AN ACT relating to blood donation.

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AN ACT relating to blood donation. 1
WHEREAS, the right to bodily autonomy and informed consent is a fundamental 2
principle of a free society, enshrined in the United States Constitution and protected by 3
federal law; and 4
WHEREAS, the choice of medical treatments, including the selection of blood 5
donors for transfusions, is an intimate and personal decision integral to individual dignity, 6
self-determination, and health; and 7
WHEREAS, the physician-patient relationship is sacrosanct and must be free from 8
interference by third parties; and 9
WHEREAS, existing federal regulations, including those of the United States Food 10
and Drug Administration, are designed to ensure the safety and integrity of directed blood 11
donations; 12
NOW, THEREFORE, 13
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 14
Section 1. KRS 214.450 is amended to read as follows: 15
As used in KRS 214.450[214.452] to 214.466, unless the context otherwise requires: 16
(1) "Autologous donation" means a process by which an individual donates his or 17
her own blood for his or her own transfusion; 18
(2) "Blood" means any blood, blood product, blood component, or blood derivative, 19
including plasma;[.] 20
(3) (a)[(2)] "Blood establishment" means a place of business under one (1) 21
management at one (1) general physical location which engages in the 22
collection, preparation, processing, labeling, packaging, and dispensing of 23
blood to any health care facility, health service, or health care provider and 24
which is licensed by the United States Food and Drug Administration. 25
(b) "Blood establishment " does not include autologous [ blood] donation 26
programs permitted under KRS 214.456;[.] 27
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(4)[(3)] "Blood-borne communicable disease" means any of those diseases which are 1
specifically so defined and set forth in administrative regulation promulgated by the 2
United States Food and Drug Administration;[.] 3
(5)[(4)] "Directed donation" means a pr ocess by which an individual selects a 4
specific donor or organization to provide blood for his or her own transfusion; 5
(6) "Donor" means either a paid or volunteer donor of blood; 6
(7) "Health facility" means any health facility as defined in [set forth unde r] KRS 7
216B.015, which provides for the transfusion of blood into a living human body;[.] 8
(8)[(5)] "Health care provider" means any person licensed or certified under the laws 9
of the Commonwealth as a dentist, physician, osteopath, registered nurse, practi cal 10
nurse, paramedic, emergency medical technician, or physician assistant;[.] 11
(9)[(6)] "Health service" means any health service as defined in[set forth under] KRS 12
216B.015,[ and] which provides for the transfusion of blood into a living human 13
body;[.] 14
(10)[(7)] "Informed consent" means the right of a person to be fully informed about 15
and to consent to or refuse medical treatments, including the selection of blood 16
donors; 17
(11) "Transfuse" means to transfer blood from one (1) person to another; and[. 18
(8) "Donor" means either a paid or volunteer donor of blood.] 19
(12)[(9)] "Untested blood" means blood that has not been tested or blood for which test 20
results have not yet been returned. 21
SECTION 2. A NEW SECTION OF KRS 214.450 TO 214.466 IS CREATED 22
TO READ AS FOLLOWS: 23
(1) An individual shall have the right to select a willing blood donor for his or her 24
own blood transfusion, provided the donation com plies with the minimum 25
standard set by the United States Food and Drug Administration. 26
(2) Blood establishments, health facilities, health services, and health care providers 27
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shall not: 1
(a) Deny, obstruct, or impose undue burdens on an individual’s right t o a 2
directed or autologous donation, when ordered by a licensed health care 3
provider; 4
(b) Refuse directed donations based on a donor’s or recipient’s vaccination 5
status, medical history, religious beliefs, or other personal choices or 6
characteristics, prov ided minimum United States Food and Drug 7
Administration safety standards are met; 8
(c) Impose fees for a donation or transfusion using an autologous donation or 9
directed donation of blood that exceed twenty percent (20%) of the charge 10
for a regular unit of blood; 11
(d) Misrepresent the availability, safety, or legality of directed or autologous 12
donations to discourage a licensed physician from ordering a directed or 13
autologous donation at the request of their patient; or 14
