AN ACT relating to coverage for breast examinations.

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AN ACT relating to coverage for breast examinations. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
Section 1. KRS 304.17-316 is amended to read as follows: 3
(1) As used in this section: 4
(a) "Breast examination" includes any: 5
1. Mammogram; 6
2. Diagnostic breast examination; and 7
3. Supplemental breast examination; 8
(b) "Cost-sharing requirements" means any: 9
1. Deductible, coinsurance, or copayment; or 10
2. Out-of-pocket expense imposed upon an insured that is similar to an 11
expense referenced in subparagraph 1. of this paragraph; 12
(c)[(b)] 1. "Diagnostic breast examination" means a medically necessary and 13
appropriate examination of the breast that is used to evaluate an 14
abnormality seen or suspected from, or detected by, a screening 15
examination for breast cancer or another means of examination. 16
2. As used in subparagraph 1. o f this paragraph, "examination of the 17
breast" includes but is not limited to an examination using diagnostic 18
mammography, breast magnetic resonance imaging, or breast 19
ultrasound; 20
(d)[(c)] 1. "Mammogram" means an X -ray examination of the breast, with at 21
least two (2) views of each breast and with an average radiation 22
exposure at the current recommended level as set forth in guidelines of 23
the American College of Radiology, using equipment dedicated 24
specifically for mammography, including but not limited to: 25
a. The X -ray tube, filter, compression device, screens, film, and 26
cassettes; 27
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b. Digital mammography; and 1
c. Breast tomosynthesis. 2
2. As used in subparagraph 1. of this paragraph, "breast tomosynthesis" 3
means a radiologic procedure that involves the acquisit ion of projection 4
images over the stationary breast to produce cross -sectional digital 5
three-dimensional images of the breast; and 6
(e)[(d)] 1. "Supplemental breast examination" means a medically necessary 7
and appropriate examination of the breast that is: 8
a. Used to screen for breast cancer when there is no abnormality seen 9
or suspected; and 10
b. Based on personal or family medical history, or additional factors, 11
that may increase the individual's risk of breast cancer. 12
2. As used in subparagraph 1. of this p aragraph, "examination of the 13
breast" includes but is not limited to: 14
a. A mammogram; and 15
b. An examination using breast magnetic resonance imaging or 16
breast ultrasound. 17
(2) Subject to subsection (3) of this section and except as otherwise provided in 18
subsection (4) of this section, a health insurance policy, plan, certificate, or contract 19
issued, renewed, or delivered in this Commonwealth: 20
(a) That provides coverage on an expense -incurred basis for surgical services for 21
a mastectomy shall also provide coverage for: 22
1. a. Low-dose mammography screening for persons who have no sign 23
or symptom of breast cancer upon self -referral or referral by a 24
health care practitioner acting within the scope of the practitioner's 25
licensure; and[.] 26
b. The coverage required un der this subparagraph may be limited to 27
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the following: 1
i. One (1) mammogram for persons ages thirty -five (35) years 2
through thirty-nine (39) years; and 3
ii. [One (1) mammogram every two (2) years for persons ages 4
forty (40) years through forty-nine (49) years; 5
iii. ]One (1) mammogram per year for persons ages forty 6
(40)[fifty (50)] years and over; and 7
[iv. A benefit of fifty dollars ($50) per screening mammogram. 8
c. The coverage required under this subparagraph shall be subject to 9
deductibles and coinsurance that are no less favorable than the 10
deductibles and coinsurance for coverage for physical illness 11
generally; and] 12
2. [a. ]Mammograms for any insured, regardless o f age, who has been 13
diagnosed with breast disease upon referral by a health care practitioner 14
acting within the scope of the practitioner's licensure[. 15
b. The coverage required under this subparagraph shall be subject to 16
the same annual deductibles or coin surance established for other 17
coverages within the policy]; 18
(b) Shall not impose any cost -sharing requirements for any breast 19
examination[diagnostic breast examination or supplemental breast 20
examination] that is covered under the policy, plan, certificate, or contract; 21
and 22
(c) Shall provide any coverage not otherwise required under this section, 23
including coverage with respect to restrictions on cost -sharing requirements, 24
for breast examinations [, including mammograms,] that is required for that 25
policy, plan, certificate, or contract under federal law. 26
