AN ACT relating to reproductive health services.

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AN ACT relating to reproductive health services. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
SECTION 1. A NEW SECTION OF KRS CHAPTER 211 IS CREATED TO 3
READ AS FOLLOWS: 4
(1) As used in this section: 5
(a) "Contraception" means an action taken to prevent pregnancy, including 6
the use of contraceptives or fertility -awareness based methods and 7
sterilization procedures; and 8
(b) "Contraceptive" means any drug, device, or biological product intended for 9
use in the prevention of pregnancy, whether specifically intended to prevent 10
pregnancy or for other health needs, that is legally marketed under the 11
Federal Food, Drug, and Cosmetic Act, such as oral contraceptives, long -12
acting reversible contraceptives, emergency contraceptives, internal and 13
external condoms, injectables, vaginal barrier methods, transdermal 14
patches, vaginal rings, or other contraceptives. 15
(2) Notwithstanding any other provision of law to the contrary, a person has a 16
statutory right to obtain contraceptives and to engage in contraception, and a 17
health care provider practicing in any place in the Commonwealth, including 18
institutions of higher education, has a corresponding right to provide 19
contraceptives, contraception, referrals, services, and information related to 20
contraception. 21
(3) The statutory rights specified in subsection (2) of this section shall not be limited 22
or otherwise infringed upon through any limitation or requirement that: 23
(a) Expressly, effectively, implicitly, or as implemented singles out: 24
1. The provision or sale of contraceptives, contraception, or information 25
related to contraception; 26
2. Health care providers who provide or dispense contr aceptives, 27
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contraception, or information related to contraception; or 1
3. Facilities in which contraceptives, contraception, or information 2
related to contraception is provided or dispensed; or 3
(b) Impedes or prohibits the sale or access to contraceptives, contraception, or 4
information related to contraception. 5
(4) To defend against a claim that a limitation or requirement violates a health care 6
provider's or patient's rights under subsection (2) of this section, a party must 7
establish by clear and convincing evidence that: 8
(a) The limitation or requirement significantly advances access to 9
contraceptives, contraception, and information related to contraception; 10
and 11
(b) Access to contraceptives, contraception, and information related to 12
contraception or the he alth of patients cannot be advanced by a less 13
restrictive alternative measure or action. 14
(5) The Commonwealth or its localities shall not administer, implement, or enforce 15
any law, administrative regulation, or other provision having the force and effect 16
of law that conflicts with any provision of this section, notwithstanding any 17
provision of federal law, including the Religious Freedom Restoration Act of 18
1993, including: 19
(a) Prohibiting or restricting the sale, provision, or use of any contraceptives; 20
(b) Prohibiting or restricting any individual from aiding another individual in 21
voluntarily obtaining or using any contraceptives or contraception; or 22
(c) Exempting any contraceptives or contraception from any other generally 23
applicable law in a way that woul d make it more difficult to sell, provide, 24
obtain, or use such contraceptives or contraception, including over -the-25
counter sales. 26
(6) The Attorney General may commence a civil action on behalf of the 27
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Commonwealth against any locality that implements or enforces any limitation or 1
requirement that violates this section, or against any person who implements or 2
enforces any limitation or requirement that violates this section. The court shall 3
hold unlawful and set aside the limitation or requirement if it is in violation of 4
this section. 5
(7) The following private rights of action shall be available under this section: 6
(a) Any individual or entity, including any health care provider or patient, 7
adversely affected by an alleged violation of this section may commen ce a 8
civil action against the Commonwealth or any locality that implements or 9
enforces any limitation or requirement that violates this section or against 10
any person who implements or enforces any limitation or requirement that 11
violates this section; and 12
(b) A health care provider may commence an action for relief on its own 13
behalf, on behalf of the provider's staff, and on behalf of the provider's 14
patients who are or may be adversely affected by an alleged violation of this 15
section. 16
(8) In any action under this section, the court may award appropriate equitable 17
relief, including temporary, preliminary, or permanent injunctive relief. 18
(9) In any action under this section, the court shall award costs of litigation, as well 19
as reasonable attorney fees, to any prevailing plaintiff. A plaintiff shall not be 20
liable to a defendant for costs or attorney's fees in any nonfrivolous action under 21
this section. 22
(10) An action under this section shall be filed in Circuit Court. The Circuit Court 23
shall exercise jurisdictio n without regard to whether the aggrieved party has 24
exhausted any administrative or other remedies that may be provided for by state 25
law. 26
(11) A locality that enforces or maintains any limitation or requirement that violates 27
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this section, or a government o fficial, including any person who is permitted to 1
implement or enforce any limitation or requirement that violates this section, 2
shall not be immune from an action challenging that limitation or requirement. 3
SECTION 2. 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) "FDA" means the United States Food and Drug Administration; 7
(b) "Health benefit plan" has the same meaning as in KRS 304.17A -005, 8
except for pur poses of this section, the term shall include student health 9
insurance offered by a Kentucky -licensed insurer under written contract 10
with a university or college whose students it proposes to insure; 11
(c) "Long-acting reversible contraception": 12
1. Means a contraception method that requires administration less than 13
once per month; and 14
2. Includes: 15
a. An intrauterine device; and 16
b. A contraceptive implant; and 17
(d) "Religious employer" means an organization that is: 18
1. Organized and operates as a nonprofit entity; and 19
2. Referred to in 26 U.S.C. sec. 6033(a)(3)(A)(i) or (iii), as amended. 20
(2) Except as otherwise provided in subsection (3) or (5) of this section, a health 21
benefit plan shall provide coverage for the following: 22
(a) All FDA-approved contraceptive drugs, devices, and products, including: 23
1. Those prescribed: 24
a. By a covered person's provider; or 25