(e) Penalize or sanction physicians who facilitate directed or autologous 15
donations for their willingness to prescribe directed or autologous 16
donations. 17
(3) Blood establishments shall: 18
(a) Publicly disclose the establishment's directed donation policies to ensure 19
transparency; and 20
(b) Provide s tandardized, concise consent forms and procedures for directed 21
donations, not to exceed the complexity of forms used by the establishment 22
for general blood donations. 23
(4) Blood establishments and health care facilities shall provide clear, accessible 24
information to patients about the patient's right to a directed or autologous 25
donation and the process for requesting a directed or autologous donation. 26
(5) A professional orga nization, health care facility, or other entity shall not 27
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misrepresent the availability, safety, or legality of directed or autologous 1
donations to discourage a licensed physician from ordering a directed or 2
autologous donation at the request of their patient. 3
(6) A physician who facilitates a directed or autologous donation at the request of his 4
or her patient shall not experience disciplinary actions, loss of license, or other 5
professional repercussions by the Kentucky Board of Medical Licensure as a 6
result of the physician's willingness to prescribe the directed or autologous 7
donation. 8
(7) A blood establishment or health facility that violates this section shall be subject 9
to fines not exceeding two hundred fifty thousand dollars ($250,000) per violation 10
as determined by the Cabinet for Health and Family Services. 11
(8) A health facility or health care provider: 12
(a) May transfuse blood that is not from a directed or autologous donation only 13
in an emergency situation in which the attending physician determine s the 14
patient is in imminent danger of death or serious physical injury and the 15
directed or autologous donation is not readily available; and 16
(b) Shall not be subject to civil or criminal liability for the transfusion of blood 17
that is not from a directed o r autologous donation in an emergency 18
situation, provided the attending health facility or health care provider has 19
obtained prior consent for the transfusion from the patient or, if the 20
patient's condition renders the patient incapable of giving consent, consent 21
from the patient's next of kin or legal guardian, if available. 22
(9) The Cabinet for Health and Family Services shall: 23
(a) Establish a reporting mechanism for individuals and physicians to report 24
obstructions, denials, or impositions of undue burden s to directed 25
donations; 26
(b) Investigate reports of obstructions, denials, or impositions of undue burdens 27
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to directed or autologous donations; 1
(c) Complete investigations within sixty (60) days of a report; and 2
(d) Promulgate administrative regulations in accordance with KRS Chapter 3
13A to implement and enforce the provisions of this section. 4
(10) An individual may bring a civil action against entities for injunctive relief and 5
damages for violations of the individual's rights to directed and autologous 6
donations. 7
Section 3. KRS 214.452 is amended to read as follows: 8
The following policies shall apply to blood establishments and to donors of blood: 9
(1) All blood establishments within the Commonwealth shall be licensed by the United 10
States Food and Drug Administration and remain in compliance with all applicable 11
federal regulations. The Cabinet for Health and Family Services shall, under 12
administrative regulations promulgated pursuant to KRS Chapter 13A, establish 13
fees necessary to cover the cost of and adhere to a schedule for regular inspection, 14
by the Office of the Inspector General of the Cabinet for Health and Family 15
Services, of all blood establishments within the Commonwealth to ascertain 16
whether each blood establishment is licensed and in compliance with KRS 214.450 17
to 214.466[214.464] and[ KRS] 214.468. The Office of the Inspector General shall 18
commence its inspection program of blood establishments no later than September 19
1, 1994. 20
(2) All blood establishments shall test blood for the human immunodeficiency virus 21
and for any known causative agent for any blood -borne communicable disease, 22
using tests approved and required, for purposes of blood donation, by the United 23
States Food and Drug Administration. 24
(3) It shall b e the duty of the administrator of any blood establishment which collects 25
blood for the purpose of distributing to another health service, health facility, or 26
