AN ACT relating to coverage for scalp cooling systems used in connection with chemotherapy treatment for breast cancer.

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AN ACT relating to coverage for scalp cooling systems used in connection with 1
chemotherapy treatment for breast cancer. 2
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 3
SECTION 1. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 4
IS CREATED TO READ AS FOLLOWS: 5
(1) As used in this section: 6
(a) "Health plan": 7
1. Means any health insurance policy, certificate, contract, or plan that 8
offers or provides coverage in this state for chemotherapy treatment 9
for breast cancer: 10
a. By direct payment, reimbursement, or otherwise; and 11
b. On a fully insured or self -insured basis or any combination 12
thereof; and 13
2. Includes a health benefit plan; and 14
(b) "Scalp cooling system" means any device used to cool the scalp to prevent 15
or reduce hair loss during chemotherapy treatment. 16
(2) To the extent permitted by federal law, a health plan shall provide coverage for 17
scalp cooling systems used in connection with chemotherapy treatment for breast 18
cancer. 19
(3) If the application of any requirement o f this section to a qualified health plan, as 20
defined in 42 U.S.C. sec. 18021(a)(1), as amended, results or would result in a 21
determination that the state must make payments to defray the cost of the 22
requirement under 42 U.S.C. sec. 18031(d)(3) and 45 C.F. R. sec. 155.170, as 23
amended, then the requirement shall not apply to the qualified health plan until 24
the requirement to make cost defrayal payments is no longer applicable. 25
Section 2. KRS 304.17A-099 is amended to read as follows: 26
(1) As used in this section, "qualified health plan" has the same meaning as in 42 27
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U.S.C. sec. 18021(a)(1), as amended. 1
(2) Notwithstanding any other provision of this chapter: 2
(a) Except as provided in paragraph (b) of this subsection, if the a pplication of a 3
provision of this chapter results, or would result, in a determination that the 4
state must make payments to defray the cost of the provision under 42 U.S.C. 5
sec. 18031(d)(3) and 45 C.F.R. sec. 155.170, as amended, then the provision 6
shall not apply to a qualified health plan or any other health insurance policy, 7
certificate, plan, or contract until the requirement to make cost defrayal 8
payments is no longer applicable; and 9
(b) This subsection shall not apply to any of the following: 10
1. A provision of this chapter that became effective on or before January 1, 11
2024; or 12
2. Section 1 of this Act. 13
(3) To the extent permitted by federal law, if the state is required under 42 U.S.C. sec. 14
18031(d)(3) and 45 C.F.R. sec. 155.170, as amended, to make pa yments to defray 15
the cost of a provision of this chapter: 16
(a) 1. Each qualified health plan issuer shall determine, and provide to the 17
commissioner, the cost attributable to the provision for the qualified 18
health plan. 19
2. The cost attributable to a provisi on for a qualified health plan under 20
subparagraph 1. of this paragraph shall be: 21
a. Calculated in accordance with generally accepted actuarial 22
principles and methodologies; 23
b. Conducted by a member of the American Academy of Actuaries; 24
and 25
c. Reported by the qualified health plan issuer to: 26
i. The commissioner; and 27
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ii. The Division of Health Benefit Exchange within the Office 1
of Data Analytics; 2
(b) The commissioner shall use the information obtained under paragraph (a) of 3
this subsection to determine the st atewide average of the cost attributable to 4
the provision for all qualified health plan issuers to which the provision is 5
applicable; and 6
(c) The required payments shall be: 7
1. Calculated based on the statewide average of the cost attributable to the 8
provision as determined by the commissioner under paragraph (b) of this 9
subsection; and 10
2. Submitted directly to qualified health plan issuers by the department 11
through a process established by the commissioner. 12
(4) A qualified health plan issuer that receives a payment under subsection (3)(c)2. of 13
this section shall: 14
(a) Reduce the premium char ged to an individual on whose behalf the issuer 15
received the payment in an amount equal to the amount of the payment; or 16
(b) Notwithstanding KRS 304.12-090, provide a premium rebate to an individual 17
on whose behalf the issuer received the payment in an amo unt equal to the 18
amount of the payment. 19
(5) Any fines collected for violations of this section shall be: 20
(a) Placed in a trust and agency account within the department, which shall not 21
lapse; and 22
(b) Used solely by the department to make payments in accord ance with 23
subsection (3)(c)2. of this section. 24
(6) The commissioner shall promulgate any administrative regulations necessary to 25
