AN ACT relating to coverage for reproductive health care.

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AN ACT relating to coverage for reproductive health care. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
SECTION 1. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 3
IS CREATED TO READ AS FOLLOWS: 4
(1) All health benefit plans shall provide coverage for: 5
(a) In vitro fertilization; 6
(b) Intrauterine insemination; and 7
(c) Any other process using assisted reproductive technology. 8
(2) The coverage required under this section shall include coverage for: 9
(a) At a minimum, two (2) cycles; and 10
(b) All health care services necessary to complete each cycle. 11
(3) If the application of any requirement of this section to a qualified health plan, as 12
defined in 42 U.S.C. sec. 18021(a)(1), as amended, results, or would result, in a 13
determination that the state must make payments to defray the cost of the 14
requirement under 42 U.S.C. sec. 18 031(d)(3) and 45 C.F.R. sec. 155.170, as 15
amended, then the requirement shall not apply to the qualified health plan until 16
the requirement to make cost defrayal payments is no longer applicable. 17
Section 2. KRS 304.17A-099 is amended to read as follows: 18
(1) As used in this section, "qualified health plan" has the same meaning as in 42 19
U.S.C. sec. 18021(a)(1), as amended. 20
(2) Notwithstanding any other provision of this chapter: 21
(a) Except as provided in paragraph (b) of this subsection, if the application of a 22
provision of this chapter results, or would result, in a determination that the 23
state must make payments to defray the cost of the provision under 42 U.S.C. 24
sec. 18031(d)(3) and 45 C.F.R. sec. 155.170, as amended, then the provision 25
shall not apply to a qualified health plan or any other health insurance policy, 26
certificate, plan, or contract until the requirement to make cost defrayal 27
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payments is no longer applicable; and 1
(b) This subsection shall not apply to any of the following: 2
1. A provision of this chapter that became effective on or before January 1, 3
2024; or 4
2. Section 1 of this Act. 5
(3) To the extent permitted by federal law, if the state is required under 42 U.S.C. sec. 6
18031(d)(3) and 45 C.F.R. sec. 155.170, a s amended, to make payments to defray 7
the cost of a provision of this chapter: 8
(a) 1. Each qualified health plan issuer shall determine, and provide to the 9
commissioner, the cost attributable to the provision for the qualified 10
health plan. 11
2. The cost attr ibutable to a provision for a qualified health plan under 12
subparagraph 1. of this paragraph shall be: 13
a. Calculated in accordance with generally accepted actuarial 14
principles and methodologies; 15
b. Conducted by a member of the American Academy of Actuaries; 16
and 17
c. Reported by the qualified health plan issuer to: 18
i. The commissioner; and 19
ii. The Division of Health Benefit Exchange within the Office 20
of Data Analytics; 21
(b) The commissioner shall use the information obtained under paragraph (a) of 22
this subsection to determine the statewide average of the cost attributable to 23
the provision for all qualified health plan issuers to which the provision is 24
applicable; and 25
(c) The required payments shall be: 26
1. Calculated based on the statewide average of the cost attr ibutable to the 27
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provision as determined by the commissioner under paragraph (b) of this 1
subsection; and 2
2. Submitted directly to qualified health plan issuers by the department 3
through a process established by the commissioner. 4
(4) A qualified health plan issuer that receives a payment under subsection (3)(c)2. of 5
this section shall: 6
(a) Reduce the premium charged to an individual on whose behalf the issuer 7
received the payment in an amount equal to the amount of the payment; or 8
(b) Notwithstanding KRS 304.12-090, provide a premium rebate to an individual 9
on whose behalf the issuer received the payment in an amount equal to the 10
amount of the payment. 11
(5) Any fines collected for violations of this section shall be: 12
(a) Placed in a trus t and agency account within the department, which shall not 13
lapse; and 14
(b) Used solely by the department to make payments in accordance with 15
subsection (3)(c)2. of this section. 16
(6) The commissioner shall promulgate any administrative regulations necessary to 17
enforce and effectuate this section. 18
Section 3. KRS 164.2871 is amended to read as follows: 19
(1) The governing board of each state postsecondary educational institution is 20
authorized to purchase liability insurance fo r the protection of the individual 21
members of the governing board, faculty, and staff of such institutions from liability 22
