AN ACT relating to mental health coverage in connection with pregnancy.

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AN ACT relating to mental health coverage in connection with pregnancy. 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) As used in this section: 5
(a) "Health benefit plan" has the same meaning as in KRS 304.17A -005, 6
except that for purposes of this sectio n the term includes student health 7
insurance offered by a Kentucky -licensed insurer under written contract 8
with a university or college whose students it proposes to insure; and 9
(b) "Pregnant and postpartum persons at increased risk of perinatal 10
depression" includes persons who have suffered a miscarriage or stillbirth. 11
(2) Except as provided in subsection (3) of this section, a health benefit plan shall 12
provide coverage for counseling interventions for pregnant and postpartum 13
persons at increased risk of perinatal depression. 14
(3) If the application of any requirement of this section to a qualified health plan, as 15
defined in 42 U.S.C. sec. 18021(a)(1), as amended, results, or would result, in a 16
determination that the state must make payments to defray the cost of the 17
requirement under 42 U.S.C. sec. 18031(d)(3) and 45 C.F.R. s ec. 155.170, as 18
amended, then the requirement shall not apply to the qualified health plan until 19
the requirement to make cost defrayal payments is no longer applicable. 20
Section 2. KRS 304.17A-099 is amended to read as follows: 21
(1) As used in this section, "qualified health plan" has the same meaning as in 42 22
U.S.C. sec. 18021(a)(1), as amended. 23
(2) Notwithstanding any other provision of this chapter: 24
(a) Except as provided in paragraph (b) of this subsection, if the appli cation of a 25
provision of this chapter results, or would result, in a determination that the 26
state must make payments to defray the cost of the provision under 42 U.S.C. 27
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sec. 18031(d)(3) and 45 C.F.R. sec. 155.170, as amended, then the provision 1
shall not apply to a qualified health plan or any other health insurance policy, 2
certificate, plan, or contract until the requirement to make cost defrayal 3
payments is no longer applicable; and 4
(b) This subsection shall not apply to any of the following: 5
1. A provision of this chapter that became effective on or before January 1, 6
2024; or 7
2. Section 1 of this Act. 8
(3) To the extent permitted by federal law, if the state is required under 42 U.S.C. sec. 9
18031(d)(3) and 45 C.F.R. sec. 155.170, as amended, to make paymen ts to defray 10
the cost of a provision of this chapter: 11
(a) 1. Each qualified health plan issuer shall determine, and provide to the 12
commissioner, the cost attributable to the provision for the qualified 13
health plan. 14
2. The cost attributable to a provision f or a qualified health plan under 15
subparagraph 1. of this paragraph shall be: 16
a. Calculated in accordance with generally accepted actuarial 17
principles and methodologies; 18
b. Conducted by a member of the American Academy of Actuaries; 19
and 20
c. Reported by the qualified health plan issuer to: 21
i. The commissioner; and 22
ii. The Division of Health Benefit Exchange within the Office 23
of Data Analytics; 24
(b) The commissioner shall use the information obtained under paragraph (a) of 25
this subsection to determine the statew ide average of the cost attributable to 26
the provision for all qualified health plan issuers to which the provision is 27
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applicable; and 1
(c) The required payments shall be: 2
1. Calculated based on the statewide average of the cost attributable to the 3
provision as determined by the commissioner under paragraph (b) of this 4
subsection; and 5
2. Submitted directly to qualified health plan issuers by the department 6
through a process established by the commissioner. 7
(4) A qualified health plan issuer that receives a pa yment under subsection (3)(c)2. of 8
this section shall: 9
(a) Reduce the premium charged to an individual on whose behalf the issuer 10
received the payment in an amount equal to the amount of the payment; or 11
(b) Notwithstanding KRS 304.12-090, provide a premium rebate to an individual 12
on whose behalf the issuer received the payment in an amount equal to the 13
amount of the payment. 14
(5) Any fines collected for violations of this section shall be: 15
(a) Placed in a trust and agency account within the department, which shall not 16
lapse; and 17
(b) Used solely by the department to make payments in accordance with 18
subsection (3)(c)2. of this section. 19
(6) The commissioner shall promulgate any administrative regul ations necessary to 20
enforce and effectuate this section. 21
Section 3. KRS 205.522 is amended to read as follows: 22
(1) With respect to the administration and provision of Medicaid benefits pursuant to 23
this chapter, the Department for Medicaid Services, any managed care organization 24
contracted to provide Medicaid benefits pursuant to this chapter, and the state's 25
medical assistance program shall be subject to, and comply with, the following, as 26