enforce and effectuate this section. 26
Section 3. KRS 304.17C-125 is amended to read as follows: 27
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The following shall apply to limited health service benefit plans, including any limited 1
health service contract, as defined in KRS 304.38A-010: 2
(1) KRS 304.17A-129; 3
(2) KRS 304.17A-262;[ and] 4
(3) KRS 304.17A-591 to 304.17A-599; and 5
(4) Section 1 of this Act. 6
Section 4. KRS 164.2871 is amended to read as follows: 7
(1) The governing board of each state postsecondary educational institution is 8
authorized to purchase liability insurance for the protection of the individua l 9
members of the governing board, faculty, and staff of such institutions from liability 10
for acts and omissions committed in the course and scope of the individual's 11
employment or service. Each institution may purchase the type and amount of 12
liability coverage deemed to best serve the interest of such institution. 13
(2) All retirement annuity allowances accrued or accruing to any employee of a state 14
postsecondary educational institution through a retirement program sponsored by 15
the state postsecondary educati onal institution are hereby exempt from any state, 16
county, or municipal tax, and shall not be subject to execution, attachment, 17
garnishment, or any other process whatsoever, nor shall any assignment thereof be 18
enforceable in any court. Except retirement be nefits accrued or accruing to any 19
employee of a state postsecondary educational institution through a retirement 20
program sponsored by the state postsecondary educational institution on or after 21
January 1, 1998, shall be subject to the tax imposed by KRS 14 1.020, to the extent 22
provided in KRS 141.010 and 141.0215. 23
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 24
members of governing boards, faculty and staff of institutions of higher education 25
in this state shall not be const rued to be a waiver of sovereign immunity or any 26
other immunity or privilege. 27
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(4) The governing board of each state postsecondary education institution is authorized 1
to provide a self -insured employer group health plan to its employees, which plan 2
shall: 3
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 4
(b) Except as provided in subsection (5) of this section, be exempt from 5
conformity with Subtitle 17A of KRS Chapter 304. 6
(5) A self-insured employer group health plan provided by the go verning board of a 7
state postsecondary education institution to its employees shall comply with: 8
(a) KRS 304.17A-129; 9
(b) KRS 304.17A-133; 10
(c) KRS 304.17A-145; 11
(d) KRS 304.17A-163 and 304.17A-1631; 12
(e) KRS 304.17A-261; 13
(f) KRS 304.17A-262; 14
(g) KRS 304.17A-264;[ and] 15
(h) KRS 304.17A-265; and 16
(i) Section 1 of this Act. 17
(6) (a) A self-insured employer group health plan provided by the governing board of 18
a state postsecondary education institution to its employees shall provide a 19
special enrollment period to pregnant women who are eligible for coverage in 20
accordance with the requirements set forth in KRS 304.17-182. 21
(b) The governing board of a state postsecondary education institution shall, at or 22
before the time an employee is initially offered the opportunity to enroll in the 23
plan or coverage, provide the employee a notice of the special enrollment 24
rights under this subsection. 25
Section 5. KRS 18A.225 is amended to read as follows: 26
(1) (a) The term "employee" for purposes of this section means: 27
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1. Any person, including an elected public official, who is regularly 1
employed by any department, office, board, agency, or branch of state 2
government; or by a public postsecondary educational institution; or by 3
any city, ur ban-county, charter county, county, or consolidated local 4
government, whose legislative body has opted to participate in the state -5
sponsored health insurance program pursuant to KRS 79.080; and who 6
is either a contributing member to any one (1) of the reti rement systems 7
administered by the state, including but not limited to the Kentucky 8
Retirement Systems, County Employees Retirement System, Kentucky 9
Teachers' Retirement System, the Legislators' Retirement Plan, or the 10
Judicial Retirement Plan; or is recei ving a contractual contribution from 11
the state toward a retirement plan; or, in the case of a public 12
postsecondary education institution, is an individual participating in an 13
optional retirement plan authorized by KRS 161.567; or is eligible to 14
participate in a retirement plan established by an employer who ceases 15
participating in the Kentucky Employees Retirement System pursuant to 16
KRS 61.522 whose employees participated in the health insurance plans 17
administered by the Personnel Cabinet prior to the emplo yer's effective 18