(3) To the extent permitted under federal law, the coverage required under subsection 27
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(2)(a) of this section shall be limited to mammograms: 1
(a) Performed by a radiographer: 2
1. Licensed under KRS Chapter 311B; or 3
2. Certified by the American Registry of Radiologic Technologists; 4
(b) Interpreted by a qualified radiologist; 5
(c) Performed under the direction of a person licensed to practice medicine and 6
certified by the American Board of Radiology; 7
(d) Performed by a facility and ordered by a health care practitioner that follow 8
federal laws relating to the notification of mammography exam results and 9
maintaining medical records; 10
(e) Performed by a facility that meets current criteria of the American College of 11
Radiology Mammography Accreditation Program; and 12
(f) Performed on dedicated equipment that meets the guidelines established by 13
the American College of Radiology. 14
(4) If the application of any requirement[ of subsection (2)] of this section would be the 15
sole cause of a health insurance policy's, plan's, certificate's, or contract's failure to 16
qualify as a Health Savings Account -qualified High Deductible Health Plan under 17
26 U.S.C. sec. 223, as amended, then the requirement shall not apply to that policy, 18
plan, certificate, or contract until the minimum deductible under 26 U.S.C. sec. 223, 19
as amended, is satisfied. 20
(5) This section shall not be construed to limit coverage: 21
(a) Provided under a health benefit plan; or 22
(b) Required under any other law. 23
SECTION 2. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 24
IS CREATED TO READ AS FOLLOWS: 25
(1) As used in this section: 26
(a) "Health benefit plan" has the same meaning as in KRS 304.17A -005, 27
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except for purposes of this section, the term includes: 1
1. Short-term limited-duration coverage; and 2
2. Student health insurance offered by a Kentucky -licensed insurer 3
under written contract with a university or college whose students it 4
proposes to insure; and 5
(b) "Most recent applicable criteria or guidelines" means the most recent 6
applicable: 7
1. American College of Radiology Appropriateness Criteria; or 8
2. Clinical practice guidelines established by the National 9
Comprehensive Cancer Network. 10
(2) Except as provided in subsection (3) of this section: 11
(a) A health benefit plan shall provide coverage of preventive screenings for the 12
detection of breast cancer for an individual who meets any of the following 13
criteria: 14
1. The individual is at increased risk of breast can cer, as determined by 15
the most recent applicable criteria or guidelines; 16
2. The individual has heterogeneously or extremely dense breasts tissue 17
as defined by the Breast Imaging Reporting and Data System 18
established by the American College of Radiology; or 19
3. A health care provider has determined, in accordance with the most 20
recent applicable criteria or guidelines, that the individual requires the 21
screening by reason of factors other than those set forth in 22
subparagraphs 1. and 2. of this paragraph, includ ing age, race, 23
ethnicity, or personal or family medical history. 24
(b) The coverage required under paragraph (a) of this subsection shall: 25
1. Not be subject to: 26
a. Frequency limitations; or 27
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b. Any deductible, coinsurance, copayment, or other cost -sharing 1
requirement; and 2
2. Include any 2D or 3D mammogram, breast ultrasound, breast 3
magnetic resonance imaging, and other screening or imaging 4
technology that is provided to an individual in accordance with the 5
most recent applicable criteria or guidelines. 6
(3) If the application of any requirement of this section would be the sole cause of a 7
health benefit plan's failure to qualify as a Health Savings Account -qualified 8
High Deductible Health Plan under 26 U.S.C. sec. 223, as amended, then the 9
requirement shall not apply to that health benefit plan until the minimum 10
deductible under 26 U.S.C. sec. 223, as amended, is satisfied. 11
(4) This section shall not be construed to limit coverage: 12
(a) Provided under a health benefit plan; or 13
(b) Required under any other law. 14
Section 3. KRS 164.2871 is amended to read as follows: 15
(1) The governing board of each state postsecondary educational institution is 16
authorized to purchase liability insurance for the protection of the individual 17
members of the governing board, faculty, and staff of such institutions from liability 18
for acts and omissions committed in the course and scope of the individual's 19
employment or service. Each institution may purchase the type and amount of 20