applicable: 27
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(a) KRS 304.17A-129; 1
(b) KRS 304.17A-145; 2
(c) KRS 304.17A-163; 3
(d) KRS 304.17A-1631; 4
(e) KRS 304.17A-167; 5
(f) KRS 304.17A-235; 6
(g) KRS 304.17A-257; 7
(h) KRS 304.17A-259; 8
(i) KRS 304.17A-263; 9
(j) KRS 304.17A-264; 10
(k) KRS 304.17A-515; 11
(l) KRS 304.17A-580; 12
(m) KRS 304.17A-600, 304.17A-603, and 304.17A-607;[ and] 13
(n) KRS 304.17A-740 to 304.17A-743; and 14
(o) Section 1 of this Act. 15
(2) A managed care organization contracted to provide Medicaid benefits pursuant to 16
this chapter shall comply with the reporting requirements of KRS 304.17A-732. 17
Section 4. KRS 205.6485 is amended to read as follows: 18
(1) As used in this section, "KCHIP" means the Kentucky Children's Health Insurance 19
Program. 20
(2) The Cabinet for Health and Family Services shall: 21
(a) Prepare a state child health plan, known as KCHIP, meeting the requirements 22
of Title XXI of the Federal Social Security Act, for submission to the 23
Secretary of the United States Department of Health and Human Services 24
within such time as will permit the state to receive the maximum amounts of 25
federal matching funds available under Title XXI; and 26
(b) By administrative regulation promulgated in accordance with KRS Chapter 27
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13A, establish the following: 1
1. The eligibility criteria for children covered by KCHIP, which shall 2
include a provision that no person eligible for services under Title XIX 3
of the Social Security Act, 42 U.S.C. secs. 1396 to 1396v, as amended, 4
shall be eligible for services under KCHIP, except to the extent that 5
Title XIX coverage is expanded by KRS 205.6481 to 205.6495 and KRS 6
304.17A-340; 7
2. The schedule of benefits to be covered by KCHIP, which shall: 8
a. Be at least equivalent to one (1) of the following: 9
i. The standard Blue Cross/Blue Shield preferred provider 10
option under the Federal Employees Health Benefit Plan 11
established by 5 U.S.C. sec. 8903(1); 12
ii. A mid-range health benefit coverage plan that is offered and 13
generally available to state employees; or 14
iii. Health insurance coverage offered by a health maintenance 15
organization that has the largest insured commercial, non -16
Medicaid enrollment of covered lives in the state; and 17
b. Comply with subsection (6) of this section; 18
3. The premium contribution per f amily for health insurance coverage 19
available under KCHIP, which shall be based: 20
a. On a six (6) month period; and 21
b. Upon a sliding scale relating to family income not to exceed: 22
i. Ten dollars ($10), to be paid by a family with income 23
between one hundred percent (100%) to one hundred thirty -24
three percent (133%) of the federal poverty level; 25
ii. Twenty dollars ($20), to be paid by a family with income 26
between one hundred thirty -four percent (134%) to one 27
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hundred forty -nine percent (149%) of the federal pov erty 1
level; and 2
iii. One hundred twenty dollars ($120), to be paid by a family 3
with income between one hundred fifty percent (150%) to 4
two hundred percent (200%) of the federal poverty level, and 5
which may be made on a partial payment plan of twenty 6
dollars ($20) per month or sixty dollars ($60) per quarter; 7
4. There shall be no copayments for services provided under KCHIP; and 8
5. a. The criteria for health services providers and insurers wishing to 9
contract with the Commonwealth to provide coverage under 10
KCHIP. 11
b. The cabinet shall provide, in any contracting process for coverage 12
of preventive services, the opportunity for a public health 13
department to bid on preventive health services to eligible children 14
within the public health department's service area. A public health 15
department shall not be disqualified from bidding because the 16
department does not currently offer all the services required by 17
this section. The criteria shall be set forth in administrative 18
regulations under KRS Chapter 13A and shall maxi mize 19
competition among the providers and insurers. The Finance and 20
Administration Cabinet shall provide oversight over contracting 21
policies and procedures to assure that the number of applicants for 22
contracts is maximized. 23
(3) Within twelve (12) months of federal approval of the state's Title XXI child health 24
plan, the Cabinet for Health and Family Services shall assure that a KCHIP 25
program is available to all eligible children in all regions of the state. If necessary, 26
in order to meet this assurance, the cabinet shall institute its own program. 27
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(4) KCHIP recipients shall have direct access without a referral from any gatekeeper 1
primary care provider to dentists for covered primary dental services and to 2
optometrists and ophthalmologists for covered primary eye and vision services. 3
(5) KCHIP shall comply with KRS 304.17A-163 and 304.17A-1631. 4
(6) The schedule of benefits required under subsection (2)(b)2. of this section shall 5
include: 6
(a) Preventive services; 7
(b) Vision services, including glasses; 8
