AN ACT relating to coverage for hearing aids and related services.

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AN ACT relating to coverage for hearing aids and related services. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
Section 1. KRS 304.17A-132 is amended to read as follows: 3
(1) As used in this section: 4
(a) "Hearing aid": 5
1. Means any wearable[, nondisposable instrument or] device designed for, 6
offered for the purpose of, or represented as aid ing persons with or 7
compensating for,[to aid or compensate for] impaired[ human] hearing; 8
2. Includes[ and] any parts, attachments, or accessories, including 9
earmolds; and[, but excluding ] 10
3. Does not include batteries and cords; and 11
(b) "Related services" means those services necessary to assess, select, and 12
appropriately adjust or fit the hearing aid to ensure optimal performance. 13
(2) A health benefit plan shall provide coverage, subject to all applicable co payments, 14
coinsurance, deductibles, and out -of-pocket limits, for the full cost of one (1) 15
hearing aid per hearing -impaired ear up to two thousand five hundred dollars 16
($2,500)[one thousand four hundred dollars ($1,400)] every thirty-six (36) months 17
for he aring aids for insured individuals under eighteen (18) years of age and all 18
related services which shall be prescribed by an audiologist licensed under KRS 19
Chapter 334A and dispensed by an audiologist or hearing instrument specialist 20
licensed under KRS Chapter 334. 21
(3) An[The] insured may choose a higher priced hearing aid and may pay the 22
difference in cost above the two thousand five hundred dollar ($2,500) [one 23
thousand four hundred dollar ($1,400)] limit as provided in this section without any 24
financial or contractual penalty to the insured or to the provider of the hearing aid. 25
(4)[(3)] A health benefit plan shall not be required to pay a claim filed by its insured 26
for payment of the cost of a hearing aid under the coverage required by [subsection 27
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(2) of ]this section if less than three (3) years prior to the date of the claim the[its] 1
insured filed a claim for payment of the cost of a hearing aid under the required 2
coverage and the claim was paid by any health benefit plan. 3
(5) (a) An insurer or administ rator that utilizes a network to provide hearing aids 4
and related services under a health benefit plan shall ensure that the 5
network is reasonably adequate and accessible with respect to the provision 6
of hearing aids and related services required to be cov ered under this 7
section. 8
(b) A reasonably adequate and accessible network, with respect to the provision 9
of hearing aids and related services required to be covered under this 10
section, shall, at a minimum offer an adequate number of accessible 11
audiologists in accordance with the requirements set forth for managed 12
care plans in KRS 304.17A-515. 13
Section 2. KRS 18A.225 is amended to read as follows: 14
(1) (a) The term "employee" for purposes of this section means: 15
1. Any perso n, including an elected public official, who is regularly 16
employed by any department, office, board, agency, or branch of state 17
government; or by a public postsecondary educational institution; or by 18
any city, urban -county, charter county, county, or conso lidated local 19
government, whose legislative body has opted to participate in the state -20
sponsored health insurance program pursuant to KRS 79.080; and who 21
is either a contributing member to any one (1) of the retirement systems 22
administered by the state, in cluding but not limited to the Kentucky 23
Retirement Systems, County Employees Retirement System, Kentucky 24
Teachers' Retirement System, the Legislators' Retirement Plan, or the 25
Judicial Retirement Plan; or is receiving a contractual contribution from 26
the sta te toward a retirement plan; or, in the case of a public 27
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postsecondary education institution, is an individual participating in an 1
optional retirement plan authorized by KRS 161.567; or is eligible to 2
participate in a retirement plan established by an empl oyer who ceases 3
participating in the Kentucky Employees Retirement System pursuant to 4
KRS 61.522 whose employees participated in the health insurance plans 5
administered by the Personnel Cabinet prior to the employer's effective 6
cessation date in the Kentucky Employees Retirement System; 7
2. Any certified or classified employee of a local board of education or a 8
public charter school as defined in KRS 160.1590; 9
3. Any elected member of a local board of education; 10
4. Any person who is a present or future recip ient of a retirement 11
allowance from the Kentucky Retirement Systems, County Employees 12