for acts and omissions committed in the course and scope of the individual's 23
employment or service. Each institution may purchase the type and amount of 24
liability coverage deemed to best serve the interest of such institution. 25
(2) All retirement annuity allowances accrued or accruing to any employee of a state 26
postsecondary educational institution through a retirement program sponsored b y 27
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the state postsecondary educational institution are hereby exempt from any state, 1
county, or municipal tax, and shall not be subject to execution, attachment, 2
garnishment, or any other process whatsoever, nor shall any assignment thereof be 3
enforceable i n any court. Except retirement benefits accrued or accruing to any 4
employee of a state postsecondary educational institution through a retirement 5
program sponsored by the state postsecondary educational institution on or after 6
January 1, 1998, shall be sub ject to the tax imposed by KRS 141.020, to the extent 7
provided in KRS 141.010 and 141.0215. 8
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 9
members of governing boards, faculty and staff of institutions of higher education 10
in this state shall not be construed to be a waiver of sovereign immunity or any 11
other immunity or privilege. 12
(4) The governing board of each state postsecondary education institution is authorized 13
to provide a self -insured employer group health plan to i ts employees, which plan 14
shall: 15
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 16
(b) Except as provided in subsection (5) of this section, be exempt from 17
conformity with Subtitle 17A of KRS Chapter 304. 18
(5) A self -insured employer gro up health plan provided by the governing board of a 19
state postsecondary education institution to its employees shall comply with: 20
(a) KRS 304.17A-129; 21
(b) KRS 304.17A-133; 22
(c) KRS 304.17A-145; 23
(d) KRS 304.17A-163 and 304.17A-1631; 24
(e) KRS 304.17A-261; 25
(f) KRS 304.17A-262; 26
(g) KRS 304.17A-264;[ and] 27
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(h) KRS 304.17A-265; and 1
(i) Section 1 of this Act. 2
(6) (a) A self-insured employer group health plan provided by the governing board of 3
a state postsecondary education institution to its employees shall provide a 4
special enrollment period to pregnant women who are eligible for coverage in 5
accordance with the requirements set forth in KRS 304.17-182. 6
(b) The governing board of a state postsecondary education institution shall, at or 7
before the time an employee is initially offered the opportunity to enroll in the 8
plan or coverage, provide the employee a notice of the special enrollment 9
rights under this subsection. 10
Section 4. KRS 18A.225 is amended to read as follows: 11
(1) (a) The term "employee" for purposes of this section means: 12
1. Any person, including an elected public official, who is regularly 13
employed by any depart ment, office, board, agency, or branch of state 14
government; or by a public postsecondary educational institution; or by 15
any city, urban -county, charter county, county, or consolidated local 16
government, whose legislative body has opted to participate in the state-17
sponsored health insurance program pursuant to KRS 79.080; and who 18
is either a contributing member to any one (1) of the retirement systems 19
administered by the state, including but not limited to the Kentucky 20
Retirement Systems, County Employees Ret irement System, Kentucky 21
Teachers' Retirement System, the Legislators' Retirement Plan, or the 22
Judicial Retirement Plan; or is receiving a contractual contribution from 23
the state toward a retirement plan; or, in the case of a public 24
postsecondary education institution, is an individual participating in an 25
optional retirement plan authorized by KRS 161.567; or is eligible to 26
participate in a retirement plan established by an employer who ceases 27
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participating in the Kentucky Employees Retirement System pursua nt to 1
KRS 61.522 whose employees participated in the health insurance plans 2
administered by the Personnel Cabinet prior to the employer's effective 3
cessation date in the Kentucky Employees Retirement System; 4
2. Any certified or classified employee of a loc al board of education or a 5
public charter school as defined in KRS 160.1590; 6
3. Any elected member of a local board of education; 7
4. Any person who is a present or future recipient of a retirement 8
allowance from the Kentucky Retirement Systems, County Empl oyees 9
Retirement System, Kentucky Teachers' Retirement System, the 10
Legislators' Retirement Plan, the Judicial Retirement Plan, or the 11