liability coverage deemed to best serve the interest of such institution. 21
(2) All retirement annuity allowances accrued or accruing to any employee of a state 22
postsecondary educational institution through a retirement program sponsored by 23
the state postsecondary educational instit ution are hereby exempt from any state, 24
county, or municipal tax, and shall not be subject to execution, attachment, 25
garnishment, or any other process whatsoever, nor shall any assignment thereof be 26
enforceable in any court. Except retirement benefits accr ued or accruing to any 27
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employee of a state postsecondary educational institution through a retirement 1
program sponsored by the state postsecondary educational institution on or after 2
January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to t he extent 3
provided in KRS 141.010 and 141.0215. 4
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 5
members of governing boards, faculty and staff of institutions of higher education 6
in this state shall not be construed to be a waiver of sovereign immunity or any 7
other immunity or privilege. 8
(4) The governing board of each state postsecondary education institution is authorized 9
to provide a self -insured employer group health plan to its employees, which plan 10
shall: 11
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 12
(b) Except as provided in subsection (5) of this section, be exempt from 13
conformity with Subtitle 17A of KRS Chapter 304. 14
(5) A self -insured employer group health plan provided by the governing boa rd of a 15
state postsecondary education institution to its employees shall comply with: 16
(a) KRS 304.17A-129; 17
(b) KRS 304.17A-133; 18
(c) KRS 304.17A-145; 19
(d) KRS 304.17A-163 and 304.17A-1631; 20
(e) KRS 304.17A-261; 21
(f) KRS 304.17A-262; 22
(g) KRS 304.17A-264;[ and] 23
(h) KRS 304.17A-265; and 24
(i) Section 2 of this Act. 25
(6) (a) A self-insured employer group health plan provided by the governing board of 26
a state postsecondary education institution to its employees shall provide a 27
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special enrollment period to pregnant women who are eligible for coverage in 1
accordance with the requirements set forth in KRS 304.17-182. 2
(b) The governing board of a state postsecondary education institution shall, at or 3
before the time an employee is initially offered the opportunity to enroll in the 4
plan or coverage, provide the employee a notice of the special enrollment 5
rights under this subsection. 6
Section 4. KRS 18A.225 is amended to read as follows: 7
(1) (a) The term "employee" for purposes of this section means: 8
1. Any person, including an elected public official, who is regularly 9
employed by any department, office, board, agency, or branch of state 10
government; or by a public postsecondary educational institu tion; or by 11
any city, urban -county, charter county, county, or consolidated local 12
government, whose legislative body has opted to participate in the state -13
sponsored health insurance program pursuant to KRS 79.080; and who 14
is either a contributing member to any one (1) of the retirement systems 15
administered by the state, including but not limited to the Kentucky 16
Retirement Systems, County Employees Retirement System, Kentucky 17
Teachers' Retirement System, the Legislators' Retirement Plan, or the 18
Judicial Retirement Plan; or is receiving a contractual contribution from 19
the state toward a retirement plan; or, in the case of a public 20
postsecondary education institution, is an individual participating in an 21
optional retirement plan authorized by KRS 161.567; or is eligible to 22
participate in a retirement plan established by an employer who ceases 23
participating in the Kentucky Employees Retirement System pursuant to 24
KRS 61.522 whose employees participated in the health insurance plans 25
administered by the Personnel Ca binet prior to the employer's effective 26
cessation date in the Kentucky Employees Retirement System; 27
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2. Any certified or classified employee of a local board of education or a 1
public charter school as defined in KRS 160.1590; 2
3. Any elected member of a local board of education; 3
4. Any person who is a present or future recipient of a retirement 4
allowance from the Kentucky Retirement Systems, County Employees 5
Retirement System, Kentucky Teachers' Retirement System, the 6
Legislators' Retirement Plan, the Judicia l Retirement Plan, or the 7
Kentucky Community and Technical College System's optional 8
retirement plan authorized by KRS 161.567, except that a person who is 9
