3
coverage by the program based upon a sliding scale relating to family income. 4
Premium contributions shall be based on a six (6) month period not to exceed: 5
1. Ten dollars ($10), to be paid by a family with income between one 6
hundred percent (100%) to one hundred thirty-three percent (133%) of 7
the federal poverty level; 8
2. Twenty dollars ($20), to be paid by a family with income between one 9
hundred thirty-four percent (134%) to one hundred forty-nine percent 10
(149%) of the federal poverty level; and 11
3. One hundred twenty dollars ($120), to be paid by a family with income 12
between one hundred fifty percent (150%) to two hundred percent 13
(200%) of the federal poverty level, and which may be made on a partial 14
payment plan of twenty dollars ($20) per month or sixty dollars ($60) 15
per quarter; 16
(d) There shall be no copayments for services provided under the Kentucky 17
Children's Health Insurance Program; and 18
(e) The criteria for health services providers and insurers wishing to contract with 19
the Commonwealth to provide the children's health insurance coverage. 20
However, the cabinet shall provide, in any contracting process for the 21
preventive health insurance program, the opportunity for a public health 22
department to bid on preventive health services to eligible children within the 23
public health department's service area. A public health department shall not 24
be disqualified from bidding because the department does not currently offer 25
all the services required by paragraph (b) of this subsection. The criteria shall 26
be set forth in administrative regulations under KRS Chapter 13A and shall 27 UNOFFICIAL COPY 24 RS BR 478
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maximize competition among the providers and insurers. The Cabinet for 1
Finance and Administration shall provide oversight over contracting policies 2
and procedures to assure that the number of applicants for contracts is 3
maximized. 4
(2) Within twelve (12) months of federal approval of the state's Title XXI child health 5
plan, the Cabinet for Health and Family Services shall assure that a KCHIP 6
program is available to all eligible children in all regions of the state. If necessary, 7
in order to meet this assurance, the cabinet shall institute its own program. 8
(3) KCHIP recipients shall have direct access without a referral from any gatekeeper 9
primary care provider to dentists for covered primary dental services and to 10
optometrists and ophthalmologists for covered primary eye and vision services. 11
(4) The Kentucky Children's Health Insurance Program[Plan] shall comply with: 12
(a) Section 2 of this Act, except subsection (4)(c) of Section 2 of this Act; 13
(b) Section 8 of this Act; and 14
(c) KRS 304.17A-163 and 304.17A-1631. 15
Section 6. KRS 18A.225 (Effective January 1, 2025) is amended to read as 16
follows: 17
(1) (a) The term "employee" for purposes of this section means: 18
1. Any person, including an elected public official, who is regularly 19
employed by any department, office, board, agency, or branch of state 20
government; or by a public postsecondary educational institution; or by 21
any city, urban-county, charter county, county, or consolidated local 22
government, whose legislative body has opted to participate in the state-23
sponsored health insurance program pursuant to KRS 79.080; and who 24
is either a contributing member to any one (1) of the retirement systems 25
administered by the state, including but not limited to the Kentucky 26
Retirement Systems, County Employees Retirement System, Kentucky 27 UNOFFICIAL COPY 24 RS BR 478
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Teachers' Retirement System, the Legislators' Retirement Plan, or the 1
Judicial Retirement Plan; or is receiving a contractual contribution from 2
the state toward a retirement plan; or, in the case of a public 3
postsecondary education institution, is an individual participating in an 4
optional retirement plan authorized by KRS 161.567; or is eligible to 5
participate in a retirement plan established by an employer who ceases 6
participating in the Kentucky Employees Retirement System pursuant to 7
KRS 61.522 whose employees participated in the health insurance plans 8
administered by the Personnel Cabinet prior to the employer's effective 9
cessation date in the Kentucky Employees Retirement System; 10
2. Any certified or classified employee of a local board of education or a 11
public charter school as defined in KRS 160.1590; 12
3. Any elected member of a local board of education; 13
4. Any person who is a present or future recipient of a retirement 14
allowance from the Kentucky Retirement Systems, County Employees 15
Retirement System, Kentucky Teachers' Retirement System, the 16
Legislators' Retirement Plan, the Judicial Retirement Plan, or the 17
