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AN ACT relating to coverage for the treatment of stuttering. 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: 5
(a) "Habilitative services" means health care services that help a person keep, 6
learn, or improve skills and functioning for daily living; 7
(b) "Habilitative speech therapy" means speech therapy that helps a person 8
keep, learn, or improve skills and functioning for daily living; 9
(c) "Rehabilitative services" means health care services that help a person 10
restore or improve skills and functioning for daily living that have been lost 11
or impaired; and 12
(d) "Rehabilitative speech therapy" means speech therapy that helps a person 13
restore or improve skills and functioning for daily living that have been lost 14
or impaired. 15
(2) Except as provided in subsection (4) of this section, any health insurance policy, 16
certificate, plan, or contract, including but not limited to a health benefit plan, 17
that provides coverage for: 18
(a) Habilitative services, shall provide coverage for habilitative speech therapy 19
as a treatment for stuttering, regardless of whether the stuttering is 20
classified as developmental; 21
(b) Rehabilitative services, shall provide coverage for rehabilitative speech 22
therapy as a treatment for stuttering; or 23
(c) Both habilitative services and rehabilitative services, shall provide the 24
coverage required under paragraphs (a) and (b) of this subsection. 25
(3) The coverage required under subsection (2) of this section shall: 26
(a) Not be: 27 UNOFFICIAL COPY 24 RS SB 111/EN
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1. Subject to any maximum annual benefit limit, including any limits on 1
the number of visits an insured may make to a speech-language 2
pathologist; 3
2. Limited based on the type of disease, injury, disorder, or other medical 4
condition that resulted in the stuttering; or 5
3. Subject to utilization review or utilization management requirements, 6
including prior authorization or a determination that the speech 7
therapy services are medically necessary; and 8
(b) 1. Include coverage for speech therapy provided in person and via 9
telehealth. 10
2. The telehealth coverage required under this paragraph shall: 11
a. Not be less than the coverage required for health benefit plans 12
under KRS 304.17A-138; and 13
b. Include the use of any communication technology, application, 14
or platform to deliver telehealth services, except coverage may be 15
restricted to technology, applications, or platforms that are 16
compliant with any applicable privacy provisions of the federal 17
Health Insurance Portability and Accountability Act of 1996, 42 18
U.S.C. sec. 1320d et seq., as amended. 19
(4) If the application of any requirement of this section to a qualified health plan as 20
defined in 42 U.S.C. sec. 18021(a)(1), as amended, would result in a 21
determination that the state must make payments to defray the cost of the 22
requirement under 42 U.S.C. sec. 18031(d)(3) and 45 C.F.R. sec. 155.170, as 23
amended, then the requirement shall not apply to the qualified health plan until 24
the cost defrayal requirement is no longer applicable. 25
Section 2. KRS 304.17C-125 (Effective January 1, 2025) is amended to read as 26
follows: 27 UNOFFICIAL COPY 24 RS SB 111/EN
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The following[KRS 304.17A-262] shall apply to limited health service benefit plans, 1
including any limited health service contract, as defined in KRS 304.38A-010: 2
(1) KRS 304.17A-262; and 3
(2) Section 1 of this Act. 4
Section 3. KRS 205.522 is amended to read as follows: 5
(1) With respect to the administration and provision of Medicaid benefits pursuant to 6
this chapter, the Department for Medicaid Services,[ and] any managed care 7
organization contracted to provide Medicaid benefits pursuant to this chapter, and 8
the state's medical assistance program shall be subject to, and comply with, the 9
following, as applicable:[provisions of ] 10
(a) KRS 304.17A-163;[, ] 11
(b) KRS 304.17A-1631;[, ] 12
(c) KRS 304.17A-167;[, ] 13
(d) KRS 304.17A-235;[, ] 14
(e) KRS 304.17A-257;[, ] 15
(f) KRS 304.17A-259;[, ] 16
(g) KRS 304.17A-263;[, ] 17
(h) KRS 304.17A-515;[, ] 18
(i) KRS 304.17A-580;[, ] 19
(j) KRS 304.17A-600, 304.17A-603, and 304.17A-607;[, and ] 20
(k) KRS 304.17A-740 to 304.17A-743; and[, as applicable] 21
(l) Section 1 of this Act. 22
(2) A managed care organization contracted to provide Medicaid benefits pursuant to 23
this chapter shall comply with the reporting requirements of KRS 304.17A-732. 24
