AN ACT relating to coverage for feeding or eating disorders.

UNOFFICIAL COPY 26 RS HB 169/GA
Page 1 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
AN ACT relating to coverage for feeding or eating disorders. 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
As used in Sections 1 to 3 of this Act: 5
(1) "Feeding or eating disorder": 6
(a) Has the same meaning as in the most recent version of the Di agnostic and 7
Statistical Manual of Mental Disorders; and 8
(b) Includes: 9
1. Anorexia nervosa; 10
2. Bulimia nervosa; 11
3. Atypical anorexia nervosa; 12
4. Binge-eating disorder; and 13
5. Any other feeding or eating disorder specified in the most recent 14
version of the Diagnostic and Statistical Manual of Mental Disorders; 15
and 16
(2) "Health plan": 17
(a) Means any health insurance policy, certificate, contract, or plan that offers 18
or provides behavioral or mental health coverage: 19
1. By direct payment, reimbursement, or otherwise; and 20
2. On a fully insured or self -insured basis or any combination thereof; 21
and 22
(b) Includes: 23
1. A health benefit plan; and 24
2. Student health insurance offered by a Kentu cky-licensed insurer 25
under written contract with a university or college whose students it 26
proposes to insure. 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 2 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
SECTION 2. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 1
IS CREATED TO READ AS FOLLOWS: 2
A health plan shal l provide coverage for the diagnosis and treatment of feeding or 3
eating disorders. 4
SECTION 3. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 5
IS CREATED TO READ AS FOLLOWS: 6
An insurer that offers or provides coverage fo r the treatment of a diagnosed feeding or 7
eating disorder under a health plan: 8
(1) Shall not utilize any of the following standards as the sole reason for denying, 9
limiting, or restricting the coverage: 10
(a) Body mass index; 11
(b) Ideal body weight; or 12
(c) Any other standard requiring an achieved weight; and 13
(2) May consider the following factors when determining the medical necessity of a 14
treatment, or the appropriate level of care, for an individual with a diagnosed 15
feeding or eating disorder: 16
(a) Eating behaviors; 17
(b) The need for supervised meals and support interventions; 18
(c) Laboratory results of heart rate, renal or cardiovascular activity, and blood 19
pressure; 20
(d) Recovery environment; and 21
(e) Co-occurring disorders. 22
Section 4. KRS 304.17C-125 is amended to read as follows: 23
The following shall apply to limited health service benefit plans, including any limited 24
health service contract[, as] defined in KRS 304.38A-010: 25
(1) KRS 304.17A-129; 26
(2) KRS 304.17A-262;[ and] 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 3 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
(3) KRS 304.17A-591 to 304.17A-599; and 1
(4) Sections 1 to 3 of this Act. 2
Section 5. KRS 304.38A-115 is amended to read as follows: 3
Limited health service organizations shall comply with: 4
(1) KRS 304.17A-262; 5
(2) KRS 304.17A-265;[ and] 6
(3) KRS 304.17A-591 to 304.17A-599; and 7
(4) Sections 1 to 3 of this Act. 8
Section 6. KRS 205.522 is amended to read as follows: 9
(1) With respect to the administration and provision o f Medicaid benefits pursuant to 10
this chapter, the Department for Medicaid Services, any managed care organization 11
contracted to provide Medicaid benefits pursuant to this chapter, and the state's 12
medical assistance program shall be subject to, and comply w ith, the following, as 13
applicable: 14
(a) KRS 304.17A-129; 15
(b) KRS 304.17A-145; 16
(c) KRS 304.17A-163; 17
(d) KRS 304.17A-1631; 18
(e) KRS 304.17A-167; 19
(f) KRS 304.17A-235; 20
(g) KRS 304.17A-257; 21
(h) KRS 304.17A-259; 22
(i) KRS 304.17A-263; 23
(j) KRS 304.17A-264; 24
(k) KRS 304.17A-515; 25
(l) KRS 304.17A-580; 26
(m) KRS 304.17A-600, 304.17A-603, and 304.17A-607;[ and] 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 4 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
(n) KRS 304.17A-740 to 304.17A-743; and 1
(o) Sections 1 to 3 of this Act. 2
(2) A managed care organization contracted to provide Medicaid benefits pursuant to 3
this chapter shall comply with the reporting requirements of KRS 304.17A-732. 4
Section 7. KRS 205.6485 is amended to read as follows: 5
(1) As used in this section, "KCHIP" means the Kentucky Children's Health Insurance 6
Program. 7
(2) The Cabinet for Health and Family Services shall: 8
(a) Prepare a state child health plan, known as KCHIP, meeting the requirements 9
of Title XXI of the Federal Social S ecurity Act, for submission to the 10
Secretary of the United States Department of Health and Human Services 11
within such time as will permit the state to receive the maximum amounts of 12
federal matching funds available under Title XXI; and 13
(b) By administrativ e regulation promulgated in accordance with KRS Chapter 14
13A, establish the following: 15
1. The eligibility criteria for children covered by KCHIP, which shall 16