receiving a retirement allowance and who is age sixty -five (65) or older 10
shall not be included, with the exception of persons covered under KRS 11
61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 12
employed pursuant to subparagraph 1. of this paragraph; and 13
5. Any eligible dependents and beneficiaries of participating employees 14
and retirees wh o are entitled to participate in the state -sponsored health 15
insurance program; 16
(b) The term "health benefit plan" for the purposes of this section means a health 17
benefit plan as defined in KRS 304.17A-005; 18
(c) The term "insurer" for the purposes of this section means an insurer as defined 19
in KRS 304.17A-005; and 20
(d) The term "managed care plan" for the purposes of this section means a 21
managed care plan as defined in KRS 304.17A-500. 22
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 23
recommendation of the secretary of the Personnel Cabinet, shall procure, in 24
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 25
from one (1) or more insurers authorized to do business in this state, a group 26
health benefit plan that may incl ude but not be limited to health maintenance 27
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organization (HMO), preferred provider organization (PPO), point of service 1
(POS), and exclusive provider organization (EPO) benefit plans 2
encompassing all or any class or classes of employees. With the exceptio n of 3
employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 4
all employers of any class of employees or former employees shall enter into 5
a contract with the Personnel Cabinet prior to including that group in the state 6
health insurance grou p. The contracts shall include but not be limited to 7
designating the entity responsible for filing any federal forms, adoption of 8
policies required for proper plan administration, acceptance of the contractual 9
provisions with health insurance carriers or t hird-party administrators, and 10
adoption of the payment and reimbursement methods necessary for efficient 11
administration of the health insurance program. Health insurance coverage 12
provided to state employees under this section shall, at a minimum, contain 13
the same benefits as provided under Kentucky Kare Standard as of January 1, 14
1994, and shall include a mail -order drug option as provided in subsection 15
(13) of this section. All employees and other persons for whom the health care 16
coverage is provided or mad e available shall annually be given an option to 17
elect health care coverage through a self -funded plan offered by the 18
Commonwealth or, if a self -funded plan is not available, from a list of 19
coverage options determined by the competitive bid process under t he 20
provisions of KRS 45A.080, 45A.085, and 45A.090 and made available 21
during annual open enrollment. 22
(b) The policy or policies shall be approved by the commissioner of insurance 23
and may contain the provisions the commissioner of insurance approves, 24
whether or not otherwise permitted by the insurance laws. 25
(c) Any carrier bidding to offer health care coverage to employees shall agree to 26
provide coverage to all members of the state group, including active 27
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employees and retirees and their eligible covered dep endents and 1
beneficiaries, within the county or counties specified in its bid. Except as 2
provided in subsection (20) of this section, any carrier bidding to offer health 3
care coverage to employees shall also agree to rate all employees as a single 4
entity, except for those retirees whose former employers insure their active 5
employees outside the state -sponsored health insurance program and as 6
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 7
(d) Any carrier bidding to offer health care coverag e to employees shall agree to 8
provide enrollment, claims, and utilization data to the Commonwealth in a 9
format specified by the Personnel Cabinet with the understanding that the data 10
shall be owned by the Commonwealth; to provide data in an electronic form 11
and within a time frame specified by the Personnel Cabinet; and to be subject 12
to penalties for noncompliance with data reporting requirements as specified 13
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 14
to protect the confide ntiality of each individual employee; however, 15
confidentiality assertions shall not relieve a carrier from the requirement of 16
providing stipulated data to the Commonwealth. 17
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 18
for timely analysis of data received from carriers and, to the extent possible, 19
provide in the request -for-proposal specifics relating to data requirements, 20
