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AN ACT relating to coverage for substance use disorder. 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) 1. "Comprehensive supervised substance use disorder treatment" 6
includes but is not limited to treatment for substance use disorder 7
through: 8
a. An inpatient facility; 9
b. A partial hospitalization program; and 10
c. An in-home program. 11
2. As used in subparagraph 1. of this paragraph, "in-home program" 12
means a program offered by a health care facility or health care 13
professional for the treatment of substance use disorder which the 14
insured accesses through telehealth as defined in KRS 211.332; and 15
(b) "Health plan": 16
1. Means any health insurance policy, certificate, contract, or plan that 17
offers or provides substance use disorder coverage: 18
a. By direct payment, reimbursement, or otherwise; and 19
b. On a fully insured or self-insured basis or any combination 20
thereof; and 21
2. Includes a health benefit plan; 22
(2) A health plan shall provide coverage for comprehensive supervised substance use 23
disorder treatment. 24
(3) (a) The coverage required under subsection (2) of this section shall not be 25
limited to a duration of less than six (6) months. 26
(b) Any prior authorization granted for coverage required under subsection (2) 27 UNOFFICIAL COPY 25 RS BR 1358
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of this section shall not be limited to a specific health care professional or 1
facility, except that, if the underlying coverage is limited to in-network 2
health care professionals or facilities, a prior authorization may also be 3
limited to in-network health care professionals or facilities. 4
(4) Nothing in this section shall be construed to limit the coverage required by: 5
(a) KRS 304.17A-138; 6
(b) KRS 304.17A-145; or 7
(c) Any other law. 8
Section 2. KRS 304.17C-125 is amended to read as follows: 9
The following shall apply to limited health service benefit plans, including any limited 10
health service contract, as defined in KRS 304.38A-010: 11
(1) KRS 304.17A-129; 12
(2) KRS 304.17A-262;[ and] 13
(3) KRS 304.17A-591 to 304.17A-599; and 14
(4) Section 1 of this Act. 15
Section 3. KRS 18A.225 is amended to read as follows: 16
(1) (a) The term "employee" for purposes of this section means: 17
1. Any person, including an elected public official, who is regularly 18
employed by any department, office, board, agency, or branch of state 19
government; or by a public postsecondary educational institution; or by 20
any city, urban-county, charter county, county, or consolidated local 21
government, whose legislative body has opted to participate in the state-22
sponsored health insurance program pursuant to KRS 79.080; and who 23
is either a contributing member to any one (1) of the retirement systems 24
administered by the state, including but not limited to the Kentucky 25
Retirement Systems, County Employees Retirement System, Kentucky 26
Teachers' Retirement System, the Legislators' Retirement Plan, or the 27 UNOFFICIAL COPY 25 RS BR 1358
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Judicial Retirement Plan; or is receiving a contractual contribution from 1
the state toward a retirement plan; or, in the case of a public 2
postsecondary education institution, is an individual participating in an 3
optional retirement plan authorized by KRS 161.567; or is eligible to 4
participate in a retirement plan established by an employer who ceases 5
participating in the Kentucky Employees Retirement System pursuant to 6
KRS 61.522 whose employees participated in the health insurance plans 7
administered by the Personnel Cabinet prior to the employer's effective 8
cessation date in the Kentucky Employees Retirement System; 9
2. Any certified or classified employee of a local board of education or a 10
public charter school as defined in KRS 160.1590; 11
3. Any elected member of a local board of education; 12
4. Any person who is a present or future recipient of a retirement 13
allowance from the Kentucky Retirement Systems, County Employees 14
Retirement System, Kentucky Teachers' Retirement System, the 15
Legislators' Retirement Plan, the Judicial Retirement Plan, or the 16
Kentucky Community and Technical College System's optional 17
retirement plan authorized by KRS 161.567, except that a person who is 18
receiving a retirement allowance and who is age sixty-five (65) or older 19
shall not be included, with the exception of persons covered under KRS 20
61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 21
employed pursuant to subparagraph 1. of this paragraph; and 22
5. Any eligible dependents and beneficiaries of participating employees 23
and retirees who are entitled to participate in the state-sponsored health 24
insurance program; 25
(b) The term "health benefit plan" for the purposes of this section means a health 26
benefit plan as defined in KRS 304.17A-005; 27 UNOFFICIAL COPY 25 RS BR 1358
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(c) The term "insurer" for the purposes of this section means an insurer as defined 1
in KRS 304.17A-005; and 2
(d) The term "managed care plan" for the purposes of this section means a 3
managed care plan as defined in KRS 304.17A-500. 4
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 5