include a provision that no person eligible for services under Title XIX 17
of the Social Security Act , 42 U.S.C. secs. 1396 to 1396v, as amended, 18
shall be eligible for services under KCHIP, except to the extent that 19
Title XIX coverage is expanded by KRS 205.6481 to 205.6495 and KRS 20
304.17A-340; 21
2. The schedule of benefits to be covered by KCHIP, which shall: 22
a. Be at least equivalent to one (1) of the following: 23
i. The standard Blue Cross/Blue Shield preferred provider 24
option under the Federal Employees Health Benefit Plan 25
established by 5 U.S.C. sec. 8903(1); 26
ii. A mid-range health benefit coverage plan t hat is offered and 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 5 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
generally available to state employees; or 1
iii. Health insurance coverage offered by a health maintenance 2
organization that has the largest insured commercial, non -3
Medicaid enrollment of covered lives in the state; and 4
b. Comply with subsection (6) of this section; 5
3. The premium contribution per family for health insurance coverage 6
available under KCHIP, which shall be based: 7
a. On a six (6) month period; and 8
b. Upon a sliding scale relating to family income not to exceed: 9
i. Ten dollars ($10), to be paid by a family with income 10
between one hundred percent (100%) to one hundred thirty -11
three percent (133%) of the federal poverty level; 12
ii. Twenty dollars ($20), to be paid by a family with income 13
between one hundred thirty -four percent (134 %) to one 14
hundred forty -nine percent (149%) of the federal poverty 15
level; and 16
iii. One hundred twenty dollars ($120), to be paid by a family 17
with income between one hundred fifty percent (150%) to 18
two hundred percent (200%) of the federal poverty level, and 19
which may be made on a partial payment plan of twenty 20
dollars ($20) per month or sixty dollars ($60) per quarter; 21
4. There shall be no copayments for services provided under KCHIP; and 22
5. a. The criteria for health services providers and insurers wishing to 23
contract with the Commonwealth to provide coverage under 24
KCHIP. 25
b. The cabinet shall provide, in any contracting process for coverage 26
of preventive services, the opportunity for a public health 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 6 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
department to bid on preventive health services to eligible children 1
within the public health department's service area. A public health 2
department shall not be disqualified from bidding because the 3
department does not currently offer all the services required by 4
this section. The criteria shall be set forth in administrative 5
regulations under KRS Chapter 13A and shall maximize 6
competition among the providers and insurers. The Finance and 7
Administration Cabinet shall provide oversight over contracting 8
policies and procedures to assure that the number of applicants for 9
contracts is maximized. 10
(3) Within twelve (12) months of federal a pproval of the state's Title XXI child health 11
plan, the Cabinet for Health and Family Services shall assure that a KCHIP 12
program is available to all eligible children in all regions of the state. If necessary, 13
in order to meet this assurance, the cabinet shall institute its own program. 14
(4) KCHIP recipients shall have direct access without a referral from any gatekeeper 15
primary care provider to dentists for covered primary dental services and to 16
optometrists and ophthalmologists for covered primary eye and vision services. 17
(5) KCHIP shall comply with: 18
(a) KRS 304.17A-163 and 304.17A-1631; and 19
(b) Sections 1 to 3 of this Act. 20
(6) The schedule of benefits required under subsection (2)(b)2. of this section shall 21
include: 22
(a) Preventive services; 23
(b) Vision services, including glasses; 24
(c) Dental services, including sealants, extractions, and fillings; and 25
(d) The coverage required under: 26
1. KRS 304.17A-129;[ and] 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 7 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
2. KRS 304.17A-145; and 1
3. Sections 1 to 3 of this Act. 2
Section 8. KRS 164.2871 is amended to read as follows: 3
(1) The governing board of each state postsecondary educational institution is 4
authorized to purchase liability insurance for the protection of the individual 5
members of the governing board, faculty, and staff of such institutions from liability 6
for acts and omissions committed in the course and scope of the individual's 7
employment or service. Each institution may purchase the type and amount of 8
liability coverage deemed to best serve the interest of such institution. 9
(2) All retirement annuity allowances accrued or accruing to any employee of a state 10
postsecondary educational institution through a retirement program sponsored by 11
the state postsecondary educational institution are hereby exempt from any state, 12
county, or municipal tax, and shall not be subject to execution, attachment, 13
garnishment, or any other process whatsoever, nor shall any assignment thereof be 14