b. As otherwise authorized under state and federal law; 26
2. Over-the-counter contraceptive drugs, devices, and products; 27
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3. Those dispensed on-site at a provider's office, if available; and 1
4. Long-acting reversible contraception administered during a 2
postpartum stay; 3
(b) Voluntary sterilization procedures; 4
(c) Patient education and counseling on contraception; and 5
(d) Follow-up services related to drugs, devices, products, and procedures 6
covered under this section, including but not limited to: 7
1. Management of side effects; 8
2. Counseling for continued adherence; and 9
3. Device insertion and removal. 10
(3) For the coverage required under subsection (2)(a) of this section, the health 11
benefit plan shall: 12
(a) If the FDA has designated a therapeutic equivalent of an FDA -approved 13
prescription contraceptive drug, device, or product, cover either: 14
1. The original FDA-approved prescription contraceptive drug, device, or 15
product; or 16
2. At least one (1) therapeutic equivalent of the original FDA -approved 17
prescription contraceptive drug, device, or product; 18
(b) If a contraceptive drug, device, or product is deemed medically inadvisable 19
by the covered person's provider, defer to the determination and judgment 20
of the provider and provide coverage for an alternate prescribed FDA -21
approved contraceptive drug, device, or product; 22
(c) Provide coverage for the supply of contraceptives intended to last over a 23
twelve (12) month duration, which, at the discretion of the provider, may be 24
furnished or dispensed all at once or over the course of twelve (12) months; 25
(d) Reimburse a provider or dispensing entity per unit for furnishing or 26
dispensing an extended supply of contraceptives; 27
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(e) Not deny the coverage required under this section because a covered person 1
changed contraceptive methods within a twelve (12) month period; and 2
(f) Not require a prescription to trigger the coverage of FDA -approved over -3
the-counter contraceptive drugs, devices, and products. 4
(4) A health benefit plan subject to the coverage requirements of this section: 5
(a) Shall not impose a deductible, coinsur ance, copayment, or any other cost -6
sharing requirement on the coverage, unless the health benefit plan is 7
offered as a qualifying high deductible health plan for a health savings 8
account, in which case the plan shall establish cost -sharing only at the 9
minimum level necessary to preserve the covered person's ability to claim 10
tax-exempt contributions and withdrawals from the person's health savings 11
account under 26 U.S.C. sec. 223, as amended; 12
(b) Except as otherwise authorized under this section, shall not i mpose any 13
restrictions or delays on the coverage; and 14
(c) Shall provide the same level of benefits to a covered person's covered 15
dependents as the plan provides to the covered person. 16
(5) (a) A religious employer may request a health benefit plan without c overage for 17
any FDA-approved drugs, devices, products, procedures, and services used 18
for contraceptive purposes that are contrary to the religious employer's 19
religious tenets. 20
(b) A religious employer that makes a request under paragraph (a) of this 21
subsection shall: 22
1. Be provided a health benefit plan without the contraceptive coverage; 23
and 24
2. Provide written notice to each prospective covered person, prior to the 25
covered person's enrollment in the health benefit plan, listing the 26
contraceptive drugs, dev ices, products, procedures, and services the 27
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employer refused to cover for religious reasons. 1
(6) Nothing in this section shall be construed to: 2
(a) Exclude coverage for contraceptive drugs, devices, and products prescribed 3
by a provider, acting within the provider's scope of practice, for reasons 4
other than contraceptive purposes, including but not limited to: 5
1. Decreasing the risk of ovarian cancer; 6
2. Eliminating symptoms of menopause; or 7
3. Contraception that is necessary to preserve the life of the co vered 8
person; or 9
(b) Require a health benefit plan to cover experimental or investigational 10
treatments. 11
Section 3. KRS 304.17A-099 is amended to read as follows: 12
(1) As used in this section, "qualified health plan" has t he same meaning as in 42 13
U.S.C. sec. 18021(a)(1), as amended. 14
(2) Notwithstanding any other provision of this chapter: 15
(a) Except as provided in paragraph (b) of this subsection, if the application of a 16
provision of this chapter results, or would result, i n a determination that the 17
state must make payments to defray the cost of the provision under 42 U.S.C. 18
sec. 18031(d)(3) and 45 C.F.R. sec. 155.170, as amended, then the provision 19
shall not apply to a qualified health plan or any other health insurance pol icy, 20
certificate, plan, or contract until the requirement to make cost defrayal 21
payments is no longer applicable; and 22
(b) This subsection shall not apply to: 23
1. A provision of this chapter that became effective on or before January 1, 24
2024; or 25
2. Section 2 of this Act. 26
(3) To the extent permitted by federal law, if the state is required under 42 U.S.C. sec. 27
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18031(d)(3) and 45 C.F.R. sec. 155.170, as amended, to make payments to defray 1
the cost of a provision of this chapter: 2
(a) 1. Each qualified h ealth plan issuer shall determine, and provide to the 3
commissioner, the cost attributable to the provision for the qualified 4
health plan. 5
2. The cost attributable to a provision for a qualified health plan under 6
subparagraph 1. of this paragraph shall be: 7
a. Calculated in accordance with generally accepted actuarial 8
principles and methodologies; 9
b. Conducted by a member of the American Academy of Actuaries; 10
and 11
c. Reported by the qualified health plan issuer to: 12
i. The commissioner; and 13
ii. The Division of Health Benefit Exchange within the Office 14
of Data Analytics; 15
(b) The commissioner shall use the information obtained under paragraph (a) of 16
this subsection to determine the statewide average of the cost attributable to 17
the provision for all qualified healt h plan issuers to which the provision is 18
applicable; and 19
(c) The required payments shall be: 20
1. Calculated based on the statewide average of the cost attributable to the 21
provision as determined by the commissioner under paragraph (b) of this 22
subsection; and 23
2. Submitted directly to qualified health plan issuers by the department 24
through a process established by the commissioner. 25
(4) A qualified health plan issuer that receives a payment under subsection (3)(c)2. of 26
this section shall: 27
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(a) Reduce the premium charged to an individual on whose behalf the issuer 1
received the payment in an amount equal to the amount of the payment; or 2