Section 4. KRS 205.6485 is amended to read as follows: 25
(1) As used in this section, "KCHIP" means the Kentucky Children's Health 26
Insurance Program. 27 UNOFFICIAL COPY 24 RS SB 111/EN
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(2) The Cabinet for Health and Family Services shall: 1
(a) Prepare a state child health plan, known as KCHIP, meeting the requirements 2
of Title XXI of the Federal Social Security Act, for submission to the 3
Secretary of the United States Department of Health and Human Services 4
within such time as will permit the state to receive the maximum amounts of 5
federal matching funds available under Title XXI; and[. The cabinet shall, ] 6
(b) By administrative regulation promulgated in accordance with KRS Chapter 7
13A, establish the following: 8
1.[(a)] The eligibility criteria for children covered by KCHIP, which 9
shall include a provision that[the Kentucky Children's Health Insurance 10
Program. However,] no person eligible for services under Title XIX of 11
the Social Security Act, 42 U.S.C. secs. 1396 to 1396v, as amended, 12
shall be eligible for services under KCHIP,[the Kentucky Children's 13
Health Insurance Program] except to the extent that Title XIX coverage 14
is expanded by KRS 205.6481 to 205.6495 and KRS 304.17A-340; 15
2.[(b)] The schedule of benefits to be covered by KCHIP[the Kentucky 16
Children's Health Insurance Program], which shall:[ include preventive 17
services, vision services including glasses, and dental services including 18
at least sealants, extractions, and fillings, and which shall] 19
a. Be at least equivalent to one (1) of the following: 20
i.[1.] The standard Blue Cross/Blue Shield preferred provider 21
option under the Federal Employees Health Benefit Plan 22
established by 5 U.S.C. sec. 8903(1); 23
ii.[2.] A mid-range health benefit coverage plan that is offered and 24
generally available to state employees; or 25
iii.[3.] Health insurance coverage offered by a health 26
maintenance organization that has the largest insured 27 UNOFFICIAL COPY 24 RS SB 111/EN
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commercial, non-Medicaid enrollment of covered lives in the 1
state; and 2
b. Comply with subsection (6) of this section; 3
3.[(c)] The premium contribution per family for[of] health insurance 4
coverage available under KCHIP, which[the Kentucky Children's 5
Health Insurance Program with provisions for the payment of premium 6
contributions by families of children eligible for coverage by the 7
program based upon a sliding scale relating to family income. Premium 8
contributions] shall be based: 9
a. On a six (6) month period; and 10
b. Upon a sliding scale relating to family income not to exceed: 11
i.[1.] Ten dollars ($10), to be paid by a family with income 12
between one hundred percent (100%) to one hundred thirty-13
three percent (133%) of the federal poverty level; 14
ii.[2.] Twenty dollars ($20), to be paid by a family with income 15
between one hundred thirty-four percent (134%) to one 16
hundred forty-nine percent (149%) of the federal poverty 17
level; and 18
iii.[3.] One hundred twenty dollars ($120), to be paid by a 19
family with income between one hundred fifty percent 20
(150%) to two hundred percent (200%) of the federal 21
poverty level, and which may be made on a partial payment 22
plan of twenty dollars ($20) per month or sixty dollars ($60) 23
per quarter; 24
4.[(d)] There shall be no copayments for services provided under 25
KCHIP[the Kentucky Children's Health Insurance Program]; and 26
5.[(e)] a. The criteria for health services providers and insurers 27 UNOFFICIAL COPY 24 RS SB 111/EN
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wishing to contract with the Commonwealth to provide[ the 1
children's health insurance] coverage under KCHIP. 2
b. [However, ]The cabinet shall provide, in any contracting process 3
for coverage of[the] preventive services[health insurance 4
program], the opportunity for a public health department to bid on 5
preventive health services to eligible children within the public 6
health department's service area. A public health department shall 7
not be disqualified from bidding because the department does not 8
currently offer all the services required by[ paragraph (b) of] this 9
section[subsection]. The criteria shall be set forth in administrative 10
regulations under KRS Chapter 13A and shall maximize 11
competition among the providers and insurers. The[ Cabinet for] 12
Finance and Administration Cabinet shall provide oversight over 13
contracting policies and procedures to assure that the number of 14