cessation date in the Kentucky Employees Retirement System; 19
2. Any certified or classified employee of a local board of education or a 20
public charter school as defined in KRS 160.1590; 21
3. Any elected member of a local board of education; 22
4. Any person who is a present or future recipient of a retirement 23
allowance from the Kentucky Retirement Systems, County Employees 24
Retirement System, Kentucky Teachers' Retirement System, the 25
Legislators' Retirement Plan, the Judicial Retirement Plan, or th e 26
Kentucky Community and Technical College System's optional 27
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retirement plan authorized by KRS 161.567, except that a person who is 1
receiving a retirement allowance and who is age sixty -five (65) or older 2
shall not be included, with the exception of person s covered under KRS 3
61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 4
employed pursuant to subparagraph 1. of this paragraph; and 5
5. Any eligible dependents and beneficiaries of participating employees 6
and retirees who are entitled to partic ipate in the state -sponsored health 7
insurance program; 8
(b) The term "health benefit plan" for the purposes of this section means a health 9
benefit plan as defined in KRS 304.17A-005; 10
(c) The term "insurer" for the purposes of this section means an insurer as defined 11
in KRS 304.17A-005; and 12
(d) The term "managed care plan" for the purposes of this section means a 13
managed care plan as defined in KRS 304.17A-500. 14
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 15
recommendation of the sec retary of the Personnel Cabinet, shall procure, in 16
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 17
from one (1) or more insurers authorized to do business in this state, a group 18
health benefit plan that may include but not be limited t o health maintenance 19
organization (HMO), preferred provider organization (PPO), point of service 20
(POS), and exclusive provider organization (EPO) benefit plans 21
encompassing all or any class or classes of employees. With the exception of 22
employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 23
all employers of any class of employees or former employees shall enter into 24
a contract with the Personnel Cabinet prior to including that group in the state 25
health insurance group. The contracts shall i nclude but not be limited to 26
designating the entity responsible for filing any federal forms, adoption of 27
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policies required for proper plan administration, acceptance of the contractual 1
provisions with health insurance carriers or third -party administrator s, and 2
adoption of the payment and reimbursement methods necessary for efficient 3
administration of the health insurance program. Health insurance coverage 4
provided to state employees under this section shall, at a minimum, contain 5
the same benefits as prov ided under Kentucky Kare Standard as of January 1, 6
1994, and shall include a mail -order drug option as provided in subsection 7
(13) of this section. All employees and other persons for whom the health care 8
coverage is provided or made available shall annual ly be given an option to 9
elect health care coverage through a self -funded plan offered by the 10
Commonwealth or, if a self -funded plan is not available, from a list of 11
coverage options determined by the competitive bid process under the 12
provisions of KRS 45A .080, 45A.085, and 45A.090 and made available 13
during annual open enrollment. 14
(b) The policy or policies shall be approved by the commissioner of insurance 15
and may contain the provisions the commissioner of insurance approves, 16
whether or not otherwise permitted by the insurance laws. 17
(c) Any carrier bidding to offer health care coverage to employees shall agree to 18
provide coverage to all members of the state group, including active 19
employees and retirees and their eligible covered dependents and 20
beneficiaries, within the county or counties specified in its bid. Except as 21
provided in subsection (20) of this section, any carrier bidding to offer health 22
care coverage to employees shall also agree to rate all employees as a single 23
entity, except for those retiree s whose former employers insure their active 24
employees outside the state -sponsored health insurance program and as 25
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 26
(d) Any carrier bidding to offer health care coverage to employees shall agr ee to 27
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provide enrollment, claims, and utilization data to the Commonwealth in a 1
format specified by the Personnel Cabinet with the understanding that the data 2
shall be owned by the Commonwealth; to provide data in an electronic form 3
and within a time frame specified by the Personnel Cabinet; and to be subject 4