(c) Dental services, including sealants, extractions, and fillings; and 9
(d) The coverage required under: 10
1. KRS 304.17A-129;[ and] 11
2. KRS 304.17A-145; and 12
3. Section 1 of this Act. 13
Section 5. KRS 164.2871 is amended to read as follows: 14
(1) The governing board of each state postsecondary educational institution is 15
authorized to purchase liability insurance for the protection of the individual 16
members of the governing board, faculty, and staff of such institutions from liability 17
for acts and omissions committed in the course and scope of the individual's 18
employment or service. Each institution may purchase the type and amount of 19
liability coverage deemed to best serve the interest of such institution. 20
(2) All retirement annuity allowances accrued or accruing to any employee of a state 21
postsecondary educational institution through a retirement program sponsored by 22
the state postsecondary educational institution are hereby exempt from any state, 23
county, or municipal tax, and shall not be subject to execution, attachment, 24
garnishment, or any other process whatsoever, nor shall any assignment thereof be 25
enforceable in any court. Except retirement benefits accrued or accruing to any 26
employee of a sta te postsecondary educational institution through a retirement 27
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program sponsored by the state postsecondary educational institution on or after 1
January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 2
provided in KRS 141.010 and 141.0215. 3
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 4
members of governing boards, faculty and staff of institutions of higher education 5
in this state shall not be construed to be a waiver of sovereign immunity or any 6
other immunity or privilege. 7
(4) The governing board of each state postsecondary education institution is authorized 8
to provide a self -insured employer group health plan to its employees, which plan 9
shall: 10
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 11
(b) Except as provided in subsection (5) of this section, be exempt from 12
conformity with Subtitle 17A of KRS Chapter 304. 13
(5) A self-insured employer group health plan provided by the governing board of a 14
state postsecondary education institution to its employees shall comply with: 15
(a) KRS 304.17A-129; 16
(b) KRS 304.17A-133; 17
(c) KRS 304.17A-145; 18
(d) KRS 304.17A-163 and 304.17A-1631; 19
(e) KRS 304.17A-261; 20
(f) KRS 304.17A-262; 21
(g) KRS 304.17A-264;[ and] 22
(h) KRS 304.17A-265; and 23
(i) Section 1 of this Act. 24
(6) (a) A self-insured employer group health plan provided by the governing board of 25
a state postsecondary education institution to its employees shall provide a 26
special enrollment period to pregnant women who are eligible for coverage in 27
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accordance with the requirements set forth in KRS 304.17-182. 1
(b) The governing board of a state postsecondary education institution shall, at or 2
before the time an employee is initially offered the opportunity to enroll in the 3
plan or coverage, provide the emp loyee a notice of the special enrollment 4
rights under this subsection. 5
Section 6. KRS 18A.225 is amended to read as follows: 6
(1) (a) The term "employee" for purposes of this section means: 7
1. Any person, including an ele cted public official, who is regularly 8
employed by any department, office, board, agency, or branch of state 9
government; or by a public postsecondary educational institution; or by 10
any city, urban -county, charter county, county, or consolidated local 11
government, whose legislative body has opted to participate in the state -12
sponsored health insurance program pursuant to KRS 79.080; and who 13
is either a contributing member to any one (1) of the retirement systems 14
administered by the state, including but not lim ited to the Kentucky 15
Retirement Systems, County Employees Retirement System, Kentucky 16
Teachers' Retirement System, the Legislators' Retirement Plan, or the 17
Judicial Retirement Plan; or is receiving a contractual contribution from 18
the state toward a retirem ent plan; or, in the case of a public 19
postsecondary education institution, is an individual participating in an 20
optional retirement plan authorized by KRS 161.567; or is eligible to 21
participate in a retirement plan established by an employer who ceases 22
participating in the Kentucky Employees Retirement System pursuant to 23
KRS 61.522 whose employees participated in the health insurance plans 24
administered by the Personnel Cabinet prior to the employer's effective 25
cessation date in the Kentucky Employees Retirement System; 26
2. Any certified or classified employee of a local board of education or a 27
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public charter school as defined in KRS 160.1590; 1
3. Any elected member of a local board of education; 2
4. Any person who is a present or future recipient of a retirement 3
allowance from the Kentucky Retirement Systems, County Employees 4
Retirement System, Kentucky Teachers' Retirement System, the 5
Legislators' Retirement Plan, the Judicial Retirement Plan, or the 6
