CHAPTER 69
Legislative Research Commission PDF Version
1
CHAPTER 69
( SB 111 )
AN ACT relating to coverage for the treatment of stuttering.
Be it enacted by the General Assembly of the Commonwealth of Kentucky:
SECTION 1. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 IS CREATED TO READ
AS FOLLOWS:
(1) As used in this section:
(a) "Habilitative services" means health care services that help a person keep, learn, or improve skills
and functioning for daily living;
(b) "Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve
skills and functioning for daily living;
(c) "Rehabilitative services" means health care services that help a person restore or improve skills and
functioning for daily living that have been lost or impaired; and
(d) "Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills
and functioning for daily living that have been lost or impaired.
(2) Except as provided in subsection (4) of this section, any health insurance policy, certificate, plan, or
contract, including but not limited to a health benefit plan, that provides coverage for:
(a) Habilitative services, shall provide coverage for habilitative speech therapy as a treatment for
stuttering, regardless of whether the stuttering is classified as developmental;
(b) Rehabilitative services, shall provide coverage for rehabilitative speech therapy as a treatment for
stuttering; or
(c) Both habilitative services and rehabilitative services, shall provide the coverage required under
paragraphs (a) and (b) of this subsection.
(3) The coverage required under subsection (2) of this section shall:
(a) Not be:
1. Subject to any maximum annual benefit limit, including any limits on the number of visits an
insured may make to a speech-language pathologist;
2. Limited based on the type of disease, injury, disorder, or other medical condition that resulted
in the stuttering; or
3. Subject to utilization review or utilization management requirements, including prior
authorization or a determination that the speech therapy services are medically necessary; and
(b) 1. Include coverage for speech therapy provided in person and via telehealth.
2. The telehealth coverage required under this paragraph shall:
a. Not be less than the coverage required for health benefit plans under KRS 304.17A-
138; and
b. Include the use of any communication technology, application, or platform to deliver
telehealth services, except coverage may be restricted to technology, applications, or
platforms that are compliant with any applicable privacy provisions of the federal
Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. sec. 1320d et
seq., as amended.
(4) If the application of any requirement of this section to a qualified health plan as defined in 42 U.S.C. sec.
18021(a)(1), as amended, would result in a determination that the state must make payments to defray the
cost of the requirement under 42 U.S.C. sec. 18031(d)(3) and 45 C.F.R. sec. 155.170, as amended, then the
requirement shall not apply to the qualified health plan until the cost defrayal requirement is no longer
applicable. ACTS OF THE GENERAL ASSEMBLY 2
Section 2. KRS 304.17C-125 (Effective January 1, 2025) is amended to read as follows:
The following[KRS 304.17A-262] shall apply to limited health service benefit plans, including any limited health
service contract, as defined in KRS 304.38A-010:
(1) KRS 304.17A-262; and
(2) Section 1 of this Act.
Section 3. KRS 205.522 is amended to read as follows:
(1) With respect to the administration and provision of Medicaid benefits pursuant to this chapter, the
Department for Medicaid Services,[ and] any managed care organization contracted to provide Medicaid
benefits pursuant to this chapter, and the state's medical assistance program shall be subject to, and comply
with, the following, as applicable:[provisions of ]
(a) KRS 304.17A-163;[, ]
(b) KRS 304.17A-1631;[, ]
(c) KRS 304.17A-167;[, ]
(d) KRS 304.17A-235;[, ]
(e) KRS 304.17A-257;[, ]
(f) KRS 304.17A-259;[, ]
(g) KRS 304.17A-263;[, ]
(h) KRS 304.17A-515;[, ]
(i) KRS 304.17A-580;[, ]
(j) KRS 304.17A-600, 304.17A-603, and 304.17A-607;[, and ]
(k) KRS 304.17A-740 to 304.17A-743; and[, as applicable]
(l) Section 1 of this Act.
(2) A managed care organization contracted to provide Medicaid benefits pursuant to this chapter shall comply
with the reporting requirements of KRS 304.17A-732.
Section 4. KRS 205.6485 is amended to read as follows:
(1) As used in this section, "KCHIP" means the Kentucky Children's Health Insurance Program.