to penalties for noncompliance with data reporting requirements as specified 5
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 6
to protect the confidentiality of each individ ual employee; however, 7
confidentiality assertions shall not relieve a carrier from the requirement of 8
providing stipulated data to the Commonwealth. 9
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 10
for timely analysis of da ta received from carriers and, to the extent possible, 11
provide in the request -for-proposal specifics relating to data requirements, 12
electronic reporting, and penalties for noncompliance. The Commonwealth 13
shall own the enrollment, claims, and utilization da ta provided by each carrier 14
and shall develop methods to protect the confidentiality of the individual. The 15
Personnel Cabinet shall include in the October annual report submitted 16
pursuant to the provisions of KRS 18A.226 to the Governor, the General 17
Assembly, and the Chief Justice of the Supreme Court, an analysis of the 18
financial stability of the program, which shall include but not be limited to 19
loss ratios, methods of risk adjustment, measurements of carrier quality of 20
service, prescription coverage and cost management, and statutorily required 21
mandates. If state self -insurance was available as a carrier option, the report 22
also shall provide a detailed financial analysis of the self -insurance fund 23
including but not limited to loss ratios, reserves, and reinsurance agreements. 24
(f) If any agency participating in the state -sponsored employee health insurance 25
program for its active employees terminates participation and there is a state 26
appropriation for the employer's contribution for active employees' health 27
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insurance coverage, then neither the agency nor the employees shall receive 1
the state -funded contribution after termination from the state -sponsored 2
employee health insurance program. 3
(g) Any funds in flexible spending accounts that remain after all reimb ursements 4
have been processed shall be transferred to the credit of the state -sponsored 5
health insurance plan's appropriation account. 6
(h) Each entity participating in the state-sponsored health insurance program shall 7
provide an amount at least equal to the state contribution rate for the employer 8
portion of the health insurance premium. For any participating entity that used 9
the state payroll system, the employer contribution amount shall be equal to 10
but not greater than the state contribution rate. 11
(3) The premiums may be paid by the policyholder: 12
(a) Wholly from funds contributed by the employee, by payroll deduction or 13
otherwise; 14
(b) Wholly from funds contributed by any department, board, agency, public 15
postsecondary education institution, or branch of state, city, urban -county, 16
charter county, county, or consolidated local government; or 17
(c) Partly from each, except that any premium d ue for health care coverage or 18
dental coverage, if any, in excess of the premium amount contributed by any 19
department, board, agency, postsecondary education institution, or branch of 20
state, city, urban -county, charter county, county, or consolidated local 21
government for any other health care coverage shall be paid by the employee. 22
(4) If an employee moves his or her place of residence or employment out of the 23
service area of an insurer offering a managed health care plan, under which he or 24
she has elected coverage, into either the service area of another managed health care 25
plan or into an area of the Commonwealth not within a managed health care plan 26
service area, the employee shall be given an option, at the time of the move or 27
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transfer, to change his or her coverage to another health benefit plan. 1
(5) No payment of premium by any department, board, agency, public postsecondary 2
educational institution, or branch of state, city, urban -county, charter county, 3
county, or consolidated local government shall co nstitute compensation to an 4
insured employee for the purposes of any statute fixing or limiting the 5
compensation of such an employee. Any premium or other expense incurred by any 6
department, board, agency, public postsecondary educational institution, or b ranch 7
of state, city, urban -county, charter county, county, or consolidated local 8
government shall be considered a proper cost of administration. 9
(6) The policy or policies may contain the provisions with respect to the class or classes 10
of employees covere d, amounts of insurance or coverage for designated classes or 11
groups of employees, policy options, terms of eligibility, and continuation of 12
insurance or coverage after retirement. 13
(7) Group rates under this section shall be made available to the disabled child of an 14