enforceable in any court. Except retirement benefits accrued or accruing to any 15
employee of a state postsecondary educational institution through a retirement 16
program sponsored by the state postsecondary educational institution on or after 17
January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 18
provided in KRS 141.010 and 141.0215. 19
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 20
members of governing boards, faculty and staff of institutions of higher education 21
in this state shall not be construed to be a waiver of sovereign i mmunity or any 22
other immunity or privilege. 23
(4) The governing board of each state postsecondary education institution is authorized 24
to provide a self -insured employer group health plan to its employees, which plan 25
shall: 26
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 8 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
(b) Except as provided in subsection (5) of this section, be exempt from 1
conformity with Subtitle 17A of KRS Chapter 304. 2
(5) A self-insured employer group health plan provided by the governing board of a 3
state postsecondary education institution to its employees shall comply with: 4
(a) KRS 304.17A-129; 5
(b) KRS 304.17A-133; 6
(c) KRS 304.17A-145; 7
(d) KRS 304.17A-163 and 304.17A-1631; 8
(e) KRS 304.17A-261; 9
(f) KRS 304.17A-262; 10
(g) KRS 304.17A-264;[ and] 11
(h) KRS 304.17A-265; and 12
(i) Sections 1 to 3 of this Act. 13
(6) (a) A self-insured employer group health plan provided by the governing board of 14
a state postsecondary education institution to its employees shall provide a 15
special enrollment period to pregnant wo men who are eligible for coverage in 16
accordance with the requirements set forth in KRS 304.17-182. 17
(b) The governing board of a state postsecondary education institution shall, at or 18
before the time an employee is initially offered the opportunity to enroll in the 19
plan or coverage, provide the employee a notice of the special enrollment 20
rights under this subsection. 21
Section 9. KRS 18A.225 is amended to read as follows: 22
(1) (a) The term "employee" for purposes of this section means: 23
1. Any person, including an elected public official, who is regularly 24
employed by any department, office, board, agency, or branch of state 25
government; or by a public postsecondary educational institution; or by 26
any city, urban -county, charter c ounty, county, or consolidated local 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 9 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
government, whose legislative body has opted to participate in the state -1
sponsored health insurance program pursuant to KRS 79.080; and who 2
is either a contributing member to any one (1) of the retirement systems 3
administered by the state, including but not limited to the Kentucky 4
Retirement Systems, County Employees Retirement System, Kentucky 5
Teachers' Retirement System, the Legislators' Retirement Plan, or the 6
Judicial Retirement Plan; or is receiving a contractual co ntribution from 7
the state toward a retirement plan; or, in the case of a public 8
postsecondary education institution, is an individual participating in an 9
optional retirement plan authorized by KRS 161.567; or is eligible to 10
participate in a retirement plan established by an employer who ceases 11
participating in the Kentucky Employees Retirement System pursuant to 12
KRS 61.522 whose employees participated in the health insurance plans 13
administered by the Personnel Cabinet prior to the employer's effective 14
cessation date in the Kentucky Employees Retirement System; 15
2. Any certified or classified employee of a local board of education or a 16
public charter school as defined in KRS 160.1590; 17
3. Any elected member of a local board of education; 18
4. Any person who is a present or future recipient of a retirement 19
allowance from the Kentucky Retirement Systems, County Employees 20
Retirement System, Kentucky Teachers' Retirement System, the 21
Legislators' Retirement Plan, the Judicial Retirement Plan, or the 22
Kentucky Community and Technical College System's optional 23
retirement plan authorized by KRS 161.567, except that a person who is 24
receiving a retirement allowance and who is age sixty -five (65) or older 25
shall not be included, with the exception of persons covered under KRS 26
61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 10 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
employed pursuant to subparagraph 1. of this paragraph; and 1
5. Any eligible dependents and beneficiaries of participating employees 2
and retirees who are entitled to participate in the state -sponsored health 3
insurance program; 4
(b) The term "health benefit plan" for the purposes of this section means a health 5
benefit plan as defined in KRS 304.17A-005; 6
(c) The term "insurer" for the purposes of this section means an insurer as defined 7
in KRS 304.17A-005; and 8
(d) The term "managed care plan" for the purposes of this section means a 9