Kentucky Community and Technical College System's optional 18
retirement plan authorized by KRS 161.567, except that a person who is 19
receiving a retirement allowance and who is age sixty-five (65) or older 20
shall not be included, with the exception of persons covered under KRS 21
61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 22
employed pursuant to subparagraph 1. of this paragraph; and 23
5. Any eligible dependents and beneficiaries of participating employees 24
and retirees who are entitled to participate in the state-sponsored health 25
insurance program; 26
(b) The term "health benefit plan" for the purposes of this section means a health 27 UNOFFICIAL COPY 24 RS BR 478
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benefit plan as defined in KRS 304.17A-005; 1
(c) The term "insurer" for the purposes of this section means an insurer as defined 2
in KRS 304.17A-005; and 3
(d) The term "managed care plan" for the purposes of this section means a 4
managed care plan as defined in KRS 304.17A-500. 5
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 6
recommendation of the secretary of the Personnel Cabinet, shall procure, in 7
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 8
from one (1) or more insurers authorized to do business in this state, a group 9
health benefit plan that may include but not be limited to health maintenance 10
organization (HMO), preferred provider organization (PPO), point of service 11
(POS), and exclusive provider organization (EPO) benefit plans 12
encompassing all or any class or classes of employees. With the exception of 13
employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 14
all employers of any class of employees or former employees shall enter into 15
a contract with the Personnel Cabinet prior to including that group in the state 16
health insurance group. The contracts shall include but not be limited to 17
designating the entity responsible for filing any federal forms, adoption of 18
policies required for proper plan administration, acceptance of the contractual 19
provisions with health insurance carriers or third-party administrators, and 20
adoption of the payment and reimbursement methods necessary for efficient 21
administration of the health insurance program. Health insurance coverage 22
provided to state employees under this section shall, at a minimum, contain 23
the same benefits as provided under Kentucky Kare Standard as of January 1, 24
1994, and shall include a mail-order drug option as provided in subsection 25
(13) of this section. All employees and other persons for whom the health care 26
coverage is provided or made available shall annually be given an option to 27 UNOFFICIAL COPY 24 RS BR 478
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elect health care coverage through a self-funded plan offered by the 1
Commonwealth or, if a self-funded plan is not available, from a list of 2
coverage options determined by the competitive bid process under the 3
provisions of KRS 45A.080, 45A.085, and 45A.090 and made available 4
during annual open enrollment. 5
(b) The policy or policies shall be approved by the commissioner of insurance 6
and may contain the provisions the commissioner of insurance approves, 7
whether or not otherwise permitted by the insurance laws. 8
(c) Any carrier bidding to offer health care coverage to employees shall agree to 9
provide coverage to all members of the state group, including active 10
employees and retirees and their eligible covered dependents and 11
beneficiaries, within the county or counties specified in its bid. Except as 12
provided in subsection (20) of this section, any carrier bidding to offer health 13
care coverage to employees shall also agree to rate all employees as a single 14
entity, except for those retirees whose former employers insure their active 15
employees outside the state-sponsored health insurance program and as 16
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 17
(d) Any carrier bidding to offer health care coverage to employees shall agree to 18
provide enrollment, claims, and utilization data to the Commonwealth in a 19
format specified by the Personnel Cabinet with the understanding that the data 20
shall be owned by the Commonwealth; to provide data in an electronic form 21
and within a time frame specified by the Personnel Cabinet; and to be subject 22
to penalties for noncompliance with data reporting requirements as specified 23
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 24
to protect the confidentiality of each individual employee; however, 25
confidentiality assertions shall not relieve a carrier from the requirement of 26
providing stipulated data to the Commonwealth. 27 UNOFFICIAL COPY 24 RS BR 478
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(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 1