Retirement System, Kentucky Teachers' Retirement System, the 13
Legislators' Retirement Plan, the Judicial Retirement Plan, or the 14
Kentucky Community and Technical College S ystem's optional 15
retirement plan authorized by KRS 161.567, except that a person who is 16
receiving a retirement allowance and who is age sixty -five (65) or older 17
shall not be included, with the exception of persons covered under KRS 18
61.702(2)(b)3. and 78.55 36(2)(b)3., unless he or she is actively 19
employed pursuant to subparagraph 1. of this paragraph; and 20
5. Any eligible dependents and beneficiaries of participating employees 21
and retirees who are entitled to participate in the state -sponsored health 22
insurance program; 23
(b) The term "health benefit plan" for the purposes of this section means a health 24
benefit plan as defined in KRS 304.17A-005; 25
(c) The term "insurer" for the purposes of this section means an insurer as defined 26
in KRS 304.17A-005; and 27
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(d) The te rm "managed care plan" for the purposes of this section means a 1
managed care plan as defined in KRS 304.17A-500. 2
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 3
recommendation of the secretary of the Personnel Cabinet, shall procu re, in 4
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 5
from one (1) or more insurers authorized to do business in this state, a group 6
health benefit plan that may include but not be limited to health maintenance 7
organization (HMO), pre ferred provider organization (PPO), point of service 8
(POS), and exclusive provider organization (EPO) benefit plans 9
encompassing all or any class or classes of employees. With the exception of 10
employers governed by the provisions of KRS Chapters 16, 18A, a nd 151B, 11
all employers of any class of employees or former employees shall enter into 12
a contract with the Personnel Cabinet prior to including that group in the state 13
health insurance group. The contracts shall include but not be limited to 14
designating the entity responsible for filing any federal forms, adoption of 15
policies required for proper plan administration, acceptance of the contractual 16
provisions with health insurance carriers or third -party administrators, and 17
adoption of the payment and reimburse ment methods necessary for efficient 18
administration of the health insurance program. Health insurance coverage 19
provided to state employees under this section shall, at a minimum, contain 20
the same benefits as provided under Kentucky Kare Standard as of Janu ary 1, 21
1994, and shall include a mail -order drug option as provided in subsection 22
(13) of this section. All employees and other persons for whom the health care 23
coverage is provided or made available shall annually be given an option to 24
elect health care c overage through a self -funded plan offered by the 25
Commonwealth or, if a self -funded plan is not available, from a list of 26
coverage options determined by the competitive bid process under the 27
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provisions of KRS 45A.080, 45A.085, and 45A.090 and made availabl e 1
during annual open enrollment. 2
(b) The policy or policies shall be approved by the commissioner of insurance 3
and may contain the provisions the commissioner of insurance approves, 4
whether or not otherwise permitted by the insurance laws. 5
(c) Any carrier bidding to offer health care coverage to employees shall agree to 6
provide coverage to all members of the state group, including active 7
employees and retirees and their eligible covered dependents and 8
beneficiaries, within the county or counties specified i n its bid. Except as 9
provided in subsection (20) of this section, any carrier bidding to offer health 10
care coverage to employees shall also agree to rate all employees as a single 11
entity, except for those retirees whose former employers insure their active 12
employees outside the state -sponsored health insurance program and as 13
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 14
(d) Any carrier bidding to offer health care coverage to employees shall agree to 15
provide enrollment, claims, and utiliz ation data to the Commonwealth in a 16
format specified by the Personnel Cabinet with the understanding that the data 17
shall be owned by the Commonwealth; to provide data in an electronic form 18
and within a time frame specified by the Personnel Cabinet; and to be subject 19
to penalties for noncompliance with data reporting requirements as specified 20
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 21
to protect the confidentiality of each individual employee; however, 22
confidentiality asser tions shall not relieve a carrier from the requirement of 23