(b) Notwithstanding KRS 304.12-090, provide a premium rebate to an individual 3
on whose behalf the issuer received the payment in a n amount equal to the 4
amount of the payment. 5
(5) Any fines collected for violations of this section shall be: 6
(a) Placed in a trust and agency account within the department, which shall not 7
lapse; and 8
(b) Used solely by the department to make payments in a ccordance with 9
subsection (3)(c)2. of this section. 10
(6) The commissioner shall promulgate any administrative regulations in accordance 11
with KRS Chapter 13A necessary to enforce and effectuate this section. 12
Section 4. KRS 164.2871 is amended to read as follows: 13
(1) The governing board of each state postsecondary educational institution is 14
authorized to purchase liability insurance for the protection of the individual 15
members of the governing board, faculty, and staff of such institutions from liability 16
for acts and omissions committed in the course and scope of the individual's 17
employment or service. Each institution may purchase the type and amount of 18
liability coverage deemed to best serve the interest of such institution. 19
(2) All retirement annuity allowances accrued or accruing to any employee of a state 20
postsecondary educational institution through a retirement program sponsored by 21
the state postsecondary educational institution are hereby exempt from any state, 22
county, or municipal tax, and shall not be subject to execution, attachment, 23
garnishment, or any other process whatsoever, nor shall any assignment thereof be 24
enforceable in any court. Except retirement benefits accrued or accruing to any 25
employee of a state post secondary educational institution through a retirement 26
program sponsored by the state postsecondary educational institution on or after 27
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January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 1
provided in KRS 141.010 and 141.0215. 2
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 3
members of governing boards, faculty and staff of institutions of higher education 4
in this state shall not be construed to be a waiver of sovereign immunity or any 5
other immunity or privilege. 6
(4) The governing board of each state postsecondary education institution is authorized 7
to provide a self -insured employer group health plan to its employees, which plan 8
shall: 9
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 10
(b) Except a s provided in subsection (5) of this section, be exempt from 11
conformity with Subtitle 17A of KRS Chapter 304. 12
(5) A self-insured employer group health plan provided by the governing board of a 13
state postsecondary education institution to its employees shall comply with: 14
(a) KRS 304.17A-129; 15
(b) KRS 304.17A-133; 16
(c) KRS 304.17A-145; 17
(d) KRS 304.17A-163 and 304.17A-1631; 18
(e) KRS 304.17A-261; 19
(f) KRS 304.17A-262; 20
(g) KRS 304.17A-264;[ and] 21
(h) KRS 304.17A-265; and 22
(i) Section 2 of this Act. 23
(6) (a) A self-insured employer group health plan provided by the governing board of 24
a state postsecondary education institution to its employees shall provide a 25
special enrollment period to pregnant women who are eligible for coverage in 26
accordance with the requirements set forth in KRS 304.17-182. 27
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(b) The governing board of a state postsecondary education institution shall, at or 1
before the time an employee is initially offered the opportunity to enroll in the 2
plan or coverage, provide the employee a notice of the special e nrollment 3
rights under this subsection. 4
Section 5. KRS 205.522 is amended to read as follows: 5
(1) With respect to the administration and provision of Medicaid benefits pursuant to 6
this chapter, the Department for Medicai d Services, any managed care organization 7
contracted to provide Medicaid benefits pursuant to this chapter, and the state's 8
medical assistance program shall be subject to, and comply with, the following, as 9
applicable: 10
(a) KRS 304.17A-129; 11
(b) KRS 304.17A-145; 12
(c) KRS 304.17A-163; 13
(d) KRS 304.17A-1631; 14
(e) KRS 304.17A-167; 15
(f) KRS 304.17A-235; 16
(g) KRS 304.17A-257; 17
(h) KRS 304.17A-259; 18
(i) KRS 304.17A-263; 19
(j) KRS 304.17A-264; 20
(k) KRS 304.17A-515; 21
(l) KRS 304.17A-580; 22
(m) KRS 304.17A-600, 304.17A-603, and 304.17A-607;[ and] 23
(n) KRS 304.17A-740 to 304.17A-743; and 24
(o) Section 2 of this Act, except subsection (4)(c) of Section 2 of this Act. 25
(2) A managed care organization contracted to provide Medicaid benefits pursuant to 26
this chapter shall comply with the reporting requirements of KRS 304.17A-732. 27
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Section 6. KRS 205.6485 is amended to read as follows: 1
(1) As used in this section, "KCHIP" means the Kentucky Children's Health Insurance 2
Program. 3
(2) The Cabinet for Health and Family Services shall: 4
(a) Prepare a state child health plan, known as KCHIP, meeting the requirements 5
of Title XXI of the Federal Social Security Act, for submission to the 6
Secretary of the United States Department of H ealth and Human Services 7
within such time as will permit the state to receive the maximum amounts of 8
federal matching funds available under Title XXI; and 9
(b) By administrative regulation promulgated in accordance with KRS Chapter 10
13A, establish the following: 11
1. The eligibility criteria for children covered by KCHIP, which shall 12
include a provision that no person eligible for services under Title XIX 13
of the Social Security Act, 42 U.S.C. secs. 1396 to 1396v, as amended, 14
shall be eligible for services under KCHIP, except to the extent that 15
Title XIX coverage is expanded by KRS 205.6481 to 205.6495 and KRS 16
304.17A-340; 17
2. The schedule of benefits to be covered by KCHIP, which shall: 18
a. Be at least equivalent to one (1) of the following: 19
i. The standard Blue C ross/Blue Shield preferred provider 20
option under the Federal Employees Health Benefit Plan 21
established by 5 U.S.C. sec. 8903(1); 22
ii. A mid-range health benefit coverage plan that is offered and 23
generally available to state employees; or 24
iii. Health insurance coverage offered by a health maintenance 25
organization that has the largest insured commercial, non -26
Medicaid enrollment of covered lives in the state; and 27
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b. Comply with subsection (6) of this section; 1
3. The premium contribution per family for health in surance coverage 2
available under KCHIP, which shall be based: 3
a. On a six (6) month period; and 4
b. Upon a sliding scale relating to family income not to exceed: 5
i. Ten dollars ($10), to be paid by a family with income 6
between one hundred percent (100%) to one hundred thirty -7
three percent (133%) of the federal poverty level; 8
ii. Twenty dollars ($20), to be paid by a family with income 9
between one hundred thirty -four percent (134%) to one 10