managed care plan as defined in KRS 304.17A-500. 10
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 11
recommendation of the secretary of the Personn el Cabinet, shall procure, in 12
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 13
from one (1) or more insurers authorized to do business in this state, a group 14
health benefit plan that may include but not be limited to health maintenance 15
organization (HMO), preferred provider organization (PPO), point of service 16
(POS), and exclusive provider organization (EPO) benefit plans 17
encompassing all or any class or classes of employees. With the exception of 18
employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 19
all employers of any class of employees or former employees shall enter into 20
a contract with the Personnel Cabinet prior to including that group in the state 21
health insurance group. The contracts shall include but not be lim ited to 22
designating the entity responsible for filing any federal forms, adoption of 23
policies required for proper plan administration, acceptance of the contractual 24
provisions with health insurance carriers or third -party administrators, and 25
adoption of th e payment and reimbursement methods necessary for efficient 26
administration of the health insurance program. Health insurance coverage 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 11 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
provided to state employees under this section shall, at a minimum, contain 1
the same benefits as provided under Kentucky K are Standard as of January 1, 2
1994, and shall include a mail -order drug option as provided in subsection 3
(13) of this section. All employees and other persons for whom the health care 4
coverage is provided or made available shall annually be given an option to 5
elect health care coverage through a self -funded plan offered by the 6
Commonwealth or, if a self -funded plan is not available, from a list of 7
coverage options determined by the competitive bid process under the 8
provisions of KRS 45A.080, 45A.085, and 45 A.090 and made available 9
during annual open enrollment. 10
(b) The policy or policies shall be approved by the commissioner of insurance 11
and may contain the provisions the commissioner of insurance approves, 12
whether or not otherwise permitted by the insurance laws. 13
(c) Any carrier bidding to offer health care coverage to employees shall agree to 14
provide coverage to all members of the state group, including active 15
employees and retirees and their eligible covered dependents and 16
beneficiaries, within the county or counties specified in its bid. Except as 17
provided in subsection (20) of this section, any carrier bidding to offer health 18
care coverage to employees shall also agree to rate all employees as a single 19
entity, except for those retirees whose former employ ers insure their active 20
employees outside the state -sponsored health insurance program and as 21
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 22
(d) Any carrier bidding to offer health care coverage to employees shall agree to 23
provide enrollm ent, claims, and utilization data to the Commonwealth in a 24
format specified by the Personnel Cabinet with the understanding that the data 25
shall be owned by the Commonwealth; to provide data in an electronic form 26
and within a time frame specified by the Per sonnel Cabinet; and to be subject 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 12 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
to penalties for noncompliance with data reporting requirements as specified 1
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 2
to protect the confidentiality of each individual employee; however , 3
confidentiality assertions shall not relieve a carrier from the requirement of 4
providing stipulated data to the Commonwealth. 5
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 6
for timely analysis of data received from carr iers and, to the extent possible, 7
provide in the request -for-proposal specifics relating to data requirements, 8
electronic reporting, and penalties for noncompliance. The Commonwealth 9
shall own the enrollment, claims, and utilization data provided by each c arrier 10
and shall develop methods to protect the confidentiality of the individual. The 11
Personnel Cabinet shall include in the October annual report submitted 12
pursuant to the provisions of KRS 18A.226 to the Governor, the General 13
Assembly, and the Chief Jus tice of the Supreme Court, an analysis of the 14
financial stability of the program, which shall include but not be limited to 15
loss ratios, methods of risk adjustment, measurements of carrier quality of 16
service, prescription coverage and cost management, and statutorily required 17
mandates. If state self -insurance was available as a carrier option, the report 18
also shall provide a detailed financial analysis of the self -insurance fund 19
including but not limited to loss ratios, reserves, and reinsurance agreements. 20
(f) If any agency participating in the state -sponsored employee health insurance 21