recommendation of the secretary of the Personnel Cabinet, shall procure, in 6
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 7
from one (1) or more insurers authorized to do business in this state, a group 8
health benefit plan that may include but not be limited to health maintenance 9
organization (HMO), preferred provider organization (PPO), point of service 10
(POS), and exclusive provider organization (EPO) benefit plans 11
encompassing all or any class or classes of employees. With the exception of 12
employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 13
all employers of any class of employees or former employees shall enter into 14
a contract with the Personnel Cabinet prior to including that group in the state 15
health insurance group. The contracts shall include but not be limited to 16
designating the entity responsible for filing any federal forms, adoption of 17
policies required for proper plan administration, acceptance of the contractual 18
provisions with health insurance carriers or third-party administrators, and 19
adoption of the payment and reimbursement methods necessary for efficient 20
administration of the health insurance program. Health insurance coverage 21
provided to state employees under this section shall, at a minimum, contain 22
the same benefits as provided under Kentucky Kare Standard as of January 1, 23
1994, and shall include a mail-order drug option as provided in subsection 24
(13) of this section. All employees and other persons for whom the health care 25
coverage is provided or made available shall annually be given an option to 26
elect health care coverage through a self-funded plan offered by the 27 UNOFFICIAL COPY 25 RS BR 1358
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Commonwealth or, if a self-funded plan is not available, from a list of 1
coverage options determined by the competitive bid process under the 2
provisions of KRS 45A.080, 45A.085, and 45A.090 and made available 3
during annual open enrollment. 4
(b) The policy or policies shall be approved by the commissioner of insurance 5
and may contain the provisions the commissioner of insurance approves, 6
whether or not otherwise permitted by the insurance laws. 7
(c) Any carrier bidding to offer health care coverage to employees shall agree to 8
provide coverage to all members of the state group, including active 9
employees and retirees and their eligible covered dependents and 10
beneficiaries, within the county or counties specified in its bid. Except as 11
provided in subsection (20) of this section, any carrier bidding to offer health 12
care coverage to employees shall also agree to rate all employees as a single 13
entity, except for those retirees whose former employers insure their active 14
employees outside the state-sponsored health insurance program and as 15
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 16
(d) Any carrier bidding to offer health care coverage to employees shall agree to 17
provide enrollment, claims, and utilization data to the Commonwealth in a 18
format specified by the Personnel Cabinet with the understanding that the data 19
shall be owned by the Commonwealth; to provide data in an electronic form 20
and within a time frame specified by the Personnel Cabinet; and to be subject 21
to penalties for noncompliance with data reporting requirements as specified 22
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 23
to protect the confidentiality of each individual employee; however, 24
confidentiality assertions shall not relieve a carrier from the requirement of 25
providing stipulated data to the Commonwealth. 26
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 27 UNOFFICIAL COPY 25 RS BR 1358
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for timely analysis of data received from carriers and, to the extent possible, 1
provide in the request-for-proposal specifics relating to data requirements, 2
electronic reporting, and penalties for noncompliance. The Commonwealth 3
shall own the enrollment, claims, and utilization data provided by each carrier 4
and shall develop methods to protect the confidentiality of the individual. The 5
Personnel Cabinet shall include in the October annual report submitted 6
pursuant to the provisions of KRS 18A.226 to the Governor, the General 7
Assembly, and the Chief Justice of the Supreme Court, an analysis of the 8
financial stability of the program, which shall include but not be limited to 9
loss ratios, methods of risk adjustment, measurements of carrier quality of 10
service, prescription coverage and cost management, and statutorily required 11
mandates. If state self-insurance was available as a carrier option, the report 12
also shall provide a detailed financial analysis of the self-insurance fund 13
including but not limited to loss ratios, reserves, and reinsurance agreements. 14
(f) If any agency participating in the state-sponsored employee health insurance 15
program for its active employees terminates participation and there is a state 16
appropriation for the employer's contribution for active employees' health 17
insurance coverage, then neither the agency nor the employees shall receive 18
the state-funded contribution after termination from the state-sponsored 19
employee health insurance program. 20
(g) Any funds in flexible spending accounts that remain after all reimbursements 21