Kentucky Community and Technical College System's optional 12
retirement plan authorized by KRS 161.567, except that a person who is 13
receiving a retirement allowance and who is age sixty -five (65) or older 14
shall not be included, with the exception of persons covered under KRS 15
61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 16
employed pursuant to subparagraph 1. of this paragraph; and 17
5. Any eligible dependents and beneficiaries of participating employees 18
and retirees who are entitled to participate in the state -sponsored health 19
insurance program; 20
(b) The term "health benefit plan" for the purposes of this section m eans a health 21
benefit plan as defined in KRS 304.17A-005; 22
(c) The term "insurer" for the purposes of this section means an insurer as defined 23
in KRS 304.17A-005; and 24
(d) The term "managed care plan" for the purposes of this section means a 25
managed care plan as defined in KRS 304.17A-500. 26
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 27
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recommendation of the secretary of the Personnel Cabinet, shall procure, in 1
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 2
from one (1) or more insurers authorized to do business in this state, a group 3
health benefit plan that may include but not be limited to health maintenance 4
organization (HMO), preferred provider organization (PPO), point of service 5
(POS), and exclusive provid er organization (EPO) benefit plans 6
encompassing all or any class or classes of employees. With the exception of 7
employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 8
all employers of any class of employees or former employees shall enter into 9
a contract with the Personnel Cabinet prior to including that group in the state 10
health insurance group. The contracts shall include but not be limited to 11
designating the entity responsible for filing any federal forms, adoption of 12
policies required for proper plan administration, acceptance of the contractual 13
provisions with health insurance carriers or third -party administrators, and 14
adoption of the payment and reimbursement methods necessary for efficient 15
administration of the health insurance prog ram. Health insurance coverage 16
provided to state employees under this section shall, at a minimum, contain 17
the same benefits as provided under Kentucky Kare Standard as of January 1, 18
1994, and shall include a mail -order drug option as provided in subsectio n 19
(13) of this section. All employees and other persons for whom the health care 20
coverage is provided or made available shall annually be given an option to 21
elect health care coverage through a self -funded plan offered by the 22
Commonwealth or, if a self -funded plan is not available, from a list of 23
coverage options determined by the competitive bid process under the 24
provisions of KRS 45A.080, 45A.085, and 45A.090 and made available 25
during annual open enrollment. 26
(b) The policy or policies shall be approved by the commissioner of insurance 27
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and may contain the provisions the commissioner of insurance approves, 1
whether or not otherwise permitted by the insurance laws. 2
(c) Any carrier bidding to offer health care coverage to employees shall agree to 3
provide covera ge to all members of the state group, including active 4
employees and retirees and their eligible covered dependents and 5
beneficiaries, within the county or counties specified in its bid. Except as 6
provided in subsection (20) of this section, any carrier bi dding to offer health 7
care coverage to employees shall also agree to rate all employees as a single 8
entity, except for those retirees whose former employers insure their active 9
employees outside the state -sponsored health insurance program and as 10
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 11
(d) Any carrier bidding to offer health care coverage to employees shall agree to 12
provide enrollment, claims, and utilization data to the Commonwealth in a 13
format specified by the Personnel Cabinet with the understanding that the data 14
shall be owned by the Commonwealth; to provide data in an electronic form 15
and within a time frame specified by the Personnel Cabinet; and to be subject 16
to penalties for noncompliance with data reporting requirements as sp ecified 17
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 18
to protect the confidentiality of each individual employee; however, 19
confidentiality assertions shall not relieve a carrier from the requirement of 20
providing stipulated data to the Commonwealth. 21
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 22
for timely analysis of data received from carriers and, to the extent possible, 23