providing stipulated data to the Commonwealth. 24
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 25
for timely analysis of data received from carriers and, to the extent possible, 26
provide in the request -for-proposal specifics relating to data requirements, 27
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electronic reporting, and penalties for noncompliance. The Commonwealth 1
shall own the enrollment, claims, and utilization data provided by each carrier 2
and shall develop methods to protect the confidentiality of the individual. The 3
Personnel Cabinet shall include in the October annual report submitted 4
pursuant to the provisions of KRS 18A.226 to the Governor, the General 5
Assembly, and the Chief Justice of the Supreme Cou rt, an analysis of the 6
financial stability of the program, which shall include but not be limited to 7
loss ratios, methods of risk adjustment, measurements of carrier quality of 8
service, prescription coverage and cost management, and statutorily required 9
mandates. If state self -insurance was available as a carrier option, the report 10
also shall provide a detailed financial analysis of the self -insurance fund 11
including but not limited to loss ratios, reserves, and reinsurance agreements. 12
(f) If any agency part icipating in the state -sponsored employee health insurance 13
program for its active employees terminates participation and there is a state 14
appropriation for the employer's contribution for active employees' health 15
insurance coverage, then neither the agency nor the employees shall receive 16
the state -funded contribution after termination from the state -sponsored 17
employee health insurance program. 18
(g) Any funds in flexible spending accounts that remain after all reimbursements 19
have been processed shall be trans ferred to the credit of the state -sponsored 20
health insurance plan's appropriation account. 21
(h) Each entity participating in the state-sponsored health insurance program shall 22
provide an amount at least equal to the state contribution rate for the employer 23
portion of the health insurance premium. For any participating entity that used 24
the state payro ll system, the employer contribution amount shall be equal to 25
but not greater than the state contribution rate. 26
(3) The premiums may be paid by the policyholder: 27
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(a) Wholly from funds contributed by the employee, by payroll deduction or 1
otherwise; 2
(b) Wholly from funds contributed by any department, board, agency, public 3
postsecondary education institution, or branch of state, city, urban -county, 4
charter county, county, or consolidated local government; or 5
(c) Partly from each, except that any premium due f or health care coverage or 6
dental coverage, if any, in excess of the premium amount contributed by any 7
department, board, agency, postsecondary education institution, or branch of 8
state, city, urban -county, charter county, county, or consolidated local 9
government for any other health care coverage shall be paid by the employee. 10
(4) If an employee moves his or her place of residence or employment out of the 11
service area of an insurer offering a managed health care plan, under which he or 12
she has elected coverage, into either the service area of another managed health care 13
plan or into an area of the Commonwealth not within a managed health care plan 14
service area, the employee shall be given an option, at the time of the move or 15
transfer, to change his or her coverage to another health benefit plan. 16
(5) No payment of premium by any department, board, agency, public postsecondary 17
educational institution, or branch of state, city, urban -county, charter county, 18
county, or consolidated local government shall consti tute compensation to an 19
insured employee for the purposes of any statute fixing or limiting the 20
compensation of such an employee. Any premium or other expense incurred by any 21
department, board, agency, public postsecondary educational institution, or branc h 22
of state, city, urban -county, charter county, county, or consolidated local 23
government shall be considered a proper cost of administration. 24
(6) The policy or policies may contain the provisions with respect to the class or classes 25
of employees covered, a mounts of insurance or coverage for designated classes or 26
groups of employees, policy options, terms of eligibility, and continuation of 27
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insurance or coverage after retirement. 1
(7) Group rates under this section shall be made available to the disabled chil d of an 2
employee regardless of the child's age if the entire premium for the disabled child's 3
coverage is paid by the state employee. A child shall be considered disabled if he or 4