have been processed shall be transferred to the credit of the state-sponsored 22
health insurance plan's appropriation account. 23
(h) Each entity participating in the state-sponsored health insurance program shall 24
provide an amount at least equal to the state contribution rate for the employer 25
portion of the health insurance premium. For any participating entity that used 26
the state payroll system, the employer contribution amount shall be equal to 27 UNOFFICIAL COPY 25 RS BR 1358
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but not greater than the state contribution rate. 1
(3) The premiums may be paid by the policyholder: 2
(a) Wholly from funds contributed by the employee, by payroll deduction or 3
otherwise; 4
(b) Wholly from funds contributed by any department, board, agency, public 5
postsecondary education institution, or branch of state, city, urban-county, 6
charter county, county, or consolidated local government; or 7
(c) Partly from each, except that any premium due for health care coverage or 8
dental coverage, if any, in excess of the premium amount contributed by any 9
department, board, agency, postsecondary education institution, or branch of 10
state, city, urban-county, charter county, county, or consolidated local 11
government for any other health care coverage shall be paid by the employee. 12
(4) If an employee moves his or her place of residence or employment out of the 13
service area of an insurer offering a managed health care plan, under which he or 14
she has elected coverage, into either the service area of another managed health care 15
plan or into an area of the Commonwealth not within a managed health care plan 16
service area, the employee shall be given an option, at the time of the move or 17
transfer, to change his or her coverage to another health benefit plan. 18
(5) No payment of premium by any department, board, agency, public postsecondary 19
educational institution, or branch of state, city, urban-county, charter county, 20
county, or consolidated local government shall constitute compensation to an 21
insured employee for the purposes of any statute fixing or limiting the 22
compensation of such an employee. Any premium or other expense incurred by any 23
department, board, agency, public postsecondary educational institution, or branch 24
of state, city, urban-county, charter county, county, or consolidated local 25
government shall be considered a proper cost of administration. 26
(6) The policy or policies may contain the provisions with respect to the class or classes 27 UNOFFICIAL COPY 25 RS BR 1358
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of employees covered, amounts of insurance or coverage for designated classes or 1
groups of employees, policy options, terms of eligibility, and continuation of 2
insurance or coverage after retirement. 3
(7) Group rates under this section shall be made available to the disabled child of an 4
employee regardless of the child's age if the entire premium for the disabled child's 5
coverage is paid by the state employee. A child shall be considered disabled if he or 6
she has been determined to be eligible for federal Social Security disability benefits. 7
(8) The health care contract or contracts for employees shall be entered into for a 8
period of not less than one (1) year. 9
(9) The secretary shall appoint thirty-two (32) persons to an Advisory Committee of 10
State Health Insurance Subscribers to advise the secretary or the secretary's 11
designee regarding the state-sponsored health insurance program for employees. 12
The secretary shall appoint, from a list of names submitted by appointing 13
authorities, members representing school districts from each of the seven (7) 14
Supreme Court districts, members representing state government from each of the 15
seven (7) Supreme Court districts, two (2) members representing retirees under age 16
sixty-five (65), one (1) member representing local health departments, two (2) 17
members representing the Kentucky Teachers' Retirement System, and three (3) 18
members at large. The secretary shall also appoint two (2) members from a list of 19
five (5) names submitted by the Kentucky Education Association, two (2) members 20
from a list of five (5) names submitted by the largest state employee organization of 21
nonschool state employees, two (2) members from a list of five (5) names submitted 22
by the Kentucky Association of Counties, two (2) members from a list of five (5) 23
names submitted by the Kentucky League of Cities, and two (2) members from a 24
list of names consisting of five (5) names submitted by each state employee 25
organization that has two thousand (2,000) or more members on state payroll 26
deduction. The advisory committee shall be appointed in January of each year and 27 UNOFFICIAL COPY 25 RS BR 1358
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shall meet quarterly. 1
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 2
provided to employees pursuant to this section shall not provide coverage for 3
obtaining or performing an abortion, nor shall any state funds be used for the 4
purpose of obtaining or performing an abortion on behalf of employees or their 5
dependents. 6
(11) Interruption of an established treatment regime with maintenance drugs shall be 7