applicants for contracts is maximized. 15
(3)[(2)] Within twelve (12) months of federal approval of the state's Title XXI child 16
health plan, the Cabinet for Health and Family Services shall assure that a KCHIP 17
program is available to all eligible children in all regions of the state. If necessary, 18
in order to meet this assurance, the cabinet shall institute its own program. 19
(4)[(3)] KCHIP recipients shall have direct access without a referral from any 20
gatekeeper primary care provider to dentists for covered primary dental services 21
and to optometrists and ophthalmologists for covered primary eye and vision 22
services. 23
(5)[(4)] KCHIP[The Kentucky Children's Health Insurance Plan] shall comply with 24
KRS 304.17A-163 and 304.17A-1631. 25
(6) The schedule of benefits required under subsection (2)(b)2. of this section shall 26
include: 27 UNOFFICIAL COPY 24 RS SB 111/EN
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(a) Preventive services; 1
(b) Vision services, including glasses; 2
(c) Dental services, including sealants, extractions, and fillings; and 3
(d) The coverage required under Section 1 of this Act. 4
Section 5. KRS 164.2871 (Effective January 1, 2025) is amended to read as 5
follows: 6
(1) The governing board of each state postsecondary educational institution is 7
authorized to purchase liability insurance for the protection of the individual 8
members of the governing board, faculty, and staff of such institutions from liability 9
for acts and omissions committed in the course and scope of the individual's 10
employment or service. Each institution may purchase the type and amount of 11
liability coverage deemed to best serve the interest of such institution. 12
(2) All retirement annuity allowances accrued or accruing to any employee of a state 13
postsecondary educational institution through a retirement program sponsored by 14
the state postsecondary educational institution are hereby exempt from any state, 15
county, or municipal tax, and shall not be subject to execution, attachment, 16
garnishment, or any other process whatsoever, nor shall any assignment thereof be 17
enforceable in any court. Except retirement benefits accrued or accruing to any 18
employee of a state postsecondary educational institution through a retirement 19
program sponsored by the state postsecondary educational institution on or after 20
January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 21
provided in KRS 141.010 and 141.0215. 22
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 23
members of governing boards, faculty and staff of institutions of higher education 24
in this state shall not be construed to be a waiver of sovereign immunity or any 25
other immunity or privilege. 26
(4) The governing board of each state postsecondary education institution is authorized 27 UNOFFICIAL COPY 24 RS SB 111/EN
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to provide a self-insured employer group health plan to its employees, which plan 1
shall: 2
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 3
(b) Except as provided in subsection (5) of this section, be exempt from 4
conformity with Subtitle 17A of KRS Chapter 304. 5
(5) A self-insured employer group health plan provided by the governing board of a 6
state postsecondary education institution to its employees shall comply with: 7
(a) KRS 304.17A-163 and 304.17A-1631; 8
(b) KRS 304.17A-265; 9
(c) KRS 304.17A-261;[ and] 10
(d) KRS 304.17A-262; and 11
(e) Section 1 of this Act. 12
Section 6. KRS 18A.225 (Effective January 1, 2025) is amended to read as 13
follows: 14
(1) (a) The term "employee" for purposes of this section means: 15
1. Any person, including an elected public official, who is regularly 16
employed by any department, office, board, agency, or branch of state 17
government; or by a public postsecondary educational institution; or by 18
any city, urban-county, charter county, county, or consolidated local 19
government, whose legislative body has opted to participate in the state-20
sponsored health insurance program pursuant to KRS 79.080; and who 21
is either a contributing member to any one (1) of the retirement systems 22
administered by the state, including but not limited to the Kentucky 23
Retirement Systems, County Employees Retirement System, Kentucky 24
Teachers' Retirement System, the Legislators' Retirement Plan, or the 25
Judicial Retirement Plan; or is receiving a contractual contribution from 26
the state toward a retirement plan; or, in the case of a public 27 UNOFFICIAL COPY 24 RS SB 111/EN