Kentucky Community and Technical College System's optional 7
retirement plan authorized by KRS 161.567, except that a person who is 8
receiving a retirement allowance and who is age sixty -five (65) or older 9
shall not be included, with the exception of persons covered under KRS 10
61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 11
employed pursuant to subparagraph 1. of this paragraph; and 12
5. Any eligible dependents and beneficiaries of participating employees 13
and retirees who are entitled to partici pate in the state -sponsored health 14
insurance program; 15
(b) The term "health benefit plan" for the purposes of this section means a health 16
benefit plan as defined in KRS 304.17A-005; 17
(c) The term "insurer" for the purposes of this section means an insurer as defined 18
in KRS 304.17A-005; and 19
(d) The term "managed care plan" for the purposes of this section means a 20
managed care plan as defined in KRS 304.17A-500. 21
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 22
recommendation of the secr etary of the Personnel Cabinet, shall procure, in 23
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 24
from one (1) or more insurers authorized to do business in this state, a group 25
health benefit plan that may include but not be limited to health maintenance 26
organization (HMO), preferred provider organization (PPO), point of service 27
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(POS), and exclusive provider organization (EPO) benefit plans 1
encompassing all or any class or classes of employees. With the exception of 2
employers governed b y the provisions of KRS Chapters 16, 18A, and 151B, 3
all employers of any class of employees or former employees shall enter into 4
a contract with the Personnel Cabinet prior to including that group in the state 5
health insurance group. The contracts shall in clude but not be limited to 6
designating the entity responsible for filing any federal forms, adoption of 7
policies required for proper plan administration, acceptance of the contractual 8
provisions with health insurance carriers or third -party administrators , and 9
adoption of the payment and reimbursement methods necessary for efficient 10
administration of the health insurance program. Health insurance coverage 11
provided to state employees under this section shall, at a minimum, contain 12
the same benefits as provi ded under Kentucky Kare Standard as of January 1, 13
1994, and shall include a mail -order drug option as provided in subsection 14
(13) of this section. All employees and other persons for whom the health care 15
coverage is provided or made available shall annuall y be given an option to 16
elect health care coverage through a self -funded plan offered by the 17
Commonwealth or, if a self -funded plan is not available, from a list of 18
coverage options determined by the competitive bid process under the 19
provisions of KRS 45A. 080, 45A.085, and 45A.090 and made available 20
during annual open enrollment. 21
(b) The policy or policies shall be approved by the commissioner of insurance 22
and may contain the provisions the commissioner of insurance approves, 23
whether or not otherwise permitted by the insurance laws. 24
(c) Any carrier bidding to offer health care coverage to employees shall agree to 25
provide coverage to all members of the state group, including active 26
employees and retirees and their eligible covered dependents and 27
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beneficiaries, within the county or counties specified in its bid. Except as 1
provided in subsection (20) of this section, any carrier bidding to offer health 2
care coverage to employees shall also agree to rate all employees as a single 3
entity, except for those retirees whose former employers insure their active 4
employees outside the state -sponsored health insurance program and as 5
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 6
(d) Any carrier bidding to offer health care coverage to employees shall agre e to 7
provide enrollment, claims, and utilization data to the Commonwealth in a 8
format specified by the Personnel Cabinet with the understanding that the data 9
shall be owned by the Commonwealth; to provide data in an electronic form 10
and within a time frame specified by the Personnel Cabinet; and to be subject 11
to penalties for noncompliance with data reporting requirements as specified 12
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 13
to protect the confidentiality of each individu al employee; however, 14
confidentiality assertions shall not relieve a carrier from the requirement of 15
providing stipulated data to the Commonwealth. 16
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 17
for timely analysis of dat a received from carriers and, to the extent possible, 18
provide in the request -for-proposal specifics relating to data requirements, 19
electronic reporting, and penalties for noncompliance. The Commonwealth 20
shall own the enrollment, claims, and utilization dat a provided by each carrier 21
and shall develop methods to protect the confidentiality of the individual. The 22