grounds for an insured to appeal a formulary change through the established appeal 8
procedures approved by the Department of Insurance, if the physician supervising 9
the treatment certifies that the change is not in the best interests of the patient. 10
(12) Any employee who is eligible for and elects to participate in the state health 11
insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 12
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 13
state health insurance contribution toward health care coverage as a result of any 14
other employment for which there is a public employer contribution. This does not 15
preclude a retiree and an active employee spouse from using both contributions to 16
the extent needed for purchase of one (1) state sponsored health insurance policy 17
for that plan year. 18
(13) (a) The policies of health insurance coverage procured under subsection (2) of 19
this section shall include a mail-order drug option for maintenance drugs for 20
state employees. Maintenance drugs may be dispensed by mail order in 21
accordance with Kentucky law. 22
(b) A health insurer shall not discriminate against any retail pharmacy located 23
within the geographic coverage area of the health benefit plan and that meets 24
the terms and conditions for participation established by the insurer, including 25
price, dispensing fee, and copay requirements of a mail-order option. The 26
retail pharmacy shall not be required to dispense by mail. 27 UNOFFICIAL COPY 25 RS BR 1358
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(c) The mail-order option shall not permit the dispensing of a controlled 1
substance classified in Schedule II. 2
(14) The policy or policies provided to state employees or their dependents pursuant to 3
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 4
aid-related services for insured individuals under eighteen (18) years of age, subject 5
to a cap of one thousand four hundred dollars ($1,400) every thirty-six (36) months 6
pursuant to KRS 304.17A-132. 7
(15) Any policy provided to state employees or their dependents pursuant to this section 8
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 9
consistent with KRS 304.17A-142. 10
(16) Any policy provided to state employees or their dependents pursuant to this section 11
shall provide coverage for obtaining amino acid-based elemental formula pursuant 12
to KRS 304.17A-258. 13
(17) If a state employee's residence and place of employment are in the same county, 14
and if the hospital located within that county does not offer surgical services, 15
intensive care services, obstetrical services, level II neonatal services, diagnostic 16
cardiac catheterization services, and magnetic resonance imaging services, the 17
employee may select a plan available in a contiguous county that does provide 18
those services, and the state contribution for the plan shall be the amount available 19
in the county where the plan selected is located. 20
(18) If a state employee's residence and place of employment are each located in 21
counties in which the hospitals do not offer surgical services, intensive care 22
services, obstetrical services, level II neonatal services, diagnostic cardiac 23
catheterization services, and magnetic resonance imaging services, the employee 24
may select a plan available in a county contiguous to the county of residence that 25
does provide those services, and the state contribution for the plan shall be the 26
amount available in the county where the plan selected is located. 27 UNOFFICIAL COPY 25 RS BR 1358
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(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 1
in the best interests of the state group to allow any carrier bidding to offer health 2
care coverage under this section to submit bids that may vary county by county or 3
by larger geographic areas. 4
(20) Notwithstanding any other provision of this section, the bid for proposals for health 5
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 6
the statewide rating structure provided in calendar year 2003 and a bid scenario that 7
allows for a regional rating structure that allows carriers to submit bids that may 8
vary by region for a given product offering as described in this subsection: 9
(a) The regional rating bid scenario shall not include a request for bid on a 10
statewide option; 11
(b) The Personnel Cabinet shall divide the state into geographical regions which 12
shall be the same as the partnership regions designated by the Department for 13
Medicaid Services for purposes of the Kentucky Health Care Partnership 14
Program established pursuant to 907 KAR 1:705; 15
(c) The request for proposal shall require a carrier's bid to include every county 16
within the region or regions for which the bid is submitted and include but not 17
be restricted to a preferred provider organization (PPO) option; 18
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 19
carrier all of the counties included in its bid within the region. If the Personnel 20
Cabinet deems the bids submitted in accordance with this subsection to be in 21
the best interests of state employees in a region, the cabinet may award the 22
contract for that region to no more than two (2) carriers; and 23
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 24
other requirements or criteria in the request for proposal. 25