for timely analysis of data received from carriers and, to the extent possible, 2
provide in the request-for-proposal specifics relating to data requirements, 3
electronic reporting, and penalties for noncompliance. The Commonwealth 4
shall own the enrollment, claims, and utilization data provided by each carrier 5
and shall develop methods to protect the confidentiality of the individual. The 6
Personnel Cabinet shall include in the October annual report submitted 7
pursuant to the provisions of KRS 18A.226 to the Governor, the General 8
Assembly, and the Chief Justice of the Supreme Court, an analysis of the 9
financial stability of the program, which shall include but not be limited to 10
loss ratios, methods of risk adjustment, measurements of carrier quality of 11
service, prescription coverage and cost management, and statutorily required 12
mandates. If state self-insurance was available as a carrier option, the report 13
also shall provide a detailed financial analysis of the self-insurance fund 14
including but not limited to loss ratios, reserves, and reinsurance agreements. 15
(f) If any agency participating in the state-sponsored employee health insurance 16
program for its active employees terminates participation and there is a state 17
appropriation for the employer's contribution for active employees' health 18
insurance coverage, then neither the agency nor the employees shall receive 19
the state-funded contribution after termination from the state-sponsored 20
employee health insurance program. 21
(g) Any funds in flexible spending accounts that remain after all reimbursements 22
have been processed shall be transferred to the credit of the state-sponsored 23
health insurance plan's appropriation account. 24
(h) Each entity participating in the state-sponsored health insurance program shall 25
provide an amount at least equal to the state contribution rate for the employer 26
portion of the health insurance premium. For any participating entity that used 27 UNOFFICIAL COPY 24 RS BR 478
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the state payroll system, the employer contribution amount shall be equal to 1
but not greater than the state contribution rate. 2
(3) The premiums may be paid by the policyholder: 3
(a) Wholly from funds contributed by the employee, by payroll deduction or 4
otherwise; 5
(b) Wholly from funds contributed by any department, board, agency, public 6
postsecondary education institution, or branch of state, city, urban-county, 7
charter county, county, or consolidated local government; or 8
(c) Partly from each, except that any premium due for health care coverage or 9
dental coverage, if any, in excess of the premium amount contributed by any 10
department, board, agency, postsecondary education institution, or branch of 11
state, city, urban-county, charter county, county, or consolidated local 12
government for any other health care coverage shall be paid by the employee. 13
(4) If an employee moves his or her place of residence or employment out of the 14
service area of an insurer offering a managed health care plan, under which he or 15
she has elected coverage, into either the service area of another managed health care 16
plan or into an area of the Commonwealth not within a managed health care plan 17
service area, the employee shall be given an option, at the time of the move or 18
transfer, to change his or her coverage to another health benefit plan. 19
(5) No payment of premium by any department, board, agency, public postsecondary 20
educational institution, or branch of state, city, urban-county, charter county, 21
county, or consolidated local government shall constitute compensation to an 22
insured employee for the purposes of any statute fixing or limiting the 23
compensation of such an employee. Any premium or other expense incurred by any 24
department, board, agency, public postsecondary educational institution, or branch 25
of state, city, urban-county, charter county, county, or consolidated local 26
government shall be considered a proper cost of administration. 27 UNOFFICIAL COPY 24 RS BR 478
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(6) The policy or policies may contain the provisions with respect to the class or classes 1
of employees covered, amounts of insurance or coverage for designated classes or 2
groups of employees, policy options, terms of eligibility, and continuation of 3
insurance or coverage after retirement. 4
(7) Group rates under this section shall be made available to the disabled child of an 5
employee regardless of the child's age if the entire premium for the disabled child's 6
coverage is paid by the state employee. A child shall be considered disabled if he or 7
she has been determined to be eligible for federal Social Security disability benefits. 8