program for its active employees terminates participation and there is a state 22
appropriation for the employer's contribution for active employees' health 23
insurance coverage, then neither the agency nor the employees shall receive 24
the state -funded contribution after termination from the state -sponsored 25
employee health insurance program. 26
(g) Any funds in flexible spending accounts that remain after all reimbursements 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 13 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
have been p rocessed shall be transferred to the credit of the state -sponsored 1
health insurance plan's appropriation account. 2
(h) Each entity participating in the state-sponsored health insurance program shall 3
provide an amount at least equal to the state contribution rate for the employer 4
portion of the health insurance premium. For any participating entity that used 5
the state payroll system, the employer contribution amount shall be equal to 6
but not greater than the state contribution rate. 7
(3) The premiums may be paid by the policyholder: 8
(a) Wholly from funds contributed by the employee, by payroll deduction or 9
otherwise; 10
(b) Wholly from funds contributed by any department, board, agency, public 11
postsecondary education institution, or branch of state, city, urban -county, 12
charter county, county, or consolidated local government; or 13
(c) Partly from each, except that any premium due for health care coverage or 14
dental coverage, if any, in excess of the premium amount contributed by any 15
department, board, agency, postsecondary education institution, or branch of 16
state, city, urban -county, charter county, county, or consolidated local 17
government for any other health care coverage shall be paid by the employee. 18
(4) If an employee moves his or her place of residence or employment out of the 19
service area of an insurer offering a managed health care plan, under which he or 20
she has elected coverage, into either the service area of another managed health care 21
plan or into an area of the Commonwealth not withi n a managed health care plan 22
service area, the employee shall be given an option, at the time of the move or 23
transfer, to change his or her coverage to another health benefit plan. 24
(5) No payment of premium by any department, board, agency, public postseco ndary 25
educational institution, or branch of state, city, urban -county, charter county, 26
county, or consolidated local government shall constitute compensation to an 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 14 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
insured employee for the purposes of any statute fixing or limiting the 1
compensation of such an employee. Any premium or other expense incurred by any 2
department, board, agency, public postsecondary educational institution, or branch 3
of state, city, urban -county, charter county, county, or consolidated local 4
government shall be considered a proper cost of administration. 5
(6) The policy or policies may contain the provisions with respect to the class or classes 6
of employees covered, amounts of insurance or coverage for designated classes or 7
groups of employees, policy options, terms of eligibility, and continuation of 8
insurance or coverage after retirement. 9
(7) Group rates under this section shall be made available to the disabled child of an 10
employee regardless of the child's age if the entire premium for the disabled child's 11
coverage is paid by the state employee. A child shall be considered disabled if he or 12
she has been determined to be eligible for federal Social Security disability benefits. 13
(8) The health care contract or contracts for employees shall be entered into for a 14
period of not less than one (1) year. 15
(9) The secretary shall appoint thirty -two (32) persons to an Advisory Committee of 16
State Health Insurance Subscribers to advise the secretary or the secretary's 17
designee regarding the state -sponsored health insurance program for employee s. 18
The secretary shall appoint, from a list of names submitted by appointing 19
authorities, members representing school districts from each of the seven (7) 20
Supreme Court districts, members representing state government from each of the 21
seven (7) Supreme Court districts, two (2) members representing retirees under age 22
sixty-five (65), one (1) member representing local health departments, two (2) 23
members representing the Kentucky Teachers' Retirement System, and three (3) 24
members at large. The secretary shall also appoint two (2) members from a list of 25
five (5) names submitted by the Kentucky Education Association, two (2) members 26
from a list of five (5) names submitted by the largest state employee organization of 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 15 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
nonschool state employees, two (2) members from a list of five (5) names submitted 1
by the Kentucky Association of Counties, two (2) members from a list of five (5) 2