(2) The Cabinet for Health and Family Services shall:
(a) Prepare a state child health plan, known as KCHIP, meeting the requirements of Title XXI of the
Federal Social Security Act, for submission to the Secretary of the United States Department of Health
and Human Services within such time as will permit the state to receive the maximum amounts of
federal matching funds available under Title XXI; and[. The cabinet shall, ]
(b) By administrative regulation promulgated in accordance with KRS Chapter 13A, establish the
following:
1.[(a)] The eligibility criteria for children covered by KCHIP, which shall include a provision that[the
Kentucky Children's Health Insurance Program. However,] no person eligible for services under
Title XIX of the Social Security Act, 42 U.S.C. secs. 1396 to 1396v, as amended, shall be
eligible for services under KCHIP,[the Kentucky Children's Health Insurance Program] except to
the extent that Title XIX coverage is expanded by KRS 205.6481 to 205.6495 and KRS
304.17A-340;
2.[(b)] The schedule of benefits to be covered by KCHIP[the Kentucky Children's Health Insurance
Program], which shall:[ include preventive services, vision services including glasses, and dental
services including at least sealants, extractions, and fillings, and which shall]
a. Be at least equivalent to one (1) of the following:
i.[1.] The standard Blue Cross/Blue Shield preferred provider option under the Federal
Employees Health Benefit Plan established by 5 U.S.C. sec. 8903(1); CHAPTER 69
Legislative Research Commission PDF Version
3
ii.[2.] A mid-range health benefit coverage plan that is offered and generally available to
state employees; or
iii.[3.] Health insurance coverage offered by a health maintenance organization that has
the largest insured commercial, non-Medicaid enrollment of covered lives in the
state; and
b. Comply with subsection (6) of this section;
3.[(c)] The premium contribution per family for[of] health insurance coverage available under KCHIP,
which[the Kentucky Children's Health Insurance Program with provisions for the payment of
premium contributions by families of children eligible for coverage by the program based upon a
sliding scale relating to family income. Premium contributions] shall be based:
a. On a six (6) month period; and
b. Upon a sliding scale relating to family income not to exceed:
i.[1.] Ten dollars ($10), to be paid by a family with income between one hundred percent
(100%) to one hundred thirty-three percent (133%) of the federal poverty level;
ii.[2.] Twenty dollars ($20), to be paid by a family with income between one hundred
thirty-four percent (134%) to one hundred forty-nine percent (149%) of the federal
poverty level; and
iii.[3.] One hundred twenty dollars ($120), to be paid by a family with income between
one hundred fifty percent (150%) to two hundred percent (200%) of the federal
poverty level, and which may be made on a partial payment plan of twenty dollars
($20) per month or sixty dollars ($60) per quarter;
4.[(d)] There shall be no copayments for services provided under KCHIP[the Kentucky Children's
Health Insurance Program]; and
5.[(e)] a. The criteria for health services providers and insurers wishing to contract with the
Commonwealth to provide[ the children's health insurance] coverage under KCHIP.
b. [However, ]The cabinet shall provide, in any contracting process for coverage of[the]
preventive services[health insurance program], the opportunity for a public health
department to bid on preventive health services to eligible children within the public
health department's service area. A public health department shall not be disqualified from
bidding because the department does not currently offer all the services required by[
paragraph (b) of] this section[subsection]. The criteria shall be set forth in administrative
regulations under KRS Chapter 13A and shall maximize competition among the providers
and insurers. The[ Cabinet for] Finance and Administration Cabinet shall provide
oversight over contracting policies and procedures to assure that the number of applicants
for contracts is maximized.
(3)[(2)] Within twelve (12) months of federal approval of the state's Title XXI child health plan, the Cabinet for
Health and Family Services shall assure that a KCHIP program is available to all eligible children in all
regions of the state. If necessary, in order to meet this assurance, the cabinet shall institute its own program.
(4)[(3)] KCHIP recipients shall have direct access without a referral from any gatekeeper primary care provider
to dentists for covered primary dental services and to optometrists and ophthalmologists for covered primary
eye and vision services.