(8) The health care contract or contracts for employees shall be entered into for a 9
period of not less than one (1) year. 10
(9) The secretary shall appoint thirty-two (32) persons to an Advisory Committee of 11
State Health Insurance Subscribers to advise the secretary or the secretary's 12
designee regarding the state-sponsored health insurance program for employees. 13
The secretary shall appoint, from a list of names submitted by appointing 14
authorities, members representing school districts from each of the seven (7) 15
Supreme Court districts, members representing state government from each of the 16
seven (7) Supreme Court districts, two (2) members representing retirees under age 17
sixty-five (65), one (1) member representing local health departments, two (2) 18
members representing the Kentucky Teachers' Retirement System, and three (3) 19
members at large. The secretary shall also appoint two (2) members from a list of 20
five (5) names submitted by the Kentucky Education Association, two (2) members 21
from a list of five (5) names submitted by the largest state employee organization of 22
nonschool state employees, two (2) members from a list of five (5) names submitted 23
by the Kentucky Association of Counties, two (2) members from a list of five (5) 24
names submitted by the Kentucky League of Cities, and two (2) members from a 25
list of names consisting of five (5) names submitted by each state employee 26
organization that has two thousand (2,000) or more members on state payroll 27 UNOFFICIAL COPY 24 RS BR 478
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deduction. The advisory committee shall be appointed in January of each year and 1
shall meet quarterly. 2
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 3
provided to employees pursuant to this section shall not provide coverage for 4
obtaining or performing an abortion, nor shall any state funds be used for the 5
purpose of obtaining or performing an abortion on behalf of employees or their 6
dependents. 7
(11) Interruption of an established treatment regime with maintenance drugs shall be 8
grounds for an insured to appeal a formulary change through the established appeal 9
procedures approved by the Department of Insurance, if the physician supervising 10
the treatment certifies that the change is not in the best interests of the patient. 11
(12) Any employee who is eligible for and elects to participate in the state health 12
insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 13
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 14
state health insurance contribution toward health care coverage as a result of any 15
other employment for which there is a public employer contribution. This does not 16
preclude a retiree and an active employee spouse from using both contributions to 17
the extent needed for purchase of one (1) state sponsored health insurance policy 18
for that plan year. 19
(13) (a) The policies of health insurance coverage procured under subsection (2) of 20
this section shall include a mail-order drug option for maintenance drugs for 21
state employees. Maintenance drugs may be dispensed by mail order in 22
accordance with Kentucky law. 23
(b) A health insurer shall not discriminate against any retail pharmacy located 24
within the geographic coverage area of the health benefit plan and that meets 25
the terms and conditions for participation established by the insurer, including 26
price, dispensing fee, and copay requirements of a mail-order option. The 27 UNOFFICIAL COPY 24 RS BR 478
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retail pharmacy shall not be required to dispense by mail. 1
(c) The mail-order option shall not permit the dispensing of a controlled 2
substance classified in Schedule II. 3
(14) The policy or policies provided to state employees or their dependents pursuant to 4
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 5
aid-related services for insured individuals under eighteen (18) years of age, subject 6
to a cap of one thousand four hundred dollars ($1,400) every thirty-six (36) months 7
pursuant to KRS 304.17A-132. 8
(15) Any policy provided to state employees or their dependents pursuant to this section 9
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 10
consistent with KRS 304.17A-142. 11
(16) Any policy provided to state employees or their dependents pursuant to this section 12
shall provide coverage for obtaining amino acid-based elemental formula pursuant 13
to KRS 304.17A-258. 14
(17) If a state employee's residence and place of employment are in the same county, 15
and if the hospital located within that county does not offer surgical services, 16
intensive care services, obstetrical services, level II neonatal services, diagnostic 17
cardiac catheterization services, and magnetic resonance imaging services, the 18
employee may select a plan available in a contiguous county that does provide 19