electronic reporting, and penalties for noncompliance. The Commonwealth 21
shall own the enrollment, claims, and utilization data provided by each carrier 22
and shall develop methods to protect the confidentiality of the individual. The 23
Personnel Cabinet shall include in the October annual report submitted 24
pursuant to the provisions of KRS 18A.226 to the Gove rnor, the General 25
Assembly, and the Chief Justice of the Supreme Court, an analysis of the 26
financial stability of the program, which shall include but not be limited to 27
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loss ratios, methods of risk adjustment, measurements of carrier quality of 1
service, prescription coverage and cost management, and statutorily required 2
mandates. If state self -insurance was available as a carrier option, the report 3
also shall provide a detailed financial analysis of the self -insurance fund 4
including but not limited to loss ratios, reserves, and reinsurance agreements. 5
(f) If any agency participating in the state -sponsored employee health insurance 6
program for its active employees terminates participation and there is a state 7
appropriation for the employer's contribution for active employees' health 8
insurance coverage, then neither the agency nor the employees shall receive 9
the state -funded contribution after termination from the state -sponsored 10
employee health insurance program. 11
(g) Any funds in flexible spending accounts that remain after all reimbursements 12
have been processed shall be transferred to the credit of the state -sponsored 13
health insurance plan's appropriation account. 14
(h) Each entity participating in the state-sponsored health insurance program shall 15
provide an amount at least equal to the state contribution rate for the employer 16
portion of the health insurance premium. For any participating entity that used 17
the state payroll system, the employer contribution amount shall be equal to 18
but not greater than the state contribution rate. 19
(3) The premiums may be paid by the policyholder: 20
(a) Wholly from funds contributed by the employee, by payroll deduction or 21
otherwise; 22
(b) Wholly from funds contributed by any department, board , agency, public 23
postsecondary education institution, or branch of state, city, urban -county, 24
charter county, county, or consolidated local government; or 25
(c) Partly from each, except that any premium due for health care coverage or 26
dental coverage, if any , in excess of the premium amount contributed by any 27
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department, board, agency, postsecondary education institution, or branch of 1
state, city, urban -county, charter county, county, or consolidated local 2
government for any other health care coverage shall be paid by the employee. 3
(4) If an employee moves his or her place of residence or employment out of the 4
service area of an insurer offering a managed health care plan, under which he or 5
she has elected coverage, into either the service area of another managed health care 6
plan or into an area of the Commonwealth not within a managed health care plan 7
service area, the employee shall be given an option, at the time of the move or 8
transfer, to change his or her coverage to another health benefit plan. 9
(5) No payment of premium by any department, board, agency, public postsecondary 10
educational institution, or branch of state, city, urban -county, charter county, 11
county, or consolidated local government shall constitute compensation to an 12
insured employee for the p urposes of any statute fixing or limiting the 13
compensation of such an employee. Any premium or other expense incurred by any 14
department, board, agency, public postsecondary educational institution, or branch 15
of state, city, urban -county, charter county, co unty, or consolidated local 16
government shall be considered a proper cost of administration. 17
(6) The policy or policies may contain the provisions with respect to the class or classes 18
of employees covered, amounts of insurance or coverage for designated cla sses or 19
groups of employees, policy options, terms of eligibility, and continuation of 20
insurance or coverage after retirement. 21
(7) Group rates under this section shall be made available to the disabled child of an 22
employee regardless of the child's age if the entire premium for the disabled child's 23
coverage is paid by the state employee. A child shall be considered disabled if he or 24
she has been determined to be eligible for federal Social Security disability benefits. 25
(8) The health care contract or contra cts for employees shall be entered into for a 26
period of not less than one (1) year. 27