employee regardless of the child's age if the entire premium for the disabled child's 15
coverage is paid by the state employee. A child shall be considered disabled if he or 16
she has been determined to be eligible for federal Social Security disability benefits. 17
(8) The health care contract or contracts for employees shall be entered into for a 18
period of not less than one (1) year. 19
(9) The secretary shall appoint thirty -two (32) persons to an Advisory Committee of 20
State Health Insurance Subscribers to advise the secretary or the secretary's 21
designee regarding the state -sponsored health insurance program for employees. 22
The secretary shall appoint, from a list of names submitted by appointing 23
authorities, members representing school districts from eac h of the seven (7) 24
Supreme Court districts, members representing state government from each of the 25
seven (7) Supreme Court districts, two (2) members representing retirees under age 26
sixty-five (65), one (1) member representing local health departments, two (2) 27
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members representing the Kentucky Teachers' Retirement System, and three (3) 1
members at large. The secretary shall also appoint two (2) members from a list of 2
five (5) names submitted by the Kentucky Education Association, two (2) members 3
from a list of five (5) names submitted by the largest state employee organization of 4
nonschool state employees, two (2) members from a list of five (5) names submitted 5
by the Kentucky Association of Counties, two (2) members from a list of five (5) 6
names submitted by the Kentucky League of Cities, and two (2) members from a 7
list of names consisting of five (5) names submitted by each state employee 8
organization that has two thousand (2,000) or more members on state payroll 9
deduction. The advisory committee shall be ap pointed in January of each year and 10
shall meet quarterly. 11
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 12
provided to employees pursuant to this section shall not provide coverage for 13
obtaining or performing an abort ion, nor shall any state funds be used for the 14
purpose of obtaining or performing an abortion on behalf of employees or their 15
dependents. 16
(11) Interruption of an established treatment regime with maintenance drugs shall be 17
grounds for an insured to appeal a formulary change through the established appeal 18
procedures approved by the Department of Insurance, if the physician supervising 19
the treatment certifies that the change is not in the best interests of the patient. 20
(12) Any employee who is eligible for an d elects to participate in the state health 21
insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 22
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 23
state health insurance contribution towa rd health care coverage as a result of any 24
other employment for which there is a public employer contribution. This does not 25
preclude a retiree and an active employee spouse from using both contributions to 26
the extent needed for purchase of one (1) state s ponsored health insurance policy 27
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for that plan year. 1
(13) (a) The policies of health insurance coverage procured under subsection (2) of 2
this section shall include a mail -order drug option for maintenance drugs for 3
state employees. Maintenance drugs may be dispensed by mail order in 4
accordance with Kentucky law. 5
(b) A health insurer shall not discriminate against any retail pharmacy located 6
within the geographic coverage area of the health benefit plan and that meets 7
the terms and conditions for participation established by the insurer, including 8
price, dispensing fee, and copay requirements of a mail -order option. The 9
retail pharmacy shall not be required to dispense by mail. 10
(c) The mail -order option shall not permit the dispensing of a controlled 11
substance classified in Schedule II. 12
(14) The policy or policies provided to state employees or their dependents pursuant to 13
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 14
aid-related services for insured individuals under eighteen (18) years of age, subject 15
to a cap of one thousand four hundred dollars ($1,400) every thirty -six (36) months 16
pursuant to KRS 304.17A-132. 17
(15) Any policy provided to state employees or their dependents pursuant to this section 18
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 19
consistent with KRS 304.17A-142. 20
(16) Any policy provided to state employees or their dependents pursuant to this section 21
shall provide coverage for obtaining amino acid -based elemental formul a pursuant 22
to KRS 304.17A-258. 23
(17) If a state employee's residence and place of employment are in the same county, 24
and if the hospital located within that county does not offer surgical services, 25
intensive care services, obstetrical services, level II neo natal services, diagnostic 26