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postsecondary education institution, is an individual participating in an 1
optional retirement plan authorized by KRS 161.567; or is eligible to 2
participate in a retirement plan established by an employer who ceases 3
participating in the Kentucky Employees Retirement System pursuant to 4
KRS 61.522 whose employees participated in the health insurance plans 5
administered by the Personnel Cabinet prior to the employer's effective 6
cessation date in the Kentucky Employees Retirement System; 7
2. Any certified or classified employee of a local board of education or a 8
public charter school as defined in KRS 160.1590; 9
3. Any elected member of a local board of education; 10
4. Any person who is a present or future recipient of a retirement 11
allowance from the Kentucky Retirement Systems, County Employees 12
Retirement System, Kentucky Teachers' Retirement System, the 13
Legislators' Retirement Plan, the Judicial Retirement Plan, or the 14
Kentucky Community and Technical College System's optional 15
retirement plan authorized by KRS 161.567, except that a person who is 16
receiving a retirement allowance and who is age sixty-five (65) or older 17
shall not be included, with the exception of persons covered under KRS 18
61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 19
employed pursuant to subparagraph 1. of this paragraph; and 20
5. Any eligible dependents and beneficiaries of participating employees 21
and retirees who are entitled to participate in the state-sponsored health 22
insurance program; 23
(b) The term "health benefit plan" for the purposes of this section means a health 24
benefit plan as defined in KRS 304.17A-005; 25
(c) The term "insurer" for the purposes of this section means an insurer as defined 26
in KRS 304.17A-005; and 27 UNOFFICIAL COPY 24 RS SB 111/EN
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(d) The term "managed care plan" for the purposes of this section means a 1
managed care plan as defined in KRS 304.17A-500. 2
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 3
recommendation of the secretary of the Personnel Cabinet, shall procure, in 4
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 5
from one (1) or more insurers authorized to do business in this state, a group 6
health benefit plan that may include but not be limited to health maintenance 7
organization (HMO), preferred provider organization (PPO), point of service 8
(POS), and exclusive provider organization (EPO) benefit plans 9
encompassing all or any class or classes of employees. With the exception of 10
employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 11
all employers of any class of employees or former employees shall enter into 12
a contract with the Personnel Cabinet prior to including that group in the state 13
health insurance group. The contracts shall include but not be limited to 14
designating the entity responsible for filing any federal forms, adoption of 15
policies required for proper plan administration, acceptance of the contractual 16
provisions with health insurance carriers or third-party administrators, and 17
adoption of the payment and reimbursement methods necessary for efficient 18
administration of the health insurance program. Health insurance coverage 19
provided to state employees under this section shall, at a minimum, contain 20
the same benefits as provided under Kentucky Kare Standard as of January 1, 21
1994, and shall include a mail-order drug option as provided in subsection 22
(13) of this section. All employees and other persons for whom the health care 23
coverage is provided or made available shall annually be given an option to 24
elect health care coverage through a self-funded plan offered by the 25
Commonwealth or, if a self-funded plan is not available, from a list of 26
coverage options determined by the competitive bid process under the 27 UNOFFICIAL COPY 24 RS SB 111/EN
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provisions of KRS 45A.080, 45A.085, and 45A.090 and made available 1
during annual open enrollment. 2
(b) The policy or policies shall be approved by the commissioner of insurance 3
and may contain the provisions the commissioner of insurance approves, 4
whether or not otherwise permitted by the insurance laws. 5
(c) Any carrier bidding to offer health care coverage to employees shall agree to 6
provide coverage to all members of the state group, including active 7
employees and retirees and their eligible covered dependents and 8
beneficiaries, within the county or counties specified in its bid. Except as 9