hundred forty -nine percent (149%) of the federal poverty 11
level; and 12
iii. One hundred twenty dollars ($120), to be paid by a family 13
with income between one hundred fifty percent (150%) to 14
two hundred percent (200%) of the federal poverty level, and 15
which may be made on a partial payment plan of twenty 16
dollars ($20) per month or sixty dollars ($60) per quarter; 17
4. There shall be no copayments for services provided under KCHIP; and 18
5. a. The criteria for health services providers and insurers wishing to 19
contract with the Commonwealth to provide coverage under 20
KCHIP. 21
b. The cabinet shall provide, in any contracting process for coverage 22
of preventive services, the opportunity for a public he alth 23
department to bid on preventive health services to eligible children 24
within the public health department's service area. A public health 25
department shall not be disqualified from bidding because the 26
department does not currently offer all the services required by 27
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this section. The criteria shall be established by [set forth in] 1
administrative regulations promulgated in accordance 2
with[under] KRS Chapter 13A and shall maximize competition 3
among the providers and insurers. The Finance and Administration 4
Cabinet shall provide oversight over contracting policies and 5
procedures to assure that the number of applicants for contracts is 6
maximized. 7
(3) Within twelve (12) months of federal approval of the state's Title XXI child health 8
plan, the Cabinet for Health and Family Services shall assure that a KCHIP 9
program is available to all eligible children in all regions of the state. If necessary, 10
in order to meet this assurance, the cabinet shall institute its own program. 11
(4) KCHIP recipients shall have direct acc ess without a referral from any gatekeeper 12
primary care provider to dentists for covered primary dental services and to 13
optometrists and ophthalmologists for covered primary eye and vision services. 14
(5) KCHIP shall comply with KRS 304.17A-163 and 304.17A-1631. 15
(6) The schedule of benefits required under subsection (2)(b)2. of this section shall 16
include: 17
(a) Preventive services; 18
(b) Vision services, including glasses; 19
(c) Dental services, including sealants, extractions, and fillings; and 20
(d) The coverage required under: 21
1. KRS 304.17A-129;[ and] 22
2. KRS 304.17A-145; and 23
3. Section 2 of this Act, except subsection (4)(c) of Section 2 of this Act. 24
Section 7. KRS 18A.225 is amended to read as follows: 25
(1) (a) The term "employee" for purposes of this section means: 26
1. Any person, including an elected public official, who is regularly 27
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employed by any department, office, board, agency, or branch of state 1
government; or by a public postsecondary educational institution; or by 2
any city, urban -county, charter county, county, or consolidated local 3
government, whose legislative body has opted to participate in the state -4
sponsored health insurance program pursuant to KRS 79.080; and who 5
is either a contributing member to any one (1) of the retirement systems 6
administered by the state, including but not limited to the Kentucky 7
Retirement Systems, County Employees Retirement System, Kentucky 8
Teachers' Retirement System, the Legislators' Retirement Plan, or the 9
Judicial Retirement Plan; or is receiving a contractual contribution from 10
the state toward a retirement plan; or, in the case of a public 11
postsecondary education institution, is an individual participating in an 12
optional retirement plan authorized by KRS 161.567; or is eligible to 13
participate in a retirement plan established by an employer who ceases 14
participating in the Kentucky Employees Retirement System pursuant to 15
KRS 61.522 whose employees participated in the health insurance plans 16
administered by the Personnel Cabinet prior to the employer's effective 17
cessation date in the Kentucky Employees Retirement System; 18
2. Any certified or classified employee of a local board of education or a 19
public charter school as defined in KRS 160.1590; 20
3. Any elected member of a local board of education; 21
4. Any person who is a present or future recipient of a retirement 22
allowance from the Kentucky Retirement Systems, County Employees 23
Retirement System, Kentucky Teachers' Retiremen t System, the 24
Legislators' Retirement Plan, the Judicial Retirement Plan, or the 25
Kentucky Community and Technical College System's optional 26
retirement plan authorized by KRS 161.567, except that a person who is 27
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receiving a retirement allowance and who is a ge sixty-five (65) or older 1
shall not be included, with the exception of persons covered under KRS 2
61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 3
employed pursuant to subparagraph 1. of this paragraph; and 4
5. Any eligible dependents and b eneficiaries of participating employees 5
and retirees who are entitled to participate in the state -sponsored health 6
insurance program; 7
(b) The term "health benefit plan" for the purposes of this section means a health 8
benefit plan as defined in KRS 304.17A-005; 9
(c) The term "insurer" for the purposes of this section means an insurer as defined 10
in KRS 304.17A-005; and 11
(d) The term "managed care plan" for the purposes of this section means a 12
managed care plan as defined in KRS 304.17A-500. 13
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 14
recommendation of the secretary of the Personnel Cabinet, shall procure, in 15
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 16
from one (1) or more insurers authorized to do business in this state, a group 17
health benefit plan that may include but not be limited to health maintenance 18
organization (HMO), preferred provider organization (PPO), point of service 19
(POS), and exclusive provider organization (EPO) benefit plans 20
encompassing all or any class or classes of employees. With the exception of 21
employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 22
all employers of any class of employees or former employees shall enter into 23
a contract with the Personnel Cabinet prior to including that group in the state 24
health insurance group. The contracts shall include but not be limited to 25
designating the entity responsible for filing any federal forms, adoption of 26
policies required for proper plan administration, acceptance of the contractual 27
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provisions with health insurance carriers or third -party administrators, and 1
adoption of the payment and rei mbursement methods necessary for efficient 2
administration of the health insurance program. Health insurance coverage 3
provided to state employees under this section shall, at a minimum, contain 4
the same benefits as provided under Kentucky Kare Standard as o f January 1, 5