provide in the request -for-proposal specifics relating to data requir ements, 24
electronic reporting, and penalties for noncompliance. The Commonwealth 25
shall own the enrollment, claims, and utilization data provided by each carrier 26
and shall develop methods to protect the confidentiality of the individual. The 27
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Personnel Cabine t shall include in the October annual report submitted 1
pursuant to the provisions of KRS 18A.226 to the Governor, the General 2
Assembly, and the Chief Justice of the Supreme Court, an analysis of the 3
financial stability of the program, which shall include b ut not be limited to 4
loss ratios, methods of risk adjustment, measurements of carrier quality of 5
service, prescription coverage and cost management, and statutorily required 6
mandates. If state self -insurance was available as a carrier option, the report 7
also shall provide a detailed financial analysis of the self -insurance fund 8
including but not limited to loss ratios, reserves, and reinsurance agreements. 9
(f) If any agency participating in the state -sponsored employee health insurance 10
program for its activ e employees terminates participation and there is a state 11
appropriation for the employer's contribution for active employees' health 12
insurance coverage, then neither the agency nor the employees shall receive 13
the state -funded contribution after termination from the state -sponsored 14
employee health insurance program. 15
(g) Any funds in flexible spending accounts that remain after all reimbursements 16
have been processed shall be transferred to the credit of the state -sponsored 17
health insurance plan's appropriation account. 18
(h) Each entity participating in the state-sponsored health insurance program shall 19
provide an amount at least equal to the state contribution rate for the employer 20
portion of the health insurance premium. For any participating entity that used 21
the state payroll system, the employer contribution amount shall be equal to 22
but not greater than the state contribution rate. 23
(3) The premiums may be paid by the policyholder: 24
(a) Wholly from funds contributed by the employee, by payroll deduction or 25
otherwise; 26
(b) Wholly from funds contributed by any department, board, agency, public 27
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postsecondary education institution, or branch of state, city, urban -county, 1
charter county, county, or consolidated local government; or 2
(c) Partly from each, except that an y premium due for health care coverage or 3
dental coverage, if any, in excess of the premium amount contributed by any 4
department, board, agency, postsecondary education institution, or branch of 5
state, city, urban -county, charter county, county, or consoli dated local 6
government for any other health care coverage shall be paid by the employee. 7
(4) If an employee moves his or her place of residence or employment out of the 8
service area of an insurer offering a managed health care plan, under which he or 9
she has elected coverage, into either the service area of another managed health care 10
plan or into an area of the Commonwealth not within a managed health care plan 11
service area, the employee shall be given an option, at the time of the move or 12
transfer, to change his or her coverage to another health benefit plan. 13
(5) No payment of premium by any department, board, agency, public postsecondary 14
educational institution, or branch of state, city, urban -county, charter county, 15
county, or consolidated local governme nt shall constitute compensation to an 16
insured employee for the purposes of any statute fixing or limiting the 17
compensation of such an employee. Any premium or other expense incurred by any 18
department, board, agency, public postsecondary educational instit ution, or branch 19
of state, city, urban -county, charter county, county, or consolidated local 20
government shall be considered a proper cost of administration. 21
(6) The policy or policies may contain the provisions with respect to the class or classes 22
of employees covered, amounts of insurance or coverage for designated classes or 23
groups of employees, policy options, terms of eligibility, and continuation of 24
insurance or coverage after retirement. 25
(7) Group rates under this section shall be made available to the disabled child of an 26
employee regardless of the child's age if the entire premium for the disabled child's 27
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coverage is paid by the state employee. A child shall be considered disabled if he or 1
she has been determined to be eligible for federal Social Security disability benefits. 2