provided in subsection (20) of this section, any carrier bidding to offer health 10
care coverage to employees shall also agree to rate all employees as a single 11
entity, except for those retirees whose former employers insure their active 12
employees outside the state-sponsored health insurance program and as 13
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 14
(d) Any carrier bidding to offer health care coverage to employees shall agree to 15
provide enrollment, claims, and utilization data to the Commonwealth in a 16
format specified by the Personnel Cabinet with the understanding that the data 17
shall be owned by the Commonwealth; to provide data in an electronic form 18
and within a time frame specified by the Personnel Cabinet; and to be subject 19
to penalties for noncompliance with data reporting requirements as specified 20
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 21
to protect the confidentiality of each individual employee; however, 22
confidentiality assertions shall not relieve a carrier from the requirement of 23
providing stipulated data to the Commonwealth. 24
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 25
for timely analysis of data received from carriers and, to the extent possible, 26
provide in the request-for-proposal specifics relating to data requirements, 27 UNOFFICIAL COPY 24 RS SB 111/EN
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electronic reporting, and penalties for noncompliance. The Commonwealth 1
shall own the enrollment, claims, and utilization data provided by each carrier 2
and shall develop methods to protect the confidentiality of the individual. The 3
Personnel Cabinet shall include in the October annual report submitted 4
pursuant to the provisions of KRS 18A.226 to the Governor, the General 5
Assembly, and the Chief Justice of the Supreme Court, an analysis of the 6
financial stability of the program, which shall include but not be limited to 7
loss ratios, methods of risk adjustment, measurements of carrier quality of 8
service, prescription coverage and cost management, and statutorily required 9
mandates. If state self-insurance was available as a carrier option, the report 10
also shall provide a detailed financial analysis of the self-insurance fund 11
including but not limited to loss ratios, reserves, and reinsurance agreements. 12
(f) If any agency participating in the state-sponsored employee health insurance 13
program for its active employees terminates participation and there is a state 14
appropriation for the employer's contribution for active employees' health 15
insurance coverage, then neither the agency nor the employees shall receive 16
the state-funded contribution after termination from the state-sponsored 17
employee health insurance program. 18
(g) Any funds in flexible spending accounts that remain after all reimbursements 19
have been processed shall be transferred to the credit of the state-sponsored 20
health insurance plan's appropriation account. 21
(h) Each entity participating in the state-sponsored health insurance program shall 22
provide an amount at least equal to the state contribution rate for the employer 23
portion of the health insurance premium. For any participating entity that used 24
the state payroll system, the employer contribution amount shall be equal to 25
but not greater than the state contribution rate. 26
(3) The premiums may be paid by the policyholder: 27 UNOFFICIAL COPY 24 RS SB 111/EN
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(a) Wholly from funds contributed by the employee, by payroll deduction or 1
otherwise; 2
(b) Wholly from funds contributed by any department, board, agency, public 3
postsecondary education institution, or branch of state, city, urban-county, 4
charter county, county, or consolidated local government; or 5
(c) Partly from each, except that any premium due for health care coverage or 6
dental coverage, if any, in excess of the premium amount contributed by any 7
department, board, agency, postsecondary education institution, or branch of 8
state, city, urban-county, charter county, county, or consolidated local 9
government for any other health care coverage shall be paid by the employee. 10
(4) If an employee moves his or her place of residence or employment out of the 11
service area of an insurer offering a managed health care plan, under which he or 12
she has elected coverage, into either the service area of another managed health care 13
plan or into an area of the Commonwealth not within a managed health care plan 14
service area, the employee shall be given an option, at the time of the move or 15