(5)[(4)] KCHIP[The Kentucky Children's Health Insurance Plan] shall comply with KRS 304.17A-163 and
304.17A-1631.
(6) The schedule of benefits required under subsection (2)(b)2. of this section shall include:
(a) Preventive services;
(b) Vision services, including glasses;
(c) Dental services, including sealants, extractions, and fillings; and
(d) The coverage required under Section 1 of this Act. ACTS OF THE GENERAL ASSEMBLY 4
Section 5. KRS 164.2871 (Effective January 1, 2025) is amended to read as follows:
(1) The governing board of each state postsecondary educational institution is authorized to purchase liability
insurance for the protection of the individual members of the governing board, faculty, and staff of such
institutions from liability for acts and omissions committed in the course and scope of the individual's
employment or service. Each institution may purchase the type and amount of liability coverage deemed to
best serve the interest of such institution.
(2) All retirement annuity allowances accrued or accruing to any employee of a state postsecondary educational
institution through a retirement program sponsored by the state postsecondary educational institution are
hereby exempt from any state, county, or municipal tax, and shall not be subject to execution, attachment,
garnishment, or any other process whatsoever, nor shall any assignment thereof be enforceable in any court.
Except retirement benefits accrued or accruing to any employee of a state postsecondary educational
institution through a retirement program sponsored by the state postsecondary educational institution on or
after January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent provided in KRS
141.010 and 141.0215.
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for members of governing boards,
faculty and staff of institutions of higher education in this state shall not be construed to be a waiver of
sovereign immunity or any other immunity or privilege.
(4) The governing board of each state postsecondary education institution is authorized to provide a self-insured
employer group health plan to its employees, which plan shall:
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and
(b) Except as provided in subsection (5) of this section, be exempt from conformity with Subtitle 17A of
KRS Chapter 304.
(5) A self-insured employer group health plan provided by the governing board of a state postsecondary education
institution to its employees shall comply with:
(a) KRS 304.17A-163 and 304.17A-1631;
(b) KRS 304.17A-265;
(c) KRS 304.17A-261;[ and]
(d) KRS 304.17A-262; and
(e) Section 1 of this Act.
Section 6. KRS 18A.225 (Effective January 1, 2025) is amended to read as follows:
(1) (a) The term "employee" for purposes of this section means:
1. Any person, including an elected public official, who is regularly employed by any department,
office, board, agency, or branch of state government; or by a public postsecondary educational
institution; or by any city, urban-county, charter county, county, or consolidated local
government, whose legislative body has opted to participate in the state-sponsored health
insurance program pursuant to KRS 79.080; and who is either a contributing member to any one
(1) of the retirement systems administered by the state, including but not limited to the Kentucky
Retirement Systems, County Employees Retirement System, Kentucky Teachers' Retirement
System, the Legislators' Retirement Plan, or the Judicial Retirement Plan; or is receiving a
contractual contribution from the state toward a retirement plan; or, in the case of a public
postsecondary education institution, is an individual participating in an optional retirement plan
authorized by KRS 161.567; or is eligible to participate in a retirement plan established by an
employer who ceases participating in the Kentucky Employees Retirement System pursuant to
KRS 61.522 whose employees participated in the health insurance plans administered by the
Personnel Cabinet prior to the employer's effective cessation date in the Kentucky Employees
Retirement System;
2. Any certified or classified employee of a local board of education or a public charter school as
defined in KRS 160.1590;
3. Any elected member of a local board of education; CHAPTER 69
Legislative Research Commission PDF Version
5
4. Any person who is a present or future recipient of a retirement allowance from the Kentucky
Retirement Systems, County Employees Retirement System, Kentucky Teachers' Retirement
System, the Legislators' Retirement Plan, the Judicial Retirement Plan, or the Kentucky
Community and Technical College System's optional retirement plan authorized by KRS
161.567, except that a person who is receiving a retirement allowance and who is age sixty-five
(65) or older shall not be included, with the exception of persons covered under KRS
61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively employed pursuant to
subparagraph 1. of this paragraph; and
5. Any eligible dependents and beneficiaries of participating employees and retirees who are
entitled to participate in the state-sponsored health insurance program;
(b) The term "health benefit plan" for the purposes of this section means a health benefit plan as defined in
KRS 304.17A-005;
(c) The term "insurer" for the purposes of this section means an insurer as defined in KRS 304.17A-005;
and
(d) The term "managed care plan" for the purposes of this section means a managed care plan as defined in
KRS 304.17A-500.