she has been determined to be eligible for federal Social Security disability benefits. 5
(8) The health care contract or contracts for employees shall be entered into for a 6
period of not less than one (1) year. 7
(9) The secretary shall appoint thirty -two (32) persons to an Advisory Committee of 8
State Health Insurance Subscribers to advise the secretary or the secretary's 9
designee regarding the state -sponsored health insurance program for employees. 10
The secretary shall appoint, from a list of names submitted by appointing 11
authorities, members representing school districts from each of the seven (7) 12
Supreme Court districts, members representing state government from each of the 13
seven (7) Supreme Court districts, two (2) members representing retirees under age 14
sixty-five (65), one (1) member representing local health departments, two (2) 15
members representing the Kentucky Teachers' Retirement System, and three (3) 16
members at large. The secretary shall also appoint two (2) members from a list of 17
five (5) names submitted by the Kentucky Education Association, two (2) members 18
from a list of five (5) names submitted by the largest state employee organization of 19
nonschool state employees, two (2) members from a list of five (5) names submitted 20
by the Kentucky Association of Counties, two (2) members from a list of five (5) 21
names submitted by the Kentucky League of Cities, and two (2) members from a 22
list of names consisting of five (5) names submitted by each state employee 23
organization that has two thousand (2,000) or more members on state payroll 24
deduction. The advisory committee shall be appoin ted in January of each year and 25
shall meet quarterly. 26
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 27
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provided to employees pursuant to this section shall not provide coverage for 1
obtaining or performing an abortion, nor shall any state funds be used for the 2
purpose of obtaining or performing an abortion on behalf of employees or their 3
dependents. 4
(11) Interruption of an established treatment regime with maintenance drugs shall be 5
grounds for an insured to appeal a fo rmulary change through the established appeal 6
procedures approved by the Department of Insurance, if the physician supervising 7
the treatment certifies that the change is not in the best interests of the patient. 8
(12) Any employee who is eligible for and el ects to participate in the state health 9
insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 10
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 11
state health insurance contribution toward h ealth care coverage as a result of any 12
other employment for which there is a public employer contribution. This does not 13
preclude a retiree and an active employee spouse from using both contributions to 14
the extent needed for purchase of one (1) state spons ored health insurance policy 15
for that plan year. 16
(13) (a) The policies of health insurance coverage procured under subsection (2) of 17
this section shall include a mail -order drug option for maintenance drugs for 18
state employees. Maintenance drugs may be dis pensed by mail order in 19
accordance with Kentucky law. 20
(b) A health insurer shall not discriminate against any retail pharmacy located 21
within the geographic coverage area of the health benefit plan and that meets 22
the terms and conditions for participation established by the insurer, including 23
price, dispensing fee, and copay requirements of a mail -order option. The 24
retail pharmacy shall not be required to dispense by mail. 25
(c) The mail -order option shall not permit the dispensing of a controlled 26
substance classified in Schedule II. 27
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(14) The policy or policies provided to state employees or their dependents pursuant to 1
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 2
aid-related services for insured individuals under eighteen (18) years of age, subject 3
to a cap of two thousand five hundred dollars ($2,500) [one thousand four hundred 4
dollars ($1,400)] every thirty-six (36) months pursuant to KRS 304.17A-132. 5
(15) Any policy provided to state employees or their dependents pursu ant to this section 6
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 7
consistent with KRS 304.17A-142. 8
(16) Any policy provided to state employees or their dependents pursuant to this section 9
shall provide coverage for obt aining amino acid -based elemental formula pursuant 10
to KRS 304.17A-258. 11
(17) If a state employee's residence and place of employment are in the same county, 12
and if the hospital located within that county does not offer surgical services, 13