(8) The health care contract or contracts for employees shall be entered into for a 3
period of not less than one (1) year. 4
(9) The secr etary shall appoint thirty -two (32) persons to an Advisory Committee of 5
State Health Insurance Subscribers to advise the secretary or the secretary's 6
designee regarding the state -sponsored health insurance program for employees. 7
The secretary shall appoint , from a list of names submitted by appointing 8
authorities, members representing school districts from each of the seven (7) 9
Supreme Court districts, members representing state government from each of the 10
seven (7) Supreme Court districts, two (2) members representing retirees under age 11
sixty-five (65), one (1) member representing local health departments, two (2) 12
members representing the Kentucky Teachers' Retirement System, and three (3) 13
members at large. The secretary shall also appoint two (2) members f rom a list of 14
five (5) names submitted by the Kentucky Education Association, two (2) members 15
from a list of five (5) names submitted by the largest state employee organization of 16
nonschool state employees, two (2) members from a list of five (5) names submitted 17
by the Kentucky Association of Counties, two (2) members from a list of five (5) 18
names submitted by the Kentucky League of Cities, and two (2) members from a 19
list of names consisting of five (5) names submitted by each state employee 20
organization th at has two thousand (2,000) or more members on state payroll 21
deduction. The advisory committee shall be appointed in January of each year and 22
shall meet quarterly. 23
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 24
provided to employees pursuant to this section shall not provide coverage for 25
obtaining or performing an abortion, nor shall any state funds be used for the 26
purpose of obtaining or performing an abortion on behalf of employees or their 27
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dependents. 1
(11) Interruption of an established treatment regime with maintenance drugs shall be 2
grounds for an insured to appeal a formulary change through the established appeal 3
procedures approved by the Department of Insurance, if the physician supervising 4
the treatment certifies that the change is not in the best interests of the patient. 5
(12) Any employee who is eligible for and elects to participate in the state health 6
insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 7
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 8
state health insurance contribution toward health care coverage as a result of any 9
other employment for which there is a public employer contribution. This does not 10
preclude a retiree and an active employee spouse from using both contributions to 11
the extent needed for purchase of one (1) state sponsored health insurance policy 12
for that plan year. 13
(13) (a) The policies of health insurance coverage procured under subsection (2) of 14
this section shall include a mail -order drug option for maintenance drugs for 15
state employees. Maintenance drugs may be dispensed by mail order in 16
accordance with Kentucky law. 17
(b) A health insurer shall not discriminate against any retail pharmacy located 18
within the geographic coverage area of the health benefit plan and that meets 19
the terms and conditions for participation established by the insurer, including 20
price, dispensing fee, and copay requirements of a mail -order option. The 21
retail pharmacy shall not be required to dispense by mail. 22
(c) The mail -order option shall not permit the dispensing of a controlled 23
substance classified in Schedule II. 24
(14) The policy or policies provided to state employees or their dependents pursuant to 25
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 26
aid-related services for insured individuals under eighteen (18) years of age, subject 27
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to a cap of one thousand four hundred dollars ($1,400) every thirty -six (36) months 1
pursuant to KRS 304.17A-132. 2
(15) Any policy provided to state employees or their dependents pursuant to this section 3
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 4
consistent with KRS 304.17A-142. 5
(16) Any policy provided to state employees or their dependents pursuant to this section 6
shall provide coverage for obtaining amino acid -based elemental formula pursuant 7
to KRS 304.17A-258. 8
(17) If a state employee's residence and place of employment are in the same county, 9
and if the hospital located within that county does not offer surgical services, 10
intensive care services, obstetrical services, level II neonatal services, diagnostic 11
cardiac catheterization services, and magnetic resonance imaging services, the 12
employee may select a plan available in a co ntiguous county that does provide 13