those services, and the state contribution for the plan shall be the amount available 20
in the county where the plan selected is located. 21
(18) If a state employee's residence and place of employment are each located in 22
counties in which the hospitals do not offer surgical services, intensive care 23
services, obstetrical services, level II neonatal services, diagnostic cardiac 24
catheterization services, and magnetic resonance imaging services, the employee 25
may select a plan available in a county contiguous to the county of residence that 26
does provide those services, and the state contribution for the plan shall be the 27 UNOFFICIAL COPY 24 RS BR 478
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amount available in the county where the plan selected is located. 1
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 2
in the best interests of the state group to allow any carrier bidding to offer health 3
care coverage under this section to submit bids that may vary county by county or 4
by larger geographic areas. 5
(20) Notwithstanding any other provision of this section, the bid for proposals for health 6
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 7
the statewide rating structure provided in calendar year 2003 and a bid scenario that 8
allows for a regional rating structure that allows carriers to submit bids that may 9
vary by region for a given product offering as described in this subsection: 10
(a) The regional rating bid scenario shall not include a request for bid on a 11
statewide option; 12
(b) The Personnel Cabinet shall divide the state into geographical regions which 13
shall be the same as the partnership regions designated by the Department for 14
Medicaid Services for purposes of the Kentucky Health Care Partnership 15
Program established pursuant to 907 KAR 1:705; 16
(c) The request for proposal shall require a carrier's bid to include every county 17
within the region or regions for which the bid is submitted and include but not 18
be restricted to a preferred provider organization (PPO) option; 19
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 20
carrier all of the counties included in its bid within the region. If the Personnel 21
Cabinet deems the bids submitted in accordance with this subsection to be in 22
the best interests of state employees in a region, the cabinet may award the 23
contract for that region to no more than two (2) carriers; and 24
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 25
other requirements or criteria in the request for proposal. 26
(21) Any fully insured health benefit plan or self-insured plan issued or renewed on or 27 UNOFFICIAL COPY 24 RS BR 478
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after July 12, 2006, to public employees pursuant to this section which provides 1
coverage for services rendered by a physician or osteopath duly licensed under KRS 2
Chapter 311 that are within the scope of practice of an optometrist duly licensed 3
under the provisions of KRS Chapter 320 shall provide the same payment of 4
coverage to optometrists as allowed for those services rendered by physicians or 5
osteopaths. 6
(22) Any fully insured health benefit plan or self-insured plan issued or renewed to 7
public employees pursuant to this section shall comply with: 8
(a) KRS 304.12-237; 9
(b) KRS 304.17A-270 and 304.17A-525; 10
(c) KRS 304.17A-600 to 304.17A-633; 11
(d) KRS 205.593; 12
(e) KRS 304.17A-700 to 304.17A-730; 13
(f) KRS 304.14-135; 14
(g) KRS 304.17A-580 and 304.17A-641; 15
(h) KRS 304.99-123; 16
(i) KRS 304.17A-138; 17
(j) KRS 304.17A-148; 18
(k) KRS 304.17A-163 and 304.17A-1631; 19
(l) KRS 304.17A-265; 20
(m) KRS 304.17A-261; 21
(n) KRS 304.17A-262;[ and] 22
(o) Section 2 of this Act; 23
(p) Section 8 of this Act; and 24
(q) Administrative regulations promulgated pursuant to statutes listed in this 25
subsection. 26
Section 7. KRS 446.350 is amended to read as follows: 27 UNOFFICIAL COPY 24 RS BR 478
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(1) Government shall not substantially burden a person's freedom of religion. The right 1
to act or refuse to act in a manner motivated by a sincerely held religious belief may 2
not be substantially burdened unless the government proves by clear and 3
convincing evidence that it has a compelling governmental interest in infringing the 4
specific act or refusal to act and has used the least restrictive means to further that 5
interest. A "burden" shall include indirect burdens such as withholding benefits, 6
assessing penalties, or an exclusion from programs or access to facilities. 7
(2) Nothing in Sections 2 or 8 of this Act shall be construed to be in violation of this 8
section. 9
SECTION 8. A NEW SECTION OF KRS CHAPTER 205 IS CREATED TO 10
READ AS FOLLOWS: 11
(1) As used in this section: 12