cardiac catheterization services, and magnetic resonance imaging services, the 27
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employee may select a plan available in a contiguous county that does provide 1
those services, and the state contribution for the plan shall be the amo unt available 2
in the county where the plan selected is located. 3
(18) If a state employee's residence and place of employment are each located in 4
counties in which the hospitals do not offer surgical services, intensive care 5
services, obstetrical services, level II neonatal services, diagnostic cardiac 6
catheterization services, and magnetic resonance imaging services, the employee 7
may select a plan available in a county contiguous to the county of residence that 8
does provide those services, and the state con tribution for the plan shall be the 9
amount available in the county where the plan selected is located. 10
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 11
in the best interests of the state group to allow any carrier bid ding to offer health 12
care coverage under this section to submit bids that may vary county by county or 13
by larger geographic areas. 14
(20) Notwithstanding any other provision of this section, the bid for proposals for health 15
insurance coverage for calendar ye ar 2004 shall include a bid scenario that reflects 16
the statewide rating structure provided in calendar year 2003 and a bid scenario that 17
allows for a regional rating structure that allows carriers to submit bids that may 18
vary by region for a given product offering as described in this subsection: 19
(a) The regional rating bid scenario shall not include a request for bid on a 20
statewide option; 21
(b) The Personnel Cabinet shall divide the state into geographical regions which 22
shall be the same as the partnership regions designated by the Department for 23
Medicaid Services for purposes of the Kentucky Health Care Partnership 24
Program established pursuant to 907 KAR 1:705; 25
(c) The request for proposal shall require a carrier's bid to include every county 26
within the region or regions for which the bid is submitted and include but not 27
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be restricted to a preferred provider organization (PPO) option; 1
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 2
carrier all of the counties included in its bid within the region. If the Personnel 3
Cabinet deems the bids submitted in accordance with this subsection to be in 4
the best interests of state employees in a region, the cabinet may award the 5
contract for that region to no more than two (2) carriers; and 6
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 7
other requirements or criteria in the request for proposal. 8
(21) Any fully insured health benefit plan or self -insured plan issued or renewed on or 9
after July 12, 2006, to public employees pursuant to this section which provides 10
coverage for services rendered by a physician or osteopath duly licensed under KRS 11
Chapter 311 that are within the scope of practice of an optometrist duly licensed 12
under the provisions of KRS Chapter 320 shall provide the same payment of 13
coverage to optometrists as allowed for those services rendered by physicians or 14
osteopaths. 15
(22) Any fully i nsured health benefit plan or self -insured plan issued or renewed to 16
public employees pursuant to this section shall comply with: 17
(a) KRS 304.12-237; 18
(b) KRS 304.17A-270 and 304.17A-525; 19
(c) KRS 304.17A-600 to 304.17A-633; 20
(d) KRS 205.593; 21
(e) KRS 304.17A-700 to 304.17A-730; 22
(f) KRS 304.14-135; 23
(g) KRS 304.17A-580 and 304.17A-641; 24
(h) KRS 304.99-123; 25
(i) KRS 304.17A-138; 26
(j) KRS 304.17A-148; 27
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(k) KRS 304.17A-163 and 304.17A-1631; 1
(l) KRS 304.17A-265; 2
(m) KRS 304.17A-261; 3
(n) KRS 304.17A-262; 4
(o) KRS 304.17A-145; 5
(p) KRS 304.17A-129; 6
(q) KRS 304.17A-133; 7
(r) KRS 304.17A-264;[ and] 8
(s) Section 1 of this Act; and 9
(t) Administrative regulations promulgated pursuant to statutes listed in this 10
subsection. 11
(23) (a) Any fully insured health benefit plan or self-insured plan issued or renewed to 12
public employees pursuant to this section shall provide a special enrollment 13
period to pregnant women who are eligible for coverage in accordance with 14
the requirements set forth in KRS 304.17-182. 15
(b) The Department of Employee Insurance shall, at or before the time a public 16
employee is initially offered the opportunity to enroll in the plan or coverage, 17
provide the employee a notice of the special enrollment rights under this 18
subsection. 19
Section 6. Sections 1, 3, 4, and 5 of this Act apply to the health insurance 20
policies, certificates, contracts, or plans issued or renewed on or after January 1, 2027. 21
Section 7. This Act takes effect January 1, 2027. 22