(21) Any fully insured health benefit plan or self-insured plan issued or renewed on or 26
after July 12, 2006, to public employees pursuant to this section which provides 27 UNOFFICIAL COPY 25 RS BR 1358
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coverage for services rendered by a physician or osteopath duly licensed under KRS 1
Chapter 311 that are within the scope of practice of an optometrist duly licensed 2
under the provisions of KRS Chapter 320 shall provide the same payment of 3
coverage to optometrists as allowed for those services rendered by physicians or 4
osteopaths. 5
(22) Any fully insured health benefit plan or self-insured plan issued or renewed to 6
public employees pursuant to this section shall comply with: 7
(a) KRS 304.12-237; 8
(b) KRS 304.17A-270 and 304.17A-525; 9
(c) KRS 304.17A-600 to 304.17A-633; 10
(d) KRS 205.593; 11
(e) KRS 304.17A-700 to 304.17A-730; 12
(f) KRS 304.14-135; 13
(g) KRS 304.17A-580 and 304.17A-641; 14
(h) KRS 304.99-123; 15
(i) KRS 304.17A-138; 16
(j) KRS 304.17A-148; 17
(k) KRS 304.17A-163 and 304.17A-1631; 18
(l) KRS 304.17A-265; 19
(m) KRS 304.17A-261; 20
(n) KRS 304.17A-262; 21
(o) KRS 304.17A-145; 22
(p) KRS 304.17A-129; 23
(q) KRS 304.17A-133; 24
(r) KRS 304.17A-264;[ and] 25
(s) Section 1 of this Act; and 26
(t) Administrative regulations promulgated pursuant to statutes listed in this 27 UNOFFICIAL COPY 25 RS BR 1358
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subsection. 1
(23) (a) Any fully insured health benefit plan or self-insured plan issued or renewed to 2
public employees pursuant to this section shall provide a special enrollment 3
period to pregnant women who are eligible for coverage in accordance with 4
the requirements set forth in KRS 304.17-182. 5
(b) The Department of Employee Insurance shall, at or before the time a public 6
employee is initially offered the opportunity to enroll in the plan or coverage, 7
provide the employee a notice of the special enrollment rights under this 8
subsection. 9
Section 4. KRS 164.2871 is amended to read as follows: 10
(1) The governing board of each state postsecondary educational institution is 11
authorized to purchase liability insurance for the protection of the individual 12
members of the governing board, faculty, and staff of such institutions from liability 13
for acts and omissions committed in the course and scope of the individual's 14
employment or service. Each institution may purchase the type and amount of 15
liability coverage deemed to best serve the interest of such institution. 16
(2) All retirement annuity allowances accrued or accruing to any employee of a state 17
postsecondary educational institution through a retirement program sponsored by 18
the state postsecondary educational institution are hereby exempt from any state, 19
county, or municipal tax, and shall not be subject to execution, attachment, 20
garnishment, or any other process whatsoever, nor shall any assignment thereof be 21
enforceable in any court. Except retirement benefits accrued or accruing to any 22
employee of a state postsecondary educational institution through a retirement 23
program sponsored by the state postsecondary educational institution on or after 24
January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 25
provided in KRS 141.010 and 141.0215. 26
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 27 UNOFFICIAL COPY 25 RS BR 1358
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members of governing boards, faculty and staff of institutions of higher education 1
in this state shall not be construed to be a waiver of sovereign immunity or any 2
other immunity or privilege. 3
(4) The governing board of each state postsecondary education institution is authorized 4
to provide a self-insured employer group health plan to its employees, which plan 5
shall: 6
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 7
(b) Except as provided in subsection (5) of this section, be exempt from 8
conformity with Subtitle 17A of KRS Chapter 304. 9
(5) A self-insured employer group health plan provided by the governing board of a 10
state postsecondary education institution to its employees shall comply with: 11
(a) KRS 304.17A-129; 12
(b) KRS 304.17A-133; 13
(c) KRS 304.17A-145; 14
(d) KRS 304.17A-163 and 304.17A-1631; 15
(e) KRS 304.17A-261; 16
(f) KRS 304.17A-262; 17
(g) KRS 304.17A-264;[ and] 18
(h) KRS 304.17A-265; and 19
(i) Section 1 of this Act. 20
(6) (a) A self-insured employer group health plan provided by the governing board of 21
a state postsecondary education institution to its employees shall provide a 22
special enrollment period to pregnant women who are eligible for coverage in 23
accordance with the requirements set forth in KRS 304.17-182. 24
(b) The governing board of a state postsecondary education institution shall, at or 25
before the time an employee is initially offered the opportunity to enroll in the 26
plan or coverage, provide the employee a notice of the special enrollment 27 UNOFFICIAL COPY 25 RS BR 1358
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rights under this subsection. 1
Section 5. Section 1 of this Act may be cited as Braxton's Law. 2
Section 6. Sections 1 to 4 of this Act apply to health plans issued or renewed on 3
or after January 1, 2026. 4
Section 7. This Act takes effect January 1, 2026. 5