transfer, to change his or her coverage to another health benefit plan. 16
(5) No payment of premium by any department, board, agency, public postsecondary 17
educational institution, or branch of state, city, urban-county, charter county, 18
county, or consolidated local government shall constitute compensation to an 19
insured employee for the purposes of any statute fixing or limiting the 20
compensation of such an employee. Any premium or other expense incurred by any 21
department, board, agency, public postsecondary educational institution, or branch 22
of state, city, urban-county, charter county, county, or consolidated local 23
government shall be considered a proper cost of administration. 24
(6) The policy or policies may contain the provisions with respect to the class or classes 25
of employees covered, amounts of insurance or coverage for designated classes or 26
groups of employees, policy options, terms of eligibility, and continuation of 27 UNOFFICIAL COPY 24 RS SB 111/EN
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insurance or coverage after retirement. 1
(7) Group rates under this section shall be made available to the disabled child of an 2
employee regardless of the child's age if the entire premium for the disabled child's 3
coverage is paid by the state employee. A child shall be considered disabled if he or 4
she has been determined to be eligible for federal Social Security disability benefits. 5
(8) The health care contract or contracts for employees shall be entered into for a 6
period of not less than one (1) year. 7
(9) The secretary shall appoint thirty-two (32) persons to an Advisory Committee of 8
State Health Insurance Subscribers to advise the secretary or the secretary's 9
designee regarding the state-sponsored health insurance program for employees. 10
The secretary shall appoint, from a list of names submitted by appointing 11
authorities, members representing school districts from each of the seven (7) 12
Supreme Court districts, members representing state government from each of the 13
seven (7) Supreme Court districts, two (2) members representing retirees under age 14
sixty-five (65), one (1) member representing local health departments, two (2) 15
members representing the Kentucky Teachers' Retirement System, and three (3) 16
members at large. The secretary shall also appoint two (2) members from a list of 17
five (5) names submitted by the Kentucky Education Association, two (2) members 18
from a list of five (5) names submitted by the largest state employee organization of 19
nonschool state employees, two (2) members from a list of five (5) names submitted 20
by the Kentucky Association of Counties, two (2) members from a list of five (5) 21
names submitted by the Kentucky League of Cities, and two (2) members from a 22
list of names consisting of five (5) names submitted by each state employee 23
organization that has two thousand (2,000) or more members on state payroll 24
deduction. The advisory committee shall be appointed in January of each year and 25
shall meet quarterly. 26
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 27 UNOFFICIAL COPY 24 RS SB 111/EN
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provided to employees pursuant to this section shall not provide coverage for 1
obtaining or performing an abortion, nor shall any state funds be used for the 2
purpose of obtaining or performing an abortion on behalf of employees or their 3
dependents. 4
(11) Interruption of an established treatment regime with maintenance drugs shall be 5
grounds for an insured to appeal a formulary change through the established appeal 6
procedures approved by the Department of Insurance, if the physician supervising 7
the treatment certifies that the change is not in the best interests of the patient. 8
(12) Any employee who is eligible for and elects to participate in the state health 9
insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 10
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 11
state health insurance contribution toward health care coverage as a result of any 12
other employment for which there is a public employer contribution. This does not 13
preclude a retiree and an active employee spouse from using both contributions to 14
the extent needed for purchase of one (1) state sponsored health insurance policy 15
for that plan year. 16
(13) (a) The policies of health insurance coverage procured under subsection (2) of 17
this section shall include a mail-order drug option for maintenance drugs for 18
state employees. Maintenance drugs may be dispensed by mail order in 19