1994, and shall include a mail -order drug option as provided in subsection 6
(13) of this section. All employees and other persons for whom the health care 7
coverage is provided or made available shall annually be given an option to 8
elect health care coverage through a self -funded plan offered by the 9
Commonwealth or, if a self -funded plan is not available, from a list of 10
coverage options determined by the competitive bid process under the 11
provisions of KRS 45A.080, 45A.085, and 45A.090 and made av ailable 12
during annual open enrollment. 13
(b) The policy or policies shall be approved by the commissioner of insurance 14
and may contain the provisions the commissioner of insurance approves, 15
whether or not otherwise permitted by the insurance laws. 16
(c) Any carrier bidding to offer health care coverage to employees shall agree to 17
provide coverage to all members of the state group, including active 18
employees and retirees and their eligible covered dependents and 19
beneficiaries, within the county or counties speci fied in its bid. Except as 20
provided in subsection (20) of this section, any carrier bidding to offer health 21
care coverage to employees shall also agree to rate all employees as a single 22
entity, except for those retirees whose former employers insure their active 23
employees outside the state -sponsored health insurance program and as 24
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 25
(d) Any carrier bidding to offer health care coverage to employees shall agree to 26
provide enrollment, claims, and utilization data to the Commonwealth in a 27
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format specified by the Personnel Cabinet with the understanding that the data 1
shall be owned by the Commonwealth; to provide data in an electronic form 2
and within a time frame specified by the Personnel Cabinet; a nd to be subject 3
to penalties for noncompliance with data reporting requirements as specified 4
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 5
to protect the confidentiality of each individual employee; however, 6
confidentiality assertions shall not relieve a carrier from the requirement of 7
providing stipulated data to the Commonwealth. 8
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 9
for timely analysis of data received from carriers and, to the extent possible, 10
provide in the request -for-proposal specifics relating to data requirements, 11
electronic reporting, and penalties for noncompliance. The Commonwealth 12
shall own the enrollment, claims, and utilization data provided by each carrier 13
and shall develop methods to protect the confidentiality of the individual. The 14
Personnel Cabinet shall include in the October annual report submitted 15
pursuant to the provisions of KRS 18A.226 to the Governor, the General 16
Assembly, and the Chief Justice of the Supre me Court, an analysis of the 17
financial stability of the program, which shall include but not be limited to 18
loss ratios, methods of risk adjustment, measurements of carrier quality of 19
service, prescription coverage and cost management, and statutorily requi red 20
mandates. If state self -insurance was available as a carrier option, the report 21
also shall provide a detailed financial analysis of the self -insurance fund 22
including but not limited to loss ratios, reserves, and reinsurance agreements. 23
(f) If any agenc y participating in the state -sponsored employee health insurance 24
program for its active employees terminates participation and there is a state 25
appropriation for the employer's contribution for active employees' health 26
insurance coverage, then neither the agency nor the employees shall receive 27
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the state -funded contribution after termination from the state -sponsored 1
employee health insurance program. 2
(g) Any funds in flexible spending accounts that remain after all reimbursements 3
have been processed shall be transferred to the credit of the state -sponsored 4
health insurance plan's appropriation account. 5
(h) Each entity participating in the state-sponsored health insurance program shall 6
provide an amount at least equal to the state contribution rate for the employer 7
portion of the health insurance premium. For any participating entity that used 8
the state payroll system, the employer contribution amount shall be equal to 9
but not greater than the state contribution rate. 10
(3) The premiums may be paid by the policyholder: 11
(a) Wholly from funds contributed by the employee, by payroll deduction or 12
otherwise; 13
(b) Wholly from funds contributed by any department, board, agency, public 14
postsecondary education institution, or branch of state, city, urban -county, 15
charter county, county, or consolidated local government; or 16
(c) Partly from each, except that any premium due for health care coverage or 17
dental coverage, if any, in excess of the premium amount contributed by any 18
department, board, agency, postsecondary education i nstitution, or branch of 19
state, city, urban -county, charter county, county, or consolidated local 20
government for any other health care coverage shall be paid by the employee. 21
(4) If an employee moves his or her place of residence or employment out of the 22
service area of an insurer offering a managed health care plan, under which he or 23
she has elected coverage, into either the service area of another managed health care 24
plan or into an area of the Commonwealth not within a managed health care plan 25
service ar ea, the employee shall be given an option, at the time of the move or 26
transfer, to change his or her coverage to another health benefit plan. 27
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(5) No payment of premium by any department, board, agency, public postsecondary 1
educational institution, or branc h of state, city, urban -county, charter county, 2
county, or consolidated local government shall constitute compensation to an 3
insured employee for the purposes of any statute fixing or limiting the 4
compensation of such an employee. Any premium or other expe nse incurred by any 5
department, board, agency, public postsecondary educational institution, or branch 6
of state, city, urban -county, charter county, county, or consolidated local 7
government shall be considered a proper cost of administration. 8
(6) The policy or policies may contain the provisions with respect to the class or classes 9
of employees covered, amounts of insurance or coverage for designated classes or 10
groups of employees, policy options, terms of eligibility, and continuation of 11
insurance or coverage after retirement. 12
(7) Group rates under this section shall be made available to the disabled child of an 13
employee regardless of the child's age if the entire premium for the disabled child's 14
coverage is paid by the state employee. A child shall be cons idered disabled if he or 15