(2) (a) The secretary of the Finance and Administration Cabinet, upon the recommendation of the secretary of
the Personnel Cabinet, shall procure, in compliance with the provisions of KRS 45A.080, 45A.085, and
45A.090, from one (1) or more insurers authorized to do business in this state, a group health benefit
plan that may include but not be limited to health maintenance organization (HMO), preferred provider
organization (PPO), point of service (POS), and exclusive provider organization (EPO) benefit plans
encompassing all or any class or classes of employees. With the exception of employers governed by
the provisions of KRS Chapters 16, 18A, and 151B, all employers of any class of employees or former
employees shall enter into a contract with the Personnel Cabinet prior to including that group in the
state health insurance group. The contracts shall include but not be limited to designating the entity
responsible for filing any federal forms, adoption of policies required for proper plan administration,
acceptance of the contractual provisions with health insurance carriers or third-party administrators, and
adoption of the payment and reimbursement methods necessary for efficient administration of the health
insurance program. Health insurance coverage provided to state employees under this section shall, at a
minimum, contain the same benefits as provided under Kentucky Kare Standard as of January 1, 1994,
and shall include a mail-order drug option as provided in subsection (13) of this section. All employees
and other persons for whom the health care coverage is provided or made available shall annually be
given an option to elect health care coverage through a self-funded plan offered by the Commonwealth
or, if a self-funded plan is not available, from a list of coverage options determined by the competitive
bid process under the provisions of KRS 45A.080, 45A.085, and 45A.090 and made available during
annual open enrollment.
(b) The policy or policies shall be approved by the commissioner of insurance and may contain the
provisions the commissioner of insurance approves, whether or not otherwise permitted by the
insurance laws.
(c) Any carrier bidding to offer health care coverage to employees shall agree to provide coverage to all
members of the state group, including active employees and retirees and their eligible covered
dependents and beneficiaries, within the county or counties specified in its bid. Except as provided in
subsection (20) of this section, any carrier bidding to offer health care coverage to employees shall also
agree to rate all employees as a single entity, except for those retirees whose former employers insure
their active employees outside the state-sponsored health insurance program and as otherwise provided
in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b.
(d) Any carrier bidding to offer health care coverage to employees shall agree to provide enrollment,
claims, and utilization data to the Commonwealth in a format specified by the Personnel Cabinet with
the understanding that the data shall be owned by the Commonwealth; to provide data in an electronic
form and within a time frame specified by the Personnel Cabinet; and to be subject to penalties for
noncompliance with data reporting requirements as specified by the Personnel Cabinet. The Personnel
Cabinet shall take strict precautions to protect the confidentiality of each individual employee; however,
confidentiality assertions shall not relieve a carrier from the requirement of providing stipulated data to
the Commonwealth. ACTS OF THE GENERAL ASSEMBLY 6
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities for timely analysis of
data received from carriers and, to the extent possible, provide in the request-for-proposal specifics
relating to data requirements, electronic reporting, and penalties for noncompliance. The
Commonwealth shall own the enrollment, claims, and utilization data provided by each carrier and shall
develop methods to protect the confidentiality of the individual. The Personnel Cabinet shall include in
the October annual report submitted pursuant to the provisions of KRS 18A.226 to the Governor, the
General Assembly, and the Chief Justice of the Supreme Court, an analysis of the financial stability of
the program, which shall include but not be limited to loss ratios, methods of risk adjustment,
measurements of carrier quality of service, prescription coverage and cost management, and statutorily
required mandates. If state self-insurance was available as a carrier option, the report also shall provide
a detailed financial analysis of the self-insurance fund including but not limited to loss ratios, reserves,
and reinsurance agreements.