names submitted by the Kentucky League of Cities, and two (2) members from a 3
list of names consisting of five (5) names submitted by each state employee 4
organization that has two thousand (2,000) or more members on state payroll 5
deduction. The advisory committee shall be appointed in January of each year and 6
shall meet quarterly. 7
(10) Notwithstanding any other provision of law to the contrar y, the policy or policies 8
provided to employees pursuant to this section shall not provide coverage for 9
obtaining or performing an abortion, nor shall any state funds be used for the 10
purpose of obtaining or performing an abortion on behalf of employees or their 11
dependents. 12
(11) Interruption of an established treatment regime with maintenance drugs shall be 13
grounds for an insured to appeal a formulary change through the established appeal 14
procedures approved by the Department of Insurance, if the physician s upervising 15
the treatment certifies that the change is not in the best interests of the patient. 16
(12) Any employee who is eligible for and elects to participate in the state health 17
insurance program as a retiree, or the spouse or beneficiary of a retiree, u nder any 18
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 19
state health insurance contribution toward health care coverage as a result of any 20
other employment for which there is a public employer contribution. This does not 21
preclude a retiree and an active employee spouse from using both contributions to 22
the extent needed for purchase of one (1) state sponsored health insurance policy 23
for that plan year. 24
(13) (a) The policies of health insurance coverage procured under s ubsection (2) of 25
this section shall include a mail -order drug option for maintenance drugs for 26
state employees. Maintenance drugs may be dispensed by mail order in 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 16 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
accordance with Kentucky law. 1
(b) A health insurer shall not discriminate against any retail pharmacy located 2
within the geographic coverage area of the health benefit plan and that meets 3
the terms and conditions for participation established by the insurer, including 4
price, dispensing fee, and copay requirements of a mail -order option. The 5
retail pharmacy shall not be required to dispense by mail. 6
(c) The mail -order option shall not permit the dispensing of a controlled 7
substance classified in Schedule II. 8
(14) The policy or policies provided to state employees or their dependents pursuant to 9
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 10
aid-related services for insured individuals under eighteen (18) years of age, subject 11
to a cap of one thousand four hundred dollars ($1,400) every thirty -six (36) months 12
pursuant to KRS 304.17A-132. 13
(15) Any policy provided to state employees or their dependents pursuant to this section 14
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 15
consistent with KRS 304.17A-142. 16
(16) Any policy provided to state employees or their dependents pursuant to this section 17
shall provide coverage for obtaining amino acid -based elemental formula pursuant 18
to KRS 304.17A-258. 19
(17) If a state employee's residence and place of employment are in the same county, 20
and if the hospital located within that county does not offer surgical services, 21
intensive care services, obstetrical services, level II neonatal services, diagnostic 22
cardiac catheterization services, and magnetic resonance imaging services, the 23
employee may s elect a plan available in a contiguous county that does provide 24
those services, and the state contribution for the plan shall be the amount available 25
in the county where the plan selected is located. 26
(18) If a state employee's residence and place of employ ment are each located in 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 17 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
counties in which the hospitals do not offer surgical services, intensive care 1
services, obstetrical services, level II neonatal services, diagnostic cardiac 2
catheterization services, and magnetic resonance imaging services, the em ployee 3
may select a plan available in a county contiguous to the county of residence that 4
does provide those services, and the state contribution for the plan shall be the 5
amount available in the county where the plan selected is located. 6
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 7
in the best interests of the state group to allow any carrier bidding to offer health 8
care coverage under this section to submit bids that may vary county by county or 9
by larger geographic areas. 10
(20) Notwithstanding any other provision of this section, the bid for proposals for health 11
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 12
the statewide rating structure provided in calendar year 2003 and a b id scenario that 13
allows for a regional rating structure that allows carriers to submit bids that may 14