Personnel Cabinet shall include in the October annual report submitted 23
pursuant to the provisions of KRS 18A.226 to the Governor, the General 24
Assembly, and the Chief Justice of the Supreme Court, an analysis of the 25
financial stability of the program, which shall include but not be limited to 26
loss ratios, methods of risk adjustment, measurements of carrier quality of 27
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service, prescription coverage and c ost management, and statutorily required 1
mandates. If state self -insurance was available as a carrier option, the report 2
also shall provide a detailed financial analysis of the self -insurance fund 3
including but not limited to loss ratios, reserves, and reinsurance agreements. 4
(f) If any agency participating in the state -sponsored employee health insurance 5
program for its active employees terminates participation and there is a state 6
appropriation for the employer's contribution for active employees' health 7
insurance coverage, then neither the agency nor the employees shall receive 8
the state -funded contribution after termination from the state -sponsored 9
employee health insurance program. 10
(g) Any funds in flexible spending accounts that remain after all reimbu rsements 11
have been processed shall be transferred to the credit of the state -sponsored 12
health insurance plan's appropriation account. 13
(h) Each entity participating in the state-sponsored health insurance program shall 14
provide an amount at least equal to the state contribution rate for the employer 15
portion of the health insurance premium. For any participating entity that used 16
the state payroll system, the employer contribution amount shall be equal to 17
but not greater than the state contribution rate. 18
(3) The premiums may be paid by the policyholder: 19
(a) Wholly from funds contributed by the employee, by payroll deduction or 20
otherwise; 21
(b) Wholly from funds contributed by any department, board, agency, public 22
postsecondary education institution, or branch of s tate, city, urban -county, 23
charter county, county, or consolidated local government; or 24
(c) Partly from each, except that any premium due for health care coverage or 25
dental coverage, if any, in excess of the premium amount contributed by any 26
department, board, agency, postsecondary education institution, or branch of 27
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state, city, urban -county, charter county, county, or consolidated local 1
government for any other health care coverage shall be paid by the employee. 2
(4) If an employee moves his or her place of residence or employment out of the 3
service area of an insurer offering a managed health care plan, under which he or 4
she has elected coverage, into either the service area of another managed health care 5
plan or into an area of the Commonwealth not within a managed health care plan 6
service area, the employee shall be given an option, at the time of the move or 7
transfer, to change his or her coverage to another health benefit plan. 8
(5) No payment of premium by any department, board, agency, public postsecond ary 9
educational institution, or branch of state, city, urban -county, charter county, 10
county, or consolidated local government shall constitute compensation to an 11
insured employee for the purposes of any statute fixing or limiting the 12
compensation of such an employee. Any premium or other expense incurred by any 13
department, board, agency, public postsecondary educational institution, or branch 14
of state, city, urban -county, charter county, county, or consolidated local 15
government shall be considered a proper cost of administration. 16
(6) The policy or policies may contain the provisions with respect to the class or classes 17
of employees covered, amounts of insurance or coverage for designated classes or 18
groups of employees, policy options, terms of eligibility, a nd continuation of 19
insurance or coverage after retirement. 20
(7) Group rates under this section shall be made available to the disabled child of an 21
employee regardless of the child's age if the entire premium for the disabled child's 22
coverage is paid by the state employee. A child shall be considered disabled if he or 23
she has been determined to be eligible for federal Social Security disability benefits. 24
(8) The health care contract or contracts for employees shall be entered into for a 25
period of not less than one (1) year. 26
(9) The secretary shall appoint thirty -two (32) persons to an Advisory Committee of 27
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State Health Insurance Subscribers to advise the secretary or the secretary's 1
designee regarding the state -sponsored health insurance program for employees. 2
The secretary shall appoint, from a list of names submitted by appointing 3
authorities, members representing school districts from each of the seven (7) 4
Supreme Court districts, members representing state government from each of the 5
seven (7) Supreme Court districts, two (2) members representing retirees under age 6
sixty-five (65), one (1) member representing local health departments, two (2) 7