she has been determined to be eligible for federal Social Security disability benefits. 16
(8) The health care contract or contracts for employees shall be entered into for a 17
period of not less than one (1) year. 18
(9) The secretary sha ll appoint thirty -two (32) persons to an Advisory Committee of 19
State Health Insurance Subscribers to advise the secretary or the secretary's 20
designee regarding the state -sponsored health insurance program for employees. 21
The secretary shall appoint, from a list of names submitted by appointing 22
authorities, members representing school districts from each of the seven (7) 23
Supreme Court districts, members representing state government from each of the 24
seven (7) Supreme Court districts, two (2) members represent ing retirees under age 25
sixty-five (65), one (1) member representing local health departments, two (2) 26
members representing the Kentucky Teachers' Retirement System, and three (3) 27
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members at large. The secretary shall also appoint two (2) members from a lis t of 1
five (5) names submitted by the Kentucky Education Association, two (2) members 2
from a list of five (5) names submitted by the largest state employee organization of 3
nonschool state employees, two (2) members from a list of five (5) names submitted 4
by the Kentucky Association of Counties, two (2) members from a list of five (5) 5
names submitted by the Kentucky League of Cities, and two (2) members from a 6
list of names consisting of five (5) names submitted by each state employee 7
organization that has tw o thousand (2,000) or more members on state payroll 8
deduction. The advisory committee shall be appointed in January of each year and 9
shall meet quarterly. 10
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 11
provided to e mployees pursuant to this section shall not provide coverage for 12
obtaining or performing an abortion, nor shall any state funds be used for the 13
purpose of obtaining or performing an abortion on behalf of employees or their 14
dependents. 15
(11) Interruption of an established treatment regime with maintenance drugs shall be 16
grounds for an insured to appeal a formulary change through the established appeal 17
procedures approved by the Department of Insurance, if the physician supervising 18
the treatment certifies that the change is not in the best interests of the patient. 19
(12) Any employee who is eligible for and elects to participate in the state health 20
insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 21
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 22
state health insurance contribution toward health care coverage as a result of any 23
other employment for which there is a public employer contribution. This does not 24
preclude a retiree and an active e mployee spouse from using both contributions to 25
the extent needed for purchase of one (1) state sponsored health insurance policy 26
for that plan year. 27
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(13) (a) The policies of health insurance coverage procured under subsection (2) of 1
this section shall inc lude a mail -order drug option for maintenance drugs for 2
state employees. Maintenance drugs may be dispensed by mail order in 3
accordance with Kentucky law. 4
(b) A health insurer shall not discriminate against any retail pharmacy located 5
within the geographic coverage area of the health benefit plan and that meets 6
the terms and conditions for participation established by the insurer, including 7
price, dispensing fee, and copay requirements of a mail -order option. The 8
retail pharmacy shall not be required to dispense by mail. 9
(c) The mail -order option shall not permit the dispensing of a controlled 10
substance classified in Schedule II. 11
(14) The policy or policies provided to state employees or their dependents pursuant to 12
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 13
aid-related services for insured individuals under eighteen (18) years of age, subject 14
to a cap of one thousand four hundred dollars ($1,400) every thirty -six (36) months 15
pursuant to KRS 304.17A-132. 16
(15) Any policy provided to state employees or their dependents pursuant to this section 17
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 18
consistent with KRS 304.17A-142. 19
(16) Any policy provided to state employees or their dependents pursuant to this section 20
shall provide coverage for obtaining amino acid -based elemental formula pursuant 21
to KRS 304.17A-258. 22
(17) If a state employee's residence and place of employment are in the same county, 23
and if the hospital located within that county does not offer surgical services, 24
intensive care services, obstetrical services, level II neonatal services, diagnostic 25
cardiac catheterization services, and magnetic resonance imaging services, the 26
employee may select a plan available in a contiguous county that does provide 27
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those services, and the state contribution for the plan shall be the amount available 1
in the county where the plan selected is located. 2
(18) If a state employee's residence a nd place of employment are each located in 3
counties in which the hospitals do not offer surgical services, intensive care 4
services, obstetrical services, level II neonatal services, diagnostic cardiac 5
catheterization services, and magnetic resonance imagin g services, the employee 6
may select a plan available in a county contiguous to the county of residence that 7
does provide those services, and the state contribution for the plan shall be the 8
amount available in the county where the plan selected is located. 9
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 10
in the best interests of the state group to allow any carrier bidding to offer health 11
care coverage under this section to submit bids that may vary county by county or 12
by larger geographic areas. 13
(20) Notwithstanding any other provision of this section, the bid for proposals for health 14
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 15
the statewide rating structure provided in calendar year 2003 and a bid scenario that 16
allows for a regional rating structure that allows carriers to submit bids that may 17
vary by region for a given product offering as described in this subsection: 18
(a) The regional rating bid scenario shall not include a req uest for bid on a 19
statewide option; 20
(b) The Personnel Cabinet shall divide the state into geographical regions which 21
shall be the same as the partnership regions designated by the Department for 22
Medicaid Services for purposes of the Kentucky Health Care Pa rtnership 23
Program established pursuant to 907 KAR 1:705; 24
(c) The request for proposal shall require a carrier's bid to include every county 25
within the region or regions for which the bid is submitted and include but not 26
be restricted to a preferred provider organization (PPO) option; 27