those services, and the state contribution for the plan shall be the amount available 14
in the county where the plan selected is located. 15
(18) If a state employee's residence and place of employment are each located in 16
counties in which the hospitals do not offer surgical services, intensive care 17
services, obstetrical services, level II neonatal services, diagnostic cardiac 18
catheterization services, and magnetic resonance imaging services, the employee 19
may select a plan avail able in a county contiguous to the county of residence that 20
does provide those services, and the state contribution for the plan shall be the 21
amount available in the county where the plan selected is located. 22
(19) The Personnel Cabinet is encouraged to stu dy whether it is fair and reasonable and 23
in the best interests of the state group to allow any carrier bidding to offer health 24
care coverage under this section to submit bids that may vary county by county or 25
by larger geographic areas. 26
(20) Notwithstanding any other provision of this section, the bid for proposals for health 27
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insurance coverage for calendar year 2004 shall include a bid scenario that reflects 1
the statewide rating structure provided in calendar year 2003 and a bid scenario that 2
allows for a regional rating structure that allows carriers to submit bids that may 3
vary by region for a given product offering as described in this subsection: 4
(a) The regional rating bid scenario shall not include a request for bid on a 5
statewide option; 6
(b) The Personnel Cabinet shall divide the state into geographical regions which 7
shall be the same as the partnership regions designated by the Department for 8
Medicaid Services for purposes of the Kentucky Health Care Partnership 9
Program established pursuant to 907 KAR 1:705; 10
(c) The request for proposal shall require a carrier's bid to include every county 11
within the region or regions for which the bid is submitted and include but not 12
be restricted to a preferred provider organization (PPO) option; 13
(d) If the Personne l Cabinet accepts a carrier's bid, the cabinet shall award the 14
carrier all of the counties included in its bid within the region. If the Personnel 15
Cabinet deems the bids submitted in accordance with this subsection to be in 16
the best interests of state empl oyees in a region, the cabinet may award the 17
contract for that region to no more than two (2) carriers; and 18
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 19
other requirements or criteria in the request for proposal. 20
(21) Any fully insured health benefit plan or self -insured plan issued or renewed on or 21
after July 12, 2006, to public employees pursuant to this section which provides 22
coverage for services rendered by a physician or osteopath duly licensed under KRS 23
Chapter 3 11 that are within the scope of practice of an optometrist duly licensed 24
under the provisions of KRS Chapter 320 shall provide the same payment of 25
coverage to optometrists as allowed for those services rendered by physicians or 26
osteopaths. 27
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(22) Any fully i nsured health benefit plan or self -insured plan issued or renewed to 1
public employees pursuant to this section shall comply with: 2
(a) KRS 304.12-237; 3
(b) KRS 304.17A-270 and 304.17A-525; 4
(c) KRS 304.17A-600 to 304.17A-633; 5
(d) KRS 205.593; 6
(e) KRS 304.17A-700 to 304.17A-730; 7
(f) KRS 304.14-135; 8
(g) KRS 304.17A-580 and 304.17A-641; 9
(h) KRS 304.99-123; 10
(i) KRS 304.17A-138; 11
(j) KRS 304.17A-148; 12
(k) KRS 304.17A-163 and 304.17A-1631; 13
(l) KRS 304.17A-265; 14
(m) KRS 304.17A-261; 15
(n) KRS 304.17A-262; 16
(o) KRS 304.17A-145; 17
(p) KRS 304.17A-129; 18
(q) KRS 304.17A-133; 19
(r) KRS 304.17A-264;[ and] 20
(s) Section 1 of this Act; and 21
(t) Administrative regulations promulgated pursuant to statutes listed in this 22
subsection. 23
(23) (a) Any fully insured health benefit plan or self-insured plan issued or renewed to 24
public employees pursuant to this section shall provide a special enrollment 25
period to pregnant women who are eligible for coverage in accordance with 26
the requirements set forth in KRS 304.17-182. 27
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(b) The Department of Employee Insurance shall, at or before the time a public 1
employee is initially offered the opportunity to enroll in the plan or coverage, 2
provide the employee a notice of the special enrollment rights under this 3
subsection. 4
Section 5. Sections 1, 3, and 4 of this Act apply to the health benefit plans 5
issued or renewed on or after January 1, 2027. 6
Section 6. This Act takes effect January 1, 2027. 7