members representing the Kentucky Teachers' Retirement System, and three (3) 8
members at large. The secretary shall al so appoint two (2) members from a list of 9
five (5) names submitted by the Kentucky Education Association, two (2) members 10
from a list of five (5) names submitted by the largest state employee organization of 11
nonschool state employees, two (2) members from a list of five (5) names submitted 12
by the Kentucky Association of Counties, two (2) members from a list of five (5) 13
names submitted by the Kentucky League of Cities, and two (2) members from a 14
list of names consisting of five (5) names submitted by each st ate employee 15
organization that has two thousand (2,000) or more members on state payroll 16
deduction. The advisory committee shall be appointed in January of each year and 17
shall meet quarterly. 18
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 19
provided to employees pursuant to this section shall not provide coverage for 20
obtaining or performing an abortion, nor shall any state funds be used for the 21
purpose of obtaining or performing an abortion on behalf of employees or th eir 22
dependents. 23
(11) Interruption of an established treatment regime with maintenance drugs shall be 24
grounds for an insured to appeal a formulary change through the established appeal 25
procedures approved by the Department of Insurance, if the physician sup ervising 26
the treatment certifies that the change is not in the best interests of the patient. 27
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(12) Any employee who is eligible for and elects to participate in the state health 1
insurance program as a retiree, or the spouse or beneficiary of a retiree, und er any 2
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 3
state health insurance contribution toward health care coverage as a result of any 4
other employment for which there is a public employer contribution. This does n ot 5
preclude a retiree and an active employee spouse from using both contributions to 6
the extent needed for purchase of one (1) state sponsored health insurance policy 7
for that plan year. 8
(13) (a) The policies of health insurance coverage procured under subsection (2) of 9
this section shall include a mail -order drug option for maintenance drugs for 10
state employees. Maintenance drugs may be dispensed by mail order in 11
accordance with Kentucky law. 12
(b) A health insurer shall not discriminate against any retail pharmacy located 13
within the geographic coverage area of the health benefit plan and that meets 14
the terms and conditions for participation established by the insurer, including 15
price, dispensing fee , and copay requirements of a mail -order option. The 16
retail pharmacy shall not be required to dispense by mail. 17
(c) The mail -order option shall not permit the dispensing of a controlled 18
substance classified in Schedule II. 19
(14) The policy or policies provi ded to state employees or their dependents pursuant to 20
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 21
aid-related services for insured individuals under eighteen (18) years of age, subject 22
to a cap of one thousand fou r hundred dollars ($1,400) every thirty -six (36) months 23
pursuant to KRS 304.17A-132. 24
(15) Any policy provided to state employees or their dependents pursuant to this section 25
shall provide coverage for the diagnosis and treatment of autism spectrum disorder s 26
consistent with KRS 304.17A-142. 27
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(16) Any policy provided to state employees or their dependents pursuant to this section 1
shall provide coverage for obtaining amino acid -based elemental formula pursuant 2
to KRS 304.17A-258. 3
(17) If a state employee's resi dence and place of employment are in the same county, 4
and if the hospital located within that county does not offer surgical services, 5
intensive care services, obstetrical services, level II neonatal services, diagnostic 6
cardiac catheterization services, a nd magnetic resonance imaging services, the 7
employee may select a plan available in a contiguous county that does provide 8
those services, and the state contribution for the plan shall be the amount available 9
in the county where the plan selected is located. 10
(18) If a state employee's residence and place of employment are each located in 11
counties in which the hospitals do not offer surgical services, intensive care 12
services, obstetrical services, level II neonatal services, diagnostic cardiac 13
catheterization services, and magnetic resonance imaging services, the employee 14
may select a plan available in a county contiguous to the county of residence that 15
does provide those services, and the state contribution for the plan shall be the 16
amount available in the county where the plan selected is located. 17
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 18
in the best interests of the state group to allow any carrier bidding to offer health 19
care coverage under this section to submi t bids that may vary county by county or 20
by larger geographic areas. 21
(20) Notwithstanding any other provision of this section, the bid for proposals for health 22