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(9) The secretary shall appoint thirty -two (32) persons to an Advisory Committee of 1
State Health Insurance Subscribers to advise the secretary or the secretary's 2
designee r egarding the state -sponsored health insurance program for employees. 3
The secretary shall appoint, from a list of names submitted by appointing 4
authorities, members representing school districts from each of the seven (7) 5
Supreme Court districts, members re presenting state government from each of the 6
seven (7) Supreme Court districts, two (2) members representing retirees under age 7
sixty-five (65), one (1) member representing local health departments, two (2) 8
members representing the Kentucky Teachers' Retir ement System, and three (3) 9
members at large. The secretary shall also appoint two (2) members from a list of 10
five (5) names submitted by the Kentucky Education Association, two (2) members 11
from a list of five (5) names submitted by the largest state employee organization of 12
nonschool state employees, two (2) members from a list of five (5) names submitted 13
by the Kentucky Association of Counties, two (2) members from a list of five (5) 14
names submitted by the Kentucky League of Cities, and two (2) members fr om a 15
list of names consisting of five (5) names submitted by each state employee 16
organization that has two thousand (2,000) or more members on state payroll 17
deduction. The advisory committee shall be appointed in January of each year and 18
shall meet quarterly. 19
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 20
provided to employees pursuant to this section shall not provide coverage for 21
obtaining or performing an abortion, nor shall any state funds be used for the 22
purpose of obtaining or performing an abortion on behalf of employees or their 23
dependents. 24
(11) Interruption of an established treatment regime with maintenance drugs shall be 25
grounds for an insured to appeal a formulary change through the established appeal 26
procedures approved by the Department of Insurance, if the physician supervising 27
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the treatment certifies that the change is not in the best interests of the patient. 1
(12) Any employee who is eligible for and elects to participate in the state health 2
insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 3
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 4
state health insurance contribution toward health care coverage as a result of any 5
other employment for which there is a public employer contribution. This does not 6
preclude a retiree and an active employee spouse from using both contributions to 7
the extent needed for purchase of one (1) state sponsored health insurance policy 8
for that plan year. 9
(13) (a) The policies of health insurance coverage procured under subsection (2) of 10
this section shall include a mail -order drug option for maintenance drugs for 11
state employees. Maintenance drugs may be dispensed by mail order in 12
accordance with Kentucky law. 13
(b) A health insurer shall not discriminate against any retail pharmacy located 14
within the geographic coverage area of the health benefit plan and that meets 15
the terms and conditions for participation established by the insurer, including 16
price, dispen sing fee, and copay requirements of a mail -order option. The 17
retail pharmacy shall not be required to dispense by mail. 18
(c) The mail -order option shall not permit the dispensing of a controlled 19
substance classified in Schedule II. 20
(14) The policy or polici es provided to state employees or their dependents pursuant to 21
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 22
aid-related services for insured individuals under eighteen (18) years of age, subject 23
to a cap of one thou sand four hundred dollars ($1,400) every thirty -six (36) months 24
pursuant to KRS 304.17A-132. 25
(15) Any policy provided to state employees or their dependents pursuant to this section 26
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 27
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consistent with KRS 304.17A-142. 1
(16) Any policy provided to state employees or their dependents pursuant to this section 2
shall provide coverage for obtaining amino acid -based elemental formula pursuant 3
to KRS 304.17A-258. 4
(17) If a state employe e's residence and place of employment are in the same county, 5
and if the hospital located within that county does not offer surgical services, 6
intensive care services, obstetrical services, level II neonatal services, diagnostic 7
cardiac catheterization ser vices, and magnetic resonance imaging services, the 8
employee may select a plan available in a contiguous county that does provide 9