(f) If any agency participating in the state-sponsored employee health insurance program for its active
employees terminates participation and there is a state appropriation for the employer's contribution for
active employees' health insurance coverage, then neither the agency nor the employees shall receive
the state-funded contribution after termination from the state-sponsored employee health insurance
program.
(g) Any funds in flexible spending accounts that remain after all reimbursements have been processed shall
be transferred to the credit of the state-sponsored health insurance plan's appropriation account.
(h) Each entity participating in the state-sponsored health insurance program shall provide an amount at
least equal to the state contribution rate for the employer portion of the health insurance premium. For
any participating entity that used the state payroll system, the employer contribution amount shall be
equal to but not greater than the state contribution rate.
(3) The premiums may be paid by the policyholder:
(a) Wholly from funds contributed by the employee, by payroll deduction or otherwise;
(b) Wholly from funds contributed by any department, board, agency, public postsecondary education
institution, or branch of state, city, urban-county, charter county, county, or consolidated local
government; or
(c) Partly from each, except that any premium due for health care coverage or dental coverage, if any, in
excess of the premium amount contributed by any department, board, agency, postsecondary education
institution, or branch of state, city, urban-county, charter county, county, or consolidated local
government for any other health care coverage shall be paid by the employee.
(4) If an employee moves his or her place of residence or employment out of the service area of an insurer
offering a managed health care plan, under which he or she has elected coverage, into either the service area of
another managed health care plan or into an area of the Commonwealth not within a managed health care plan
service area, the employee shall be given an option, at the time of the move or transfer, to change his or her
coverage to another health benefit plan.
(5) No payment of premium by any department, board, agency, public postsecondary educational institution, or
branch of state, city, urban-county, charter county, county, or consolidated local government shall constitute
compensation to an insured employee for the purposes of any statute fixing or limiting the compensation of
such an employee. Any premium or other expense incurred by any department, board, agency, public
postsecondary educational institution, or branch of state, city, urban-county, charter county, county, or
consolidated local government shall be considered a proper cost of administration.
(6) The policy or policies may contain the provisions with respect to the class or classes of employees covered,
amounts of insurance or coverage for designated classes or groups of employees, policy options, terms of
eligibility, and continuation of insurance or coverage after retirement.
(7) Group rates under this section shall be made available to the disabled child of an employee regardless of the
child's age if the entire premium for the disabled child's coverage is paid by the state employee. A child shall
be considered disabled if he or she has been determined to be eligible for federal Social Security disability
benefits.
(8) The health care contract or contracts for employees shall be entered into for a period of not less than one (1)
year. CHAPTER 69
Legislative Research Commission PDF Version
7
(9) The secretary shall appoint thirty-two (32) persons to an Advisory Committee of State Health Insurance
Subscribers to advise the secretary or the secretary's designee regarding the state-sponsored health insurance
program for employees. The secretary shall appoint, from a list of names submitted by appointing authorities,
members representing school districts from each of the seven (7) Supreme Court districts, members
representing state government from each of the seven (7) Supreme Court districts, two (2) members
representing retirees under age sixty-five (65), one (1) member representing local health departments, two (2)
members representing the Kentucky Teachers' Retirement System, and three (3) members at large. The
secretary shall also appoint two (2) members from a list of five (5) names submitted by the Kentucky
Education Association, two (2) members from a list of five (5) names submitted by the largest state employee
organization of nonschool state employees, two (2) members from a list of five (5) names submitted by the
Kentucky Association of Counties, two (2) members from a list of five (5) names submitted by the Kentucky
League of Cities, and two (2) members from a list of names consisting of five (5) names submitted by each
state employee organization that has two thousand (2,000) or more members on state payroll deduction. The
advisory committee shall be appointed in January of each year and shall meet quarterly.
(10) Notwithstanding any other provision of law to the contrary, the policy or policies provided to employees
pursuant to this section shall not provide coverage for obtaining or performing an abortion, nor shall any state
funds be used for the purpose of obtaining or performing an abortion on behalf of employees or their
dependents.