intensive care serv ices, obstetrical services, level II neonatal services, diagnostic 14
cardiac catheterization services, and magnetic resonance imaging services, the 15
employee may select a plan available in a contiguous county that does provide 16
those services, and the state co ntribution for the plan shall be the amount available 17
in the county where the plan selected is located. 18
(18) If a state employee's residence and place of employment are each located in 19
counties in which the hospitals do not offer surgical services, intensi ve care 20
services, obstetrical services, level II neonatal services, diagnostic cardiac 21
catheterization services, and magnetic resonance imaging services, the employee 22
may select a plan available in a county contiguous to the county of residence that 23
does p rovide those services, and the state contribution for the plan shall be the 24
amount available in the county where the plan selected is located. 25
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 26
in the best interests of the state group to allow any carrier bidding to offer health 27
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care coverage under this section to submit bids that may vary county by county or 1
by larger geographic areas. 2
(20) Notwithstanding any other provision of this section, the bid for proposals for h ealth 3
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 4
the statewide rating structure provided in calendar year 2003 and a bid scenario that 5
allows for a regional rating structure that allows carriers to submit bids that may 6
vary by region for a given product offering as described in this subsection: 7
(a) The regional rating bid scenario shall not include a request for bid on a 8
statewide option; 9
(b) The Personnel Cabinet shall divide the state into geographical regions whi ch 10
shall be the same as the partnership regions designated by the Department for 11
Medicaid Services for purposes of the Kentucky Health Care Partnership 12
Program established pursuant to 907 KAR 1:705; 13
(c) The request for proposal shall require a carrier's bi d to include every county 14
within the region or regions for which the bid is submitted and include but not 15
be restricted to a preferred provider organization (PPO) option; 16
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 17
carrier all of the counties included in its bid within the region. If the Personnel 18
Cabinet deems the bids submitted in accordance with this subsection to be in 19
the best interest s of state employees in a region, the cabinet may award the 20
contract for that region to no more than two (2) carriers; and 21
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 22
other requirements or criteria in the request for proposal. 23
(21) Any fully insured health benefit plan or self -insured plan issued or renewed on or 24
after July 12, 2006, to public employees pursuant to this section which provides 25
coverage for services rendered by a physician or osteopath duly licensed under KRS 26
Chapter 311 that are within the scope of practice of an optometrist duly licensed 27
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under the provisions of KRS Chapter 320 shall provide the same payment of 1
coverage to optometrists as allowed for those services rendered by physicians or 2
osteopaths. 3
(22) Any fully insured health benefit plan or self -insured plan issued or renewed to 4
public employees pursuant to this section shall comply with: 5
(a) KRS 304.12-237; 6
(b) KRS 304.17A-270 and 304.17A-525; 7
(c) KRS 304.17A-600 to 304.17A-633; 8
(d) KRS 205.593; 9
(e) KRS 304.17A-700 to 304.17A-730; 10
(f) KRS 304.14-135; 11
(g) KRS 304.17A-580 and 304.17A-641; 12
(h) KRS 304.99-123; 13
(i) KRS 304.17A-138; 14
(j) KRS 304.17A-148; 15
(k) KRS 304.17A-163 and 304.17A-1631; 16
(l) KRS 304.17A-265; 17
(m) KRS 304.17A-261; 18
(n) KRS 304.17A-262; 19
(o) KRS 304.17A-145; 20
(p) KRS 304.17A-129; 21
(q) KRS 304.17A-133; 22
(r) KRS 304.17A-264; and 23
(s) Administrative regulations promulgated pursuant to statutes listed in this 24
subsection. 25
(23) (a) Any fully insured health benefit plan or self-insured plan issued or renewed to 26
public employees pursuant to this section shall provide a special enrollment 27
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period to pregnant women who are eligible for coverage in accordance with 1
the requirements set forth in KRS 304.17-182. 2
(b) The Department of Employee Insurance shall, at or before the time a public 3
employee is initially offered the opportunity to enroll in the plan or coverage, 4
provide the employee a notice of the special enrollment rights under this 5
subsection. 6
Section 3. This Act applies to health benefit plans issued or renewed on or after 7
January 1, 2027. 8
Section 4. This Act takes effect January 1, 2027. 9