(a) "Family planning services": 13
1. Means family planning services that are provided under the Medicaid 14
program; 15
2. Shall include: 16
a. Sexual health education and family planning counseling; and 17
b. Other medical diagnosis, treatment, or preventive care routinely 18
provided as part of a family planning service visit; and 19
3. Shall not include an elective abortion, as defined in KRS 304.5-160; 20
and 21
(b) "Low-income individual" means an individual who: 22
1. Has an income level that is equal to or below ninety-five percent 23
(95%) of the federal poverty level; and 24
2. Does not qualify for full coverage under the Medicaid program. 25
(2) Within ninety (90) days of the effective date of this section, the Cabinet for Health 26
and Family Services shall apply for a waiver or a state plan amendment with the 27 UNOFFICIAL COPY 24 RS BR 478
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Centers for Medicare and Medicaid Services within the United States Department 1
of Health and Human Services to: 2
(a) Offer a program that provides family planning services to low-income 3
individuals; and 4
(b) Receive a federal match rate of ninety percent (90%) of state expenditures 5
for family planning services provided under the waiver or state plan 6
amendment. 7
(3) If the waiver or state plan amendment described in subsection (2) of this section 8
is approved, the Cabinet for Health and Family Services shall report to the 9
Legislative Research Commission, while the waiver or state plan amendment is in 10
effect, annually before November 30, the following: 11
(a) The number of qualified individuals served under the program; 12
(b) The cost of the program; and 13
(c) The effectiveness of the program, including any: 14
1. Savings to the Medicaid program from reduction in enrollment; 15
2. Reduction in the number of abortions; 16
3. Reduction in the number of unintended pregnancies; 17
4. Reduction in the number of individuals requiring services from the 18
program for women, infants, and children established in 42 U.S.C. 19
sec. 1786; and 20
5. Other costs and benefits as a result of the program. 21
SECTION 9. A NEW SECTION OF KRS CHAPTER 315 IS CREATED TO 22
READ AS FOLLOWS: 23
(1) As used in this section, "hormonal contraceptive" means a self-administered 24
drug, or a transdermal patch applied to the skin of a patient by the patient or by a 25
practitioner, that releases a drug composed of a combination of hormones 26
approved by the United States Food and Drug Administration to prevent 27 UNOFFICIAL COPY 24 RS BR 478
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pregnancy. 1
(2) A pharmacist, in good faith, is authorized to provide hormonal contraceptives 2
according to a valid collaborative care agreement containing a nonpatient-3
specific prescriptive order and standardized procedures developed and executed 4
by one (1) or more authorized prescribers. 5
(3) The board, in collaboration with the Kentucky Board of Medical Licensure, shall 6
promulgate administrative regulations pursuant to KRS Chapter 13A to establish 7
standard procedures for the provision of hormonal contraceptives by 8
pharmacists. The standard procedures adopted pursuant to this section shall 9
require a pharmacist to: 10
(a) Complete a training program approved by the Cabinet for Health and 11
Family Services related to the provision of hormonal contraceptives; 12
(b) Provide the patient with a self-screening risk assessment tool developed or 13
approved by the Cabinet for Health and Family Services; 14
(c) Provide the patient with documentation about the hormonal contraceptive 15
that was provided to the patient and advise the patient to consult with a 16
primary care practitioner or women's healthcare practitioner; 17
(d) Provide the patient with a standardized factsheet that includes but is not 18
limited to the indications and contraindications for use of the drug, 19
appropriate method for using the drug, importance of a medical follow-up, 20
and other appropriate information; 21
(e) Provide the patient with the contact information of a primary care 22
practitioner or women's healthcare practitioner within a reasonable period 23
of time after provision of the hormonal contraceptive; and 24
(f) Either dispense the hormonal contraceptive or refer the patient to a 25
pharmacy that may dispense the hormonal contraceptive as soon as 26
practicable after the pharmacist determines that the patient should receive 27 UNOFFICIAL COPY 24 RS BR 478
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the medication. 1
(4) The administrative regulations promulgated under this section shall prohibit a 2
pharmacist from requiring a patient to schedule an appointment with the 3
pharmacist for the provision or dispensing of a hormonal contraceptive. 4
(5) (a) A pharmacist or the pharmacist's employer or agent may charge the annual 5