(11) Interruption of an established treatment regime with maintenance drugs shall be grounds for an insured to
appeal a formulary change through the established appeal procedures approved by the Department of
Insurance, if the physician supervising the treatment certifies that the change is not in the best interests of the
patient.
(12) Any employee who is eligible for and elects to participate in the state health insurance program as a retiree, or
the spouse or beneficiary of a retiree, under any one (1) of the state-sponsored retirement systems shall not be
eligible to receive the state health insurance contribution toward health care coverage as a result of any other
employment for which there is a public employer contribution. This does not preclude a retiree and an active
employee spouse from using both contributions to the extent needed for purchase of one (1) state sponsored
health insurance policy for that plan year.
(13) (a) The policies of health insurance coverage procured under subsection (2) of this section shall include a
mail-order drug option for maintenance drugs for state employees. Maintenance drugs may be
dispensed by mail order in accordance with Kentucky law.
(b) A health insurer shall not discriminate against any retail pharmacy located within the geographic
coverage area of the health benefit plan and that meets the terms and conditions for participation
established by the insurer, including price, dispensing fee, and copay requirements of a mail-order
option. The retail pharmacy shall not be required to dispense by mail.
(c) The mail-order option shall not permit the dispensing of a controlled substance classified in Schedule II.
(14) The policy or policies provided to state employees or their dependents pursuant to this section shall provide
coverage for obtaining a hearing aid and acquiring hearing aid-related services for insured individuals under
eighteen (18) years of age, subject to a cap of one thousand four hundred dollars ($1,400) every thirty-six (36)
months pursuant to KRS 304.17A-132.
(15) Any policy provided to state employees or their dependents pursuant to this section shall provide coverage for
the diagnosis and treatment of autism spectrum disorders consistent with KRS 304.17A-142.
(16) Any policy provided to state employees or their dependents pursuant to this section shall provide coverage for
obtaining amino acid-based elemental formula pursuant to KRS 304.17A-258.
(17) If a state employee's residence and place of employment are in the same county, and if the hospital located
within that county does not offer surgical services, intensive care services, obstetrical services, level II
neonatal services, diagnostic cardiac catheterization services, and magnetic resonance imaging services, the
employee may select a plan available in a contiguous county that does provide those services, and the state
contribution for the plan shall be the amount available in the county where the plan selected is located.
(18) If a state employee's residence and place of employment are each located in counties in which the hospitals do
not offer surgical services, intensive care services, obstetrical services, level II neonatal services, diagnostic
cardiac catheterization services, and magnetic resonance imaging services, the employee may select a plan ACTS OF THE GENERAL ASSEMBLY 8
available in a county contiguous to the county of residence that does provide those services, and the state
contribution for the plan shall be the amount available in the county where the plan selected is located.
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and in the best interests of the
state group to allow any carrier bidding to offer health care coverage under this section to submit bids that may
vary county by county or by larger geographic areas.
(20) Notwithstanding any other provision of this section, the bid for proposals for health insurance coverage for
calendar year 2004 shall include a bid scenario that reflects the statewide rating structure provided in calendar
year 2003 and a bid scenario that allows for a regional rating structure that allows carriers to submit bids that
may vary by region for a given product offering as described in this subsection:
(a) The regional rating bid scenario shall not include a request for bid on a statewide option;
(b) The Personnel Cabinet shall divide the state into geographical regions which shall be the same as the
partnership regions designated by the Department for Medicaid Services for purposes of the Kentucky
Health Care Partnership Program established pursuant to 907 KAR 1:705;
(c) The request for proposal shall require a carrier's bid to include every county within the region or regions
for which the bid is submitted and include but not be restricted to a preferred provider organization
(PPO) option;
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the carrier all of the counties
included in its bid within the region. If the Personnel Cabinet deems the bids submitted in accordance
with this subsection to be in the best interests of state employees in a region, the cabinet may award the
contract for that region to no more than two (2) carriers; and
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including other requirements or
criteria in the request for proposal.