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 23
the statewide rating structure provided in calendar year 2003 and a bid scenario that 24
allows for a regional rating structure that allows carriers to submit bids that may 25
vary by region for a given product offering as described in this subsection: 26
(a) The regional rat ing bid scenario shall not include a request for bid on a 27
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statewide option; 1
(b) The Personnel Cabinet shall divide the state into geographical regions which 2
shall be the same as the partnership regions designated by the Department for 3
Medicaid Services for purposes of the Kentucky Health Care Partnership 4
Program established pursuant to 907 KAR 1:705; 5
(c) The request for proposal shall require a carrier's bid to include every county 6
within the region or regions for which the bid is submitted and include but not 7
be restricted to a preferred provider organization (PPO) option; 8
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 9
carrier all of the counties included in its bid within the region. If the Personnel 10
Cabinet deems the bid s submitted in accordance with this subsection to be in 11
the best interests of state employees in a region, the cabinet may award the 12
contract for that region to no more than two (2) carriers; and 13
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 14
other requirements or criteria in the request for proposal. 15
(21) Any fully insured health benefit plan or self -insured plan issued or renewed on or 16
after July 12, 2006, to public employees pursuant to this section which provides 17
coverage for services rendered by a physician or osteopath duly licensed under KRS 18
Chapter 311 that are within the scope of practice of an optometrist duly licensed 19
under the provisions of KRS Chapter 320 shall provide the same payment of 20
coverage to optometri sts as allowed for those services rendered by physicians or 21
osteopaths. 22
(22) Any fully insured health benefit plan or self -insured plan issued or renewed to 23
public employees pursuant to this section shall comply with: 24
(a) KRS 304.12-237; 25
(b) KRS 304.17A-270 and 304.17A-525; 26
(c) KRS 304.17A-600 to 304.17A-633; 27
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(d) KRS 205.593; 1
(e) KRS 304.17A-700 to 304.17A-730; 2
(f) KRS 304.14-135; 3
(g) KRS 304.17A-580 and 304.17A-641; 4
(h) KRS 304.99-123; 5
(i) KRS 304.17A-138; 6
(j) KRS 304.17A-148; 7
(k) KRS 304.17A-163 and 304.17A-1631; 8
(l) KRS 304.17A-265; 9
(m) KRS 304.17A-261; 10
(n) KRS 304.17A-262; 11
(o) KRS 304.17A-145; 12
(p) KRS 304.17A-129; 13
(q) KRS 304.17A-133; 14
(r) KRS 304.17A-264;[ and] 15
(s) Section 1 of this Act; and 16
(t) Administrative regulations promulg ated pursuant to statutes listed in this 17
subsection. 18
(23) (a) Any fully insured health benefit plan or self-insured plan issued or renewed to 19
public employees pursuant to this section shall provide a special enrollment 20
period to pregnant women who are elig ible for coverage in accordance with 21
the requirements set forth in KRS 304.17-182. 22
(b) The Department of Employee Insurance shall, at or before the time a public 23
employee is initially offered the opportunity to enroll in the plan or coverage, 24
provide the e mployee a notice of the special enrollment rights under this 25
subsection. 26
Section 7. Sections 1, 5, and 6 of this Act apply to health benefit plans issued or 27
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renewed on or after January 1, 2027. 1
Section 8. If the Cabinet for Health and Family Services or the Department for 2
Medicaid Services determines that a state plan amendment, waiver, or any other form of 3
authorization or approval from any federal agency to implement Section 3 or 4 of this Act 4
is necessary to prevent the loss of federal funds or to comply with federal law, the cabinet 5
or department: 6
(1) Shall, within 90 days after the effective date of this section, request the 7
necessary federal authorization or approval to implement Sections 3 and 4 of this Act; 8
and 9
(2) May only delay implementation of the provisions of Sections 3 and 4 of this 10
Act for which federal authorization or approval was deemed necessary until the federal 11
authorization or approval is granted. 12
Section 9. Sections 3, 4, and 8 of this Act shall constitute the specific 13
authorization required under KRS 205.5372(1). 14
Section 10. The Department for Medicaid Services or the Cabinet for Health 15
and Family Services shall, in accordance with KRS 205.525, provide a copy of any state 16
plan amendment, waiver application, or other request for authorization or approval 17
submitted pursuant to Section 8 of this Act to the Legislative Research Commission for 18
referral to the Interim Joint Committees on Health Services and Appropriations and 19
Revenue and shall provide an update on the status of any application or request submitted 20
pursuant to Section 8 of this Act at the request of the Legislative Research Commission 21
or any committee thereof. 22
Section 11. Sections 1 to 7 of this Act take effect January 1, 2027. 23