those services, and the state contribution for the plan shall be the amount available 10
in the county where the plan selected is located. 11
(18) If a state employee's residence and place of employment are each located in 12
counties in which the hospitals do not offer surgical services, intensive care 13
services, obstetrical services, level II neonatal services, diagnostic cardiac 14
catheterization services, and magnetic resonance imaging services, the employee 15
may select a plan available in a county contiguous to the county of residence that 16
does provide those services, and the state contribution for the plan shall be the 17
amount available in the county where the plan selected is located. 18
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 19
in the best interests of the state group to allow any carrier bidding to offer health 20
care coverage under this section to submit bids that may vary county by county or 21
by larger geographic areas. 22
(20) Notwithstanding any other provision of this section, the bid for proposals for health 23
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 24
the statewide rating structure provided in calendar year 2003 and a bid scenario that 25
allows for a regional rating structure that allows carriers to submit bids that may 26
vary by region for a given product offering as described in this subsection: 27
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(a) The regi onal rating bid scenario shall not include a request for bid on a 1
statewide option; 2
(b) The Personnel Cabinet shall divide the state into geographical regions which 3
shall be the same as the partnership regions designated by the Department for 4
Medicaid Serv ices for purposes of the Kentucky Health Care Partnership 5
Program established pursuant to 907 KAR 1:705; 6
(c) The request for proposal shall require a carrier's bid to include every county 7
within the region or regions for which the bid is submitted and include but not 8
be restricted to a preferred provider organization (PPO) option; 9
(d) If the Personnel Cabinet acc epts a carrier's bid, the cabinet shall award the 10
carrier all of the counties included in its bid within the region. If the Personnel 11
Cabinet deems the bids submitted in accordance with this subsection to be in 12
the best interests of state employees in a re gion, the cabinet may award the 13
contract for that region to no more than two (2) carriers; and 14
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 15
other requirements or criteria in the request for proposal. 16
(21) Any fully ins ured health benefit plan or self -insured plan issued or renewed on or 17
after July 12, 2006, to public employees pursuant to this section which provides 18
coverage for services rendered by a physician or osteopath duly licensed under KRS 19
Chapter 311 that are w ithin the scope of practice of an optometrist duly licensed 20
under the provisions of KRS Chapter 320 shall provide the same payment of 21
coverage to optometrists as allowed for those services rendered by physicians or 22
osteopaths. 23
(22) Any fully insured health benefit plan or self -insured plan issued or renewed to 24
public employees pursuant to this section shall comply with: 25
(a) KRS 304.12-237; 26
(b) KRS 304.17A-270 and 304.17A-525; 27
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(c) KRS 304.17A-600 to 304.17A-633; 1
(d) KRS 205.593; 2
(e) KRS 304.17A-700 to 304.17A-730; 3
(f) KRS 304.14-135; 4
(g) KRS 304.17A-580 and 304.17A-641; 5
(h) KRS 304.99-123; 6
(i) KRS 304.17A-138; 7
(j) KRS 304.17A-148; 8
(k) KRS 304.17A-163 and 304.17A-1631; 9
(l) KRS 304.17A-265; 10
(m) KRS 304.17A-261; 11
(n) KRS 304.17A-262; 12
(o) KRS 304.17A-145; 13
(p) KRS 304.17A-129; 14
(q) KRS 304.17A-133; 15
(r) KRS 304.17A-264;[ and] 16
(s) Section 2 of this Act; and 17
(t) Administrative regulations promulgated pursuant to statutes listed in this 18
subsection. 19
(23) (a) Any fully insured health benefit plan or self-insured plan issued or renewed to 20
public employees pursuant to this section shall provide a special enrollment 21
period to pregnant women who are eligible for coverage in accordance with 22
the requirements set forth in KRS 304.17-182. 23
(b) The Department of Employee Insurance sh all, at or before the time a public 24
employee is initially offered the opportunity to enroll in the plan or coverage, 25
provide the employee a notice of the special enrollment rights under this 26
subsection. 27
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Section 5. Sections 1 to 4 of this Act apply to health insurance policies, plans, 1
certificates, and contracts issued, renewed, or delivered on or after January 1, 2027. 2
Section 6. This Act takes effect January 1, 2027. 3