(21) Any fully insured health benefit plan or self-insured plan issued or renewed on or after July 12, 2006, to public
employees pursuant to this section which provides coverage for services rendered by a physician or osteopath
duly licensed under KRS Chapter 311 that are within the scope of practice of an optometrist duly licensed
under the provisions of KRS Chapter 320 shall provide the same payment of coverage to optometrists as
allowed for those services rendered by physicians or osteopaths.
(22) Any fully insured health benefit plan or self-insured plan issued or renewed to public employees pursuant to
this section shall comply with:
(a) KRS 304.12-237;
(b) KRS 304.17A-270 and 304.17A-525;
(c) KRS 304.17A-600 to 304.17A-633;
(d) KRS 205.593;
(e) KRS 304.17A-700 to 304.17A-730;
(f) KRS 304.14-135;
(g) KRS 304.17A-580 and 304.17A-641;
(h) KRS 304.99-123;
(i) KRS 304.17A-138;
(j) KRS 304.17A-148;
(k) KRS 304.17A-163 and 304.17A-1631;
(l) KRS 304.17A-265;
(m) KRS 304.17A-261;
(n) KRS 304.17A-262;[ and]
(o) Section 1 of this Act; and
(p) Administrative regulations promulgated pursuant to statutes listed in this subsection. CHAPTER 69
Legislative Research Commission PDF Version
9
Section 7. Sections 1, 2, 5, and 6 of this Act apply to policies, certificates, plans, and contracts issued or
renewed on or after January 1, 2025.
Section 8. (1) For purposes of 45 C.F.R. sec. 156.115, the benefits required under Section 1 of this Act
are intended to be, and shall be considered, substantially equal to the benefits required under the state's EHB-
benchmark plan.
(2) For purposes of 45 C.F.R. sec. 155.170, the benefits required under Section 1 of this Act are intended to
be, and shall be considered by the state as, a benefit required by State action "for purposes of compliance with
Federal requirements," and thus, the state shall not consider or identify the benefits required under Section 1 of this
Act as being in addition to the essential health benefits required under federal law.
(3) The "Federal requirements" referred to in subsection (2) of this section include:
(a) The requirement to provide coverage for essential health benefits, which shall include items and
services covered within the category of rehabilitative and habilitative services and devices, as required under 42
U.S.C. sec. 18022(b)(1)(G), as amended; and
(b) The requirement to not discriminate in the provision of health benefits, as required under 45 C.F.R. sec.
156.125, 45 C.F.R. sec. 92.2, and 45 C.F.R. sec. 147.104.
(4) The commissioner of insurance and any other state official or state agency shall:
(a) Comply with the requirements of this section; and
(b) Not take any action that is in violation of or in conflict with this section.
Section 9. Notwithstanding KRS 194A.099:
(1) Within 90 days of the effective date of this section and subject to Section 8 of this Act, the Department
of Insurance shall identify, in accordance with 45 C.F.R. sec. 155.170(a)(3), whether the application of any
requirement of Section 1 of this Act to a qualified health plan (QHP) is in addition to the essential health benefits
required under federal law.
(2) If it is determined that the application of any requirement of Section 1 of this Act to a QHP is in
addition to the essential health benefits required under federal law, then the department shall, within 180 days of the
effective date of this section, apply for a waiver under 42 U.S.C. sec. 18052, as amended, or any other applicable
federal law of all or any of the cost defrayal requirements under 42 U.S.C. sec. 18031(d)(3) and 45 C.F.R. sec.
155.170, as amended.
(3) The application required under subsection (2) of this section:
(a) Shall comply with the requirements of federal law for obtaining a waiver; and
(b) May propose changes to the state's EHB-benchmark plan, as defined in 45 C.F.R. sec. 156.20, that are
not in conflict with existing state law.
Section 10. If the Cabinet for Health and Family Services determines that a waiver or other authorization
from a federal agency is necessary to implement Section 3 or 4 of this Act for any reason, including the loss of
federal funds, the cabinet shall, within 90 days of the effective date of this section, request the waiver or
authorization, and may only delay implementation of those provisions for which a waiver or authorization was
deemed necessary until the waiver or authorization is granted.
Section 11. Sections 1 to 7 of this Act take effect January 1, 2025.
Signed by Governor April 4, 2024.