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(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 1
carrier all of the counties included in its bid within the region. If the Personnel 2
Cabinet deems the bids submitted in accordance with this subs ection to be in 3
the best interests of state employees in a region, the cabinet may award the 4
contract for that region to no more than two (2) carriers; and 5
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 6
other requirements or criteria in the request for proposal. 7
(21) Any fully insured health benefit plan or self -insured plan issued or renewed on or 8
after July 12, 2006, to public employees pursuant to this section which provides 9
coverage for services rendered by a physician or osteopath duly licensed under KRS 10
Chapter 311 that are within the scope of practice of an optometrist duly licensed 11
under the provisions of KRS Chapter 320 shall provide the same payment of 12
coverage to optometrists as allowed for those services render ed by physicians or 13
osteopaths. 14
(22) Any fully insured health benefit plan or self -insured plan issued or renewed to 15
public employees pursuant to this section shall comply with: 16
(a) KRS 304.12-237; 17
(b) KRS 304.17A-270 and 304.17A-525; 18
(c) KRS 304.17A-600 to 304.17A-633; 19
(d) KRS 205.593; 20
(e) KRS 304.17A-700 to 304.17A-730; 21
(f) KRS 304.14-135; 22
(g) KRS 304.17A-580 and 304.17A-641; 23
(h) KRS 304.99-123; 24
(i) KRS 304.17A-138; 25
(j) KRS 304.17A-148; 26
(k) KRS 304.17A-163 and 304.17A-1631; 27
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(l) KRS 304.17A-265; 1
(m) KRS 304.17A-261; 2
(n) KRS 304.17A-262; 3
(o) KRS 304.17A-145; 4
(p) KRS 304.17A-129; 5
(q) KRS 304.17A-133; 6
(r) KRS 304.17A-264;[ and] 7
(s) Section 2 of this Act; and 8
(t) Administrative regulations promulgated pursuant to statutes listed in this 9
subsection. 10
(23) (a) Any fully insured health benefit plan or self-insured plan issued or renewed to 11
public employees pursuant to this section shall provide a special enrollment 12
period to pregnant women who are eligible for coverage in accordance with 13
the requirements set forth in KRS 304.17-182. 14
(b) The Department of Employee Insurance shall, at or before the time a public 15
employee is initially offered the opportunity to enroll in t he plan or coverage, 16
provide the employee a notice of the special enrollment rights under this 17
subsection. 18
Section 8. KRS 446.350 is amended to read as follows: 19
(1) Government shall not substantially burden a person's fr eedom of religion. The right 20
to act or refuse to act in a manner motivated by a sincerely held religious belief may 21
not be substantially burdened unless the government proves by clear and 22
convincing evidence that it has a compelling governmental interest i n infringing the 23
specific act or refusal to act and has used the least restrictive means to further that 24
interest. A "burden" shall include indirect burdens such as withholding benefits, 25
assessing penalties, or an exclusion from programs or access to facilities. 26
(2) Nothing in Section 1, 2, or 9 of this Act shall be construed to be in violation of 27
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this section. 1
SECTION 9. A NEW SECTION OF KRS CHAPTER 205 IS CREATED TO 2
READ AS FOLLOWS: 3
(1) As used in this section: 4
(a) "Family planning services": 5
1. Means family planning services that are provided under the Medicaid 6
program; 7
2. Includes: 8
a. Sexual health education and family planning counseling; and 9
b. Other medical diagnosis, treatment, or preventive care routinely 10
provided as part of a family planning service visit; and 11
3. Does not include an elective abortion, as defined in KRS 304.5 -160; 12
and 13
(b) "Low-income individual" means an individual who: 14
1. Has an income level that is equal to or below ninety -five percent 15
(95%) of the federal poverty level; and 16
2. Does not qualify for full coverage under the Medicaid program. 17
(2) Within ninety (90) days of the effective date of this section, the Cabinet for Health 18
and Family Services shall apply for a waiver or a state plan amendment with the 19
Centers for Medicare and Medicaid Services within the United States Department 20
of Health and Human Services to: 21
(a) Offer a program that provides family planning services to low -income 22
individuals; and 23
(b) Receive a federal match rate of ninety p ercent (90%) of state expenditures 24
for family planning services provided under the waiver or state plan 25
amendment. 26
(3) If the waiver or state plan amendment described in subsection (2) of this section 27
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is approved, the Cabinet for Health and Family Services shall report to the 1
Legislative Research Commission, while the waiver or state plan amendment is in 2
effect, annually before November 30, the following: 3
(a) The number of qualified individuals served under the program; 4
(b) The cost of the program; and 5
(c) The effectiveness of the program, including any: 6
1. Savings to the Medicaid program from reduction in enrollment; 7
2. Reduction in the number of abortions; 8
3. Reduction in the number of unintended pregnancies; 9
4. Reduction i n the number of individuals requiring services from the 10
program for women, infants, and children established in 42 U.S.C. 11
sec. 1786; and 12
5. Other costs and benefits as a result of the program. 13
SECTION 10. A NEW SECTION O F KRS CHAPTER 315 IS CREATED TO 14
READ AS FOLLOWS: 15
(1) As used in this section, "hormonal contraceptive" means a self -administered 16
drug, or a transdermal patch applied to the skin of a patient by the patient or by a 17
practitioner, that releases a drug compose d of a combination of hormones 18
approved by the United States Food and Drug Administration to prevent 19
pregnancy. 20
(2) A pharmacist, acting in good faith, is authorized to provide hormonal 21
contraceptives according to a valid collaborative care agreement conta ining a 22
nonpatient-specific prescriptive order and standardized procedures developed and 23
executed by one (1) or more authorized prescribers. 24
(3) The board, in collaboration with the Kentucky Board of Medical Licensure, shall 25
promulgate administrative regul ations in accordance with KRS Chapter 13A to 26
establish standard procedures for the provision of hormonal contraceptives by 27
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pharmacists. The standard procedures adopted pursuant to this section shall 1
require a pharmacist to: 2
(a) Complete a training program approved by the Cabinet for Health and 3
Family Services related to the provision of hormonal contraceptives; 4
(b) Provide the patient with a self -screening risk assessment tool developed or 5
approved by the Cabinet for Health and Family Services; 6
(c) Provide the patient with documentation about the hormonal contraceptive 7
that was provided to the patient and advise the patient to consult with a 8
primary care practitioner or women's healthcare practitioner; 9
