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AN ACT relating to mental health parity and declaring an emergency. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
Section 1. KRS 304.17A-661 is amended to read as follows: 3
(1) Notwithstanding any other provision of law: 4
(a) 1. A health benefit plan [issued or renewed on or after January 1, 2022, 5
]that provides coverage for treatment of a mental health condition shall 6
provide coverage of any treatment of a mental health condition under 7
terms or conditions that are no more restrictive than the terms or 8
conditions provided for treatment of a physical health condition. 9
2. Expenses for mental health and physical health conditions shall be 10
combined for purposes of meeting deductible and out-of-pocket limits 11
required under a health benefit plan. 12
3. A health benefit plan that does not otherwise provide for management of 13
care under the plan or that does not provide for the same degree of 14
management of care for all health or mental health conditions may 15
provide coverage for treatment of mental health conditions through a 16
managed care organization; 17
(b) With respect to mental health condition benefits in any classification of 18
benefits, a health benefit plan required to comply with paragraph (a) of this 19
subsection shall not impose: 20
1. A nonquantitative treatment limitation that does not apply to medical 21
and surgical benefits in the same classification; and 22
2. Medical necessity criteria or a nonquantitative treatment limitation 23
unless, under the terms of the plan, as written and in operation, any 24
processes, strategies, evidentiary standards, or other factors used in 25
applying the criteria or limitation to mental health condition benefits in 26
the classification are comparable to, and are applied no more stringently 27 UNOFFICIAL COPY 25 RS BR 225
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than, the processes, strategies, evidentiary standards, or other factors 1
used in applying the criteria or limitation to medical and surgical 2
benefits in the same classification; and 3
(c) Paragraph (b) of this subsection shall be construed to require, at a minimum, 4
compliance with the requirements for nonquantitative treatment limitations set 5
forth in the Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. 6
sec. 300gg-26, as amended, and any related federal regulations, as amended, 7
including but not limited to 45 C.F.R. secs. 146.136, 147.160, and 8
156.115(a)(3). 9
(2) (a) An insurer that issues or renews a health benefit plan that is subject to the 10
provisions of this section shall submit an annual report to the commissioner 11
and the Legislative Research Commission for referral to the Interim Joint 12
Committee on Health Services, on or before June[April] 1 of each year[ 13
following January 1, 2022], that contains the following: 14
1. A description of the process used to develop or select the medical 15
necessity criteria for both mental health condition benefits and medical 16
and surgical benefits; 17
2. Identification of all nonquantitative treatment limitations applicable to 18
benefits and services covered under the plan that are applied to both 19
mental health condition benefits and medical and surgical benefits 20
within each classification of benefits; 21
3. The results of an analysis that demonstrates compliance with subsection 22
(1)(b) and (c) of this section for the medical necessity criteria described 23
in subparagraph 1. of this paragraph and for each nonquantitative 24
treatment limitation identified in subparagraph 2. of this paragraph, as 25
written and in operation. At a minimum, the results of the analysis shall: 26
a. Identify the factors used to determine that a nonquantitative 27 UNOFFICIAL COPY 25 RS BR 225
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treatment limitation will apply to a benefit, including factors that 1
were considered but rejected; 2
b. Identify and define the specific evidentiary standards used to 3
define the factors and any other evidence relied upon in designing 4
each nonquantitative treatment limitation; 5
c. Provide the comparative analyses, including the results of the 6
analyses, performed to determine that the processes and strategies: 7
i. Used to design each nonquantitative treatment limitation, as 8
written, and the as-written processes and strategies used to 9
apply the nonquantitative treatment limitation to mental 10
health condition benefits are comparable to, and are applied 11
no more stringently than, the processes and strategies used to 12
design each nonquantitative treatment limitation, as written, 13
and the as-written processes and strategies used to apply the 14
nonquantitative treatment limitation to medical and surgical 15
benefits; and 16
ii. Used to apply each nonquantitative treatment limitation, in 17
operation, for mental health condition benefits are 18
comparable to, and are applied no more stringently than, the 19
processes and strategies used to apply each nonquantitative 20
treatment limitation, in operation, for medical and surgical 21
benefits; and 22
d. Disclose the specific findings and conclusions reached by the 23
insurer that the results of the analyses performed under this 24
subparagraph indicate that the insurer is in compliance with 25
subsection (1)(b) and (c) of this section; and 26
4. Any additional information that may be prescribed by the commissioner 27 UNOFFICIAL COPY 25 RS BR 225
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for use in determining compliance with the requirements of this section. 1
(b) The annual report shall be submitted in a manner and format prescribed by the 2
commissioner through administrative regulation. 3
(3) A willful violation of this section shall constitute an act of discrimination and shall 4
be an unfair trade practice under this chapter. The remedies provided under Subtitle 5
12 of this chapter shall apply to conduct in violation of this section. 6
Section 2. Whereas parity in the provision of mental health condition benefits is 7
imperative to the health and well-being of the citizens of the Commonwealth, an 8
emergency is declared to exist, and this Act takes effect upon its passage and approval by 9
the Governor or upon its otherwise becoming a law. 10