administrative fee for services provided pursuant to this section in addition 6
to any costs associated with the dispensing of the drug and paid by the 7
pharmacy insurance benefit. 8
(b) Upon an oral, telephonic, electronic, or written request from a patient or 9
customer, a pharmacist or pharmacist's employee shall disclose the total 10
cost that a consumer would pay for pharmacist-provided hormonal 11
contraceptives. As used in this subsection, "total cost" includes providing 12
the consumer with specific information regarding the price of the hormonal 13
contraceptive and the price of the administrative fee charged. This 14
limitation is not intended to interfere with other contractually agreed-upon 15
terms between a pharmacist or a pharmacist's employer or agent and a 16
health insurance plan or insurer. Patients who are insured or covered and 17
receive a pharmacy benefit that covers the cost of hormonal contraceptives 18
shall not be required to pay an administrative fee but may be required to pay 19
copayments pursuant to the terms and conditions of their coverage. 20
(6) All state and federal laws governing insurance coverage of contraceptive drugs, 21
devices, products, and services shall apply to hormonal contraceptives provided by 22
a pharmacist under this section. 23
(7) The board and the Kentucky Board of Medical Licensure shall ensure 24
compliance with this section, and each board is specifically charged with the 25
enforcement of this section with respect to its respective licensees. 26
(8) Any pharmacist or prescriber acting in good faith and with reasonable care 27 UNOFFICIAL COPY 24 RS BR 478
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involved in the provision of hormonal contraceptives pursuant to this section 1
shall be immune from disciplinary or adverse administrative actions under this 2
chapter for acts or omissions related to the provision of a hormonal 3
contraceptive. 4
(9) A pharmacist or prescriber involved in the provision of hormonal contraceptives 5
pursuant to this section shall be immune from civil liability unless the injury 6
results from the gross negligence or willful misconduct of the pharmacist or 7
provider. 8
(10) This section shall not apply to a valid patient-specific prescription for a hormonal 9
contraceptive issued by an authorized prescriber and dispensed by a pharmacist 10
pursuant to the valid prescription. 11
Section 10. (1) Each insurer of a health benefit plan, as defined in Section 2 12
of this Act, shall, in consultation with its pharmacy benefit manager, if any, submit to the 13
commissioner of the Department of Insurance, at a time and in a manner prescribed by 14
the commissioner, a report that: 15
(a) Explains how the insurer may provide coverage for over-the-counter oral 16
contraceptives and over-the-counter emergency contraceptives in its health benefit plans 17
without requiring a prescription and without imposing cost-sharing; and 18
(b) Indicates whether the insurer provides the coverage referenced in paragraph 19
(a) of this subsection, and if the insurer does not provide the coverage, whether they 20
would, or are likely to, add the coverage to one or more of the insurer's health benefit 21
plans. 22
(2) The commissioner of the Department of Insurance shall utilize the 23
information received under subsection (1) of this section, in addition to any other 24
information available to the commissioner, to submit a written report to the Legislative 25
Research Commission, on or before July 1, 2026, that shall include: 26
(a) Recommendations on how insurers of health benefit plans could provide 27 UNOFFICIAL COPY 24 RS BR 478
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coverage for over-the-counter oral contraceptives and over-the-counter emergency 1
contraceptives in health benefit plans without a prescription or cost sharing; 2
(b) The estimated impact of the coverage referred to in paragraph (a) of this 3
subsection on health insurance premiums, and 4
(c) Statistics on how many insurers intend to add the benefit to any or all of its 5
health insurance plans. 6
Section 11. Sections 2 to 8 of this Act apply to health benefit plans issued, 7
renewed, amended, effective, or delivered on or after January 1, 2025. 8
Section 12. Sections 2 to 8 of this Act shall take effect January 1, 2025. 9
Section 13. If the Cabinet for Health and Family Services determines that a 10
waiver or any other authorization from a federal agency is necessary to implement any 11
provision of this Act for any reason, including the loss of federal funds, the Cabinet shall, 12
within 90 days after the effective date of this section, request the waiver or authorization, 13
and may only delay implementation of those provisions for which a waiver or 14
authorization was deemed necessary until the waiver or authorization is granted. 15