vary by region for a given product offering as described in this subsection: 15
(a) The regional rating bid scenario shall not include a request for bid on a 16
statewide option; 17
(b) The Personnel Cabinet shall divide the state into geographical regions which 18
shall be the same as the partnership regions designated by the Department for 19
Medicaid Services for purposes of the Kentucky Health Care Partnership 20
Program established pursuant to 907 KAR 1:705; 21
(c) The request for proposal shall require a carrier's bid to include every county 22
within the region or regions for which the bid is submitted and include but not 23
be restricted to a preferred provider organization (PPO) option; 24
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 25
carrier all of the counties included in its bid within the region. If the Personnel 26
Cabinet deems the bids submitted in accordance with this subsection to be in 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 18 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
the best interests of state employees in a region, the cabinet may award the 1
contract for that region to no more than two (2) carriers; and 2
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 3
other requirements or criteria in the request for proposal. 4
(21) Any fully insured health benefit plan or self -insured plan issued or renewed on or 5
after July 12, 2006, to publi c employees pursuant to this section which provides 6
coverage for services rendered by a physician or osteopath duly licensed under KRS 7
Chapter 311 that are within the scope of practice of an optometrist duly licensed 8
under the provisions of KRS Chapter 320 shall provide the same payment of 9
coverage to optometrists as allowed for those services rendered by physicians or 10
osteopaths. 11
(22) Any fully insured health benefit plan or self -insured plan issued or renewed to 12
public employees pursuant to this section shall comply with: 13
(a) KRS 304.12-237; 14
(b) KRS 304.17A-270 and 304.17A-525; 15
(c) KRS 304.17A-600 to 304.17A-633; 16
(d) KRS 205.593; 17
(e) KRS 304.17A-700 to 304.17A-730; 18
(f) KRS 304.14-135; 19
(g) KRS 304.17A-580 and 304.17A-641; 20
(h) KRS 304.99-123; 21
(i) KRS 304.17A-138; 22
(j) KRS 304.17A-148; 23
(k) KRS 304.17A-163 and 304.17A-1631; 24
(l) KRS 304.17A-265; 25
(m) KRS 304.17A-261; 26
(n) KRS 304.17A-262; 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 19 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
(o) KRS 304.17A-145; 1
(p) KRS 304.17A-129; 2
(q) KRS 304.17A-133; 3
(r) KRS 304.17A-264;[ and] 4
(s) Sections 1 to 3 of this Act; and 5
(t) Administrative regulations promulgated pursuant to statutes listed in this 6
subsection. 7
(23) (a) Any fully insured health benefit plan or self-insured plan issued or renewed to 8
public employees pursuant to this section shall provide a special enrollment 9
period to pregnant women who are eligible for coverage in accordance with 10
the requirements set forth in KRS 304.17-182. 11
(b) The Department of Employee Insurance shall, at or before the time a public 12
employee is initially offered the opportunity to enroll i n the plan or coverage, 13
provide the employee a notice of the special enrollment rights under this 14
subsection. 15
Section 10. Sections 1, 2, 3, 4, 5, 8, and 9 of this Act apply to health plans 16
issued or renewed on or after January 1, 2027. 17
Section 11. If the Cabinet for Health and Family Services or the Department for 18
Medicaid Services determines that a state plan amendment, waiver, or any other form of 19
authorization or approval from any federal agency to implement Section 6 or 7 of this Act 20
is necessary to prevent the loss of federal funds or to comply with federal law, the cabinet 21
or department: 22
(1) Shall, within 90 days after the effective date of this section, request the 23
necessary federal authorization or approval to implement Sections 6 and 7 of this Act; 24
and 25
(2) May only delay implementation of the provisions of Sections 6 and 7 of this 26
Act for which federal authorization or approval was deemed necessary until the federal 27
UNOFFICIAL COPY 26 RS HB 169/GA
Page 20 of 20
HB016910.100 - 467 - XXXX 2/3/2026 2:21 PM GA
authorization or approval is granted. 1
Section 12. Sections 6, 7, and 11 of this Act shall constitute the specific 2
authorization required under KRS 205.5372(1). 3
Section 13. The Department for Medicaid Services or the Cabinet for Health 4
and Family Services shall, in accordance with KRS 205.525, provide a copy of any state 5
plan amendment, waiv er application, or other request for authorization or approval 6
submitted pursuant to Section 11 of this Act to the Legislative Research Commission for 7
referral to the Interim Joint Committees on Health Services and Appropriations and 8
Revenue and shall provide an update on the status of any application or request submitted 9
pursuant to Section 11 of this Act at the request of the Legislative Research Commission 10
or any committee thereof. 11
Section 14. Sections 1 to 10 of this Act take effect January 1, 2027. 12