(d) Provide the patient with a standardized factsheet th at includes but is not 10
limited to the indications and contraindications for use of the drug, 11
appropriate method for using the drug, importance of a medical follow -up, 12
and other appropriate information; 13
(e) Provide the patient with the contact information o f a primary care 14
practitioner or women's healthcare practitioner within a reasonable period 15
of time after provision of the hormonal contraceptive; and 16
(f) Either dispense the hormonal contraceptive or refer the patient to a 17
pharmacy that may dispense the h ormonal contraceptive as soon as 18
practicable after the pharmacist determines that the patient should receive 19
the medication. 20
(4) The administrative regulations promulgated under this section shall prohibit a 21
pharmacist from requiring a patient to schedule an appointment with the 22
pharmacist for the provision or dispensing of a hormonal contraceptive. 23
(5) (a) A pharmacist or the pharmacist's employer or agent may charge the annual 24
administrative fee for services provided pursuant to this section in addition 25
to any costs associated with the dispensing of the drug and paid by the 26
pharmacy insurance benefit. 27
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(b) Upon an oral, telephonic, electronic, or written request from a patient or 1
customer, a pharmacist or pharmacist's employee shall disclose the total 2
cost that a consumer would pay for pharmacist -provided hormonal 3
contraceptives. As used in this paragraph, "total cost" includes providing 4
the consumer with specific information regarding the price of the hormonal 5
contraceptive and the price of the administrati ve fee charged. This 6
limitation is not intended to interfere with other contractually agreed -upon 7
terms between a pharmacist or a pharmacist's employer or agent and a 8
health insurance plan or insurer. Patients who are insured or covered and 9
receive a pharm acy benefit that covers the cost of hormonal contraceptives 10
shall not be required to pay an administrative fee but may be required to pay 11
copayments pursuant to the terms and conditions of their coverage. 12
(6) All state and federal laws governing insurance coverage of contraceptive drugs, 13
devices, products, and services shall apply to hormonal contraceptives provided by 14
a pharmacist under this section. 15
(7) The board and the Kentucky Board of Medical Licensure shall ensure 16
compliance with this section, and ea ch board is specifically charged with the 17
enforcement of this section with respect to its respective licensees. 18
(8) Any pharmacist or prescriber acting in good faith and with reasonable care 19
involved in the provision of hormonal contraceptives pursuant to this section 20
shall be immune from disciplinary or adverse administrative actions under this 21
chapter for acts or omissions related to the provision of a hormonal 22
contraceptive. 23
(9) A pharmacist or prescriber involved in the provision of hormonal contracepti ves 24
pursuant to this section shall be immune from civil liability unless the injury 25
results from the gross negligence or willful misconduct of the pharmacist or 26
provider. 27
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(10) This section shall not apply to a valid patient-specific prescription for a hormonal 1
contraceptive issued by an authorized prescriber and dispensed by a pharmacist 2
pursuant to the valid prescription. 3
Section 11. Sections 2, 4, and 7 of this Act apply to health benefit plans issued, 4
renewed, amended, effective, or delivered on or after January 1, 2027. 5
Section 12. Sections 2, 3, 4, 5, 6, and 7 of this Act take effect January 1, 2027. 6
Section 13. (1) For purposes of 45 C.F.R. sec. 156.115, the benefits required 7
under Section 2 of this Act are intended to be, and shall be considered, substantially equal 8
to the benefits required under the state's EHB-benchmark plan. 9
(2) For purposes of 45 C.F.R. sec. 155.170, the benefits required under Section 2 10
of this Act are intended to be, and shall be considered by the state as, a benefit required 11
by State action "for purposes of compliance with Federal re quirements," and thus, the 12
state shall not consider or identify the benefits required under Section 2 of this Act as 13
being in addition to the essential health benefits required under federal law. 14
(3) The "Federal requirements" referred to in subsection (2) of this section 15
include the requirement to provide coverage for preventive health services under 42 16
U.S.C. sec. 300gg-13. 17
(4) The commissioner of insurance and any other state official or state agency 18
shall: 19
(a) Comply with the requirements of this section; and 20
(b) Not take any action that is in violation of or in conflict with this section. 21
Section 14. Notwithstanding KRS 194A.099: 22
(1) Within 90 days of the effective date of this section and subject to Section 13 23
of this Act, the Department of Insurance shall identify, in accordance with 45 C.F.R. sec. 24
155.170(a)(3), whether the application of any requirement of Section 2 of this Act to a 25
qualified health plan (QHP) is in addition to the essential health benefits requir ed under 26
federal law. 27
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(2) If it is determined that the application of any requirement of Section 2 of this 1
Act to a QHP is in addition to the essential health benefits required under federal law, 2
then the department shall, within 180 days of the effective date of this section, apply for a 3
waiver under 42 U.S.C. sec. 18052, as amended, or any other applicable federal law of all 4
or any of the cost defrayal requirements under 42 U.S.C. sec. 18031(d)(3) and 45 C.F.R. 5
sec. 155.170, as amended. 6
(3) The application required under subsection (2) of this section: 7
(a) Shall comply with the requirements of federal law for obtaining a waiver; and 8
(b) May propose changes to the state's EHB -benchmark plan, as defined in 45 9
C.F.R. sec. 156.20, that are not in conflict with existing state law. 10
Section 15. If the Cabinet for Health and Family Services or the Department for 11
Medicaid Services determines that a state plan amendment, waiver, or any other form of 12
authorization or approval from any federal agency to implement Section 5, 6, or 9 of this 13
Act is necessary to prevent the loss of federal funds or to comply with federal law, the 14
cabinet or department: 15
(1) Shall, within 90 days after the effective date of this section, request the 16
necessary federal authorization or approval to implement Sections 5, 6, and 9 of this Act; 17
and 18
(2) May only delay implementation of the provisions of Sections 5, 6, and 9 of 19
this Act for which federal authorization or approval was deemed necessary until the 20
federal authorization or approval is granted. 21
Section 16. Sections 5, 6, 9, and 15 of this Act shall constitute the specific 22
authorization required under KRS 205.5372(1). 23