accordance with Kentucky law. 20
(b) A health insurer shall not discriminate against any retail pharmacy located 21
within the geographic coverage area of the health benefit plan and that meets 22
the terms and conditions for participation established by the insurer, including 23
price, dispensing fee, and copay requirements of a mail-order option. The 24
retail pharmacy shall not be required to dispense by mail. 25
(c) The mail-order option shall not permit the dispensing of a controlled 26
substance classified in Schedule II. 27 UNOFFICIAL COPY 24 RS SB 111/EN
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(14) The policy or policies provided to state employees or their dependents pursuant to 1
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 2
aid-related services for insured individuals under eighteen (18) years of age, subject 3
to a cap of one thousand four hundred dollars ($1,400) every thirty-six (36) months 4
pursuant to KRS 304.17A-132. 5
(15) Any policy provided to state employees or their dependents pursuant to this section 6
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 7
consistent with KRS 304.17A-142. 8
(16) Any policy provided to state employees or their dependents pursuant to this section 9
shall provide coverage for obtaining amino acid-based elemental formula pursuant 10
to KRS 304.17A-258. 11
(17) If a state employee's residence and place of employment are in the same county, 12
and if the hospital located within that county does not offer surgical services, 13
intensive care services, obstetrical services, level II neonatal services, diagnostic 14
cardiac catheterization services, and magnetic resonance imaging services, the 15
employee may select a plan available in a contiguous county that does provide 16
those services, and the state contribution for the plan shall be the amount available 17
in the county where the plan selected is located. 18
(18) If a state employee's residence and place of employment are each located in 19
counties in which the hospitals do not offer surgical services, intensive care 20
services, obstetrical services, level II neonatal services, diagnostic cardiac 21
catheterization services, and magnetic resonance imaging services, the employee 22
may select a plan available in a county contiguous to the county of residence that 23
does provide those services, and the state contribution for the plan shall be the 24
amount available in the county where the plan selected is located. 25
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 26
in the best interests of the state group to allow any carrier bidding to offer health 27 UNOFFICIAL COPY 24 RS SB 111/EN
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care coverage under this section to submit bids that may vary county by county or 1
by larger geographic areas. 2
(20) Notwithstanding any other provision of this section, the bid for proposals for health 3
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 4
the statewide rating structure provided in calendar year 2003 and a bid scenario that 5
allows for a regional rating structure that allows carriers to submit bids that may 6
vary by region for a given product offering as described in this subsection: 7
(a) The regional rating bid scenario shall not include a request for bid on a 8
statewide option; 9
(b) The Personnel Cabinet shall divide the state into geographical regions which 10
shall be the same as the partnership regions designated by the Department for 11
Medicaid Services for purposes of the Kentucky Health Care Partnership 12
Program established pursuant to 907 KAR 1:705; 13
(c) The request for proposal shall require a carrier's bid to include every county 14
within the region or regions for which the bid is submitted and include but not 15
be restricted to a preferred provider organization (PPO) option; 16
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 17
carrier all of the counties included in its bid within the region. If the Personnel 18
Cabinet deems the bids submitted in accordance with this subsection to be in 19
the best interests of state employees in a region, the cabinet may award the 20
contract for that region to no more than two (2) carriers; and 21
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 22
other requirements or criteria in the request for proposal. 23
(21) Any fully insured health benefit plan or self-insured plan issued or renewed on or 24
after July 12, 2006, to public employees pursuant to this section which provides 25
coverage for services rendered by a physician or osteopath duly licensed under KRS 26