health-care provider the blood for transfusion to: 27
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(a) Secure donor consent and a signed written risk factor history and donor 1
consent form for each potential paid or volunteer donor for the purpose of 2
determining if the potential donor is at high risk for infection with the human 3
immunodeficiency virus, or has tested confirmatory positive for infection with 4
the human immunodeficiency virus; or has acquired immune deficiency 5
syndrome; or has tested confirmatory positive for infection with any causative 6
agent for acquired immune deficiency syndrome recognized by the United 7
States Centers for Disease Con trol; or has a blood -borne communicable 8
disease; 9
(b) Provide a means for a potential donor to self-elect not to donate blood; 10
(c) Refuse donation or sale of blood by persons at high risk for infection with the 11
human immunodeficiency virus, or who have been medically diagnosed as 12
having acquired immune deficiency syndrome, or who have tested 13
confirmatory positive for infection with the human immunodeficiency virus, 14
or who have a blood-borne communicable disease; 15
(d) Post a sign in the blood establishment whi ch is visible to all potential donors 16
and which states: "Persons with acquired immune deficiency syndrome 17
(AIDS), or who have tested confirmatory positive for infection with the 18
human immunodeficiency virus (HIV), or who have a blood -borne 19
communicable disease or who have one (1) or more risk factors for the human 20
immunodeficiency virus as determined by the United States Centers for 21
Disease Control, are prohibited by law from donating or selling blood. 22
Persons violating the law are guilty of a Class D felon y. ASK STAFF OF 23
THIS BLOOD ESTABLISHMENT." 24
(4) The provisions of this section shall not be construed to impose requirements which 25
are in conflict with donor eligibility requirements set out in United States Food and 26
Drug Administration or American Association of Blood Banks standards. 27
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Section 4. KRS 214.456 is amended to read as follows: 1
The following policies shall apply to autologous and directed blood donations: 2
(1) Any otherwise qualified donor who wishes to direct a donation of blood to that 3
person or to another particular individual may do so. The surcharge for any 4
autologous or directed donation of blood shall not exceed twenty percent (20%) of 5
the charge for a regular unit of blood. 6
(2) If the donation is to another particular individual, the requirements of KRS 214.454 7
shall be met if the recipient and the recipient's attending physician have requested 8
the donation. 9
(3) Blood collected as a directed donation may be used for someone other than, or in 10
addition to, the designated recipient if the donor's blood is not compatible with that 11
of the designated recipient or if any part of the donation is not needed by the 12
designated recipient. 13
(4) Each blood establishment shall advise prospective donors of the opportunity for 14
autologous and directed donations and of the provisions of this section and of KRS 15
214.450[214.452] to 214.466. 16
(5) Autologous blood donation programs shall be exempt from KRS 214.454. 17
Section 5. KRS 214.990 is amended to read as follows: 18
(1) Every head of a family who willfully fails or refuses and every physician who fails 19
or refuses to comply with KRS 214.010 shall be guilty of a violation for each day 20
he neglects or refuses to report. Repeated failure to report is sufficient cause for the 21
revocation of a physician's certificate to practice medicine in this state. 22
(2) Any person who willfully violates any administrative regulation promulgated under 23
KRS Chapter 13A by the Cabinet for Health and Family Services under KRS 24
214.020 shall be guilty of a Class B misdemeanor. 25
(3) Any physician or other person legally permitted to engage in attendance upon a 26
pregnant woman during pregnancy or at delivery who fails to exercise due diligence 27
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in complying with KRS 214.160 and 214.170 shall be guilty of a violation. 1
(4) Any person who violates any of the provisions of KRS 214.280 to 214.310 shall be 2
guilty of a Class A misdemeanor. 3
(5) Any person who violates any provision of KRS 214.034 or KRS 158.035 shall be 4
guilty of a Class B misdemeanor. 5
(6) Any person who violates any provision of KRS 214.420 shall be guilty of a 6
violation. Each violation shall constitute a separate offense. 7
(7) Any person who knowingly violates any provision of KRS