Chapter 311 that are within the scope of practice of an optometrist duly licensed 27 UNOFFICIAL COPY 24 RS SB 111/EN
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under the provisions of KRS Chapter 320 shall provide the same payment of 1
coverage to optometrists as allowed for those services rendered by physicians or 2
osteopaths. 3
(22) Any fully insured health benefit plan or self-insured plan issued or renewed to 4
public employees pursuant to this section shall comply with: 5
(a) KRS 304.12-237; 6
(b) KRS 304.17A-270 and 304.17A-525; 7
(c) KRS 304.17A-600 to 304.17A-633; 8
(d) KRS 205.593; 9
(e) KRS 304.17A-700 to 304.17A-730; 10
(f) KRS 304.14-135; 11
(g) KRS 304.17A-580 and 304.17A-641; 12
(h) KRS 304.99-123; 13
(i) KRS 304.17A-138; 14
(j) KRS 304.17A-148; 15
(k) KRS 304.17A-163 and 304.17A-1631; 16
(l) KRS 304.17A-265; 17
(m) KRS 304.17A-261; 18
(n) KRS 304.17A-262;[ and] 19
(o) Section 1 of this Act; and 20
(p) Administrative regulations promulgated pursuant to statutes listed in this 21
subsection. 22
Section 7. Sections 1, 2, 5, and 6 of this Act apply to policies, certificates, 23
plans, and contracts issued or renewed on or after January 1, 2025. 24
Section 8. (1) For purposes of 45 C.F.R. sec. 156.115, the benefits required 25
under Section 1 of this Act are intended to be, and shall be considered, substantially equal 26
to the benefits required under the state's EHB-benchmark plan. 27 UNOFFICIAL COPY 24 RS SB 111/EN
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(2) For purposes of 45 C.F.R. sec. 155.170, the benefits required under Section 1 1
of this Act are intended to be, and shall be considered by the state as, a benefit required 2
by State action "for purposes of compliance with Federal requirements," and thus, the 3
state shall not consider or identify the benefits required under Section 1 of this Act as 4
being in addition to the essential health benefits required under federal law. 5
(3) The "Federal requirements" referred to in subsection (2) of this section 6
include: 7
(a) The requirement to provide coverage for essential health benefits, which shall 8
include items and services covered within the category of rehabilitative and habilitative 9
services and devices, as required under 42 U.S.C. sec. 18022(b)(1)(G), as amended; and 10
(b) The requirement to not discriminate in the provision of health benefits, as 11
required under 45 C.F.R. sec. 156.125, 45 C.F.R. sec. 92.2, and 45 C.F.R. sec. 147.104. 12
(4) The commissioner of insurance and any other state official or state agency 13
shall: 14
(a) Comply with the requirements of this section; and 15
(b) Not take any action that is in violation of or in conflict with this section. 16
Section 9. Notwithstanding KRS 194A.099: 17
(1) Within 90 days of the effective date of this section and subject to Section 8 of 18
this Act, the Department of Insurance shall identify, in accordance with 45 C.F.R. sec. 19
155.170(a)(3), whether the application of any requirement of Section 1 of this Act to a 20
qualified health plan (QHP) is in addition to the essential health benefits required under 21
federal law. 22
(2) If it is determined that the application of any requirement of Section 1 of this 23
Act to a QHP is in addition to the essential health benefits required under federal law, 24
then the department shall, within 180 days of the effective date of this section, apply for a 25
waiver under 42 U.S.C. sec. 18052, as amended, or any other applicable federal law of all 26
or any of the cost defrayal requirements under 42 U.S.C. sec. 18031(d)(3) and 45 C.F.R. 27 UNOFFICIAL COPY 24 RS SB 111/EN
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sec. 155.170, as amended. 1
(3) The application required under subsection (2) of this section: 2
(a) Shall comply with the requirements of federal law for obtaining a waiver; and 3
(b) May propose changes to the state's EHB-benchmark plan, as defined in 45 4
C.F.R. sec. 156.20, that are not in conflict with existing state law. 5
Section 10. If the Cabinet for Health and Family Services determines that a 6
waiver or other authorization from a federal agency is necessary to implement Section 3 7
or 4 of this Act for any reason, including the loss of federal funds, the cabinet shall, 8
within 90 days of the effective date of this section, request the waiver or authorization, 9
and may only delay implementation of those provisions for which a waiver or 10
authorization was deemed necessary until the waiver or authorization is granted. 11
Section 11. Sections 1 to 7 of this Act take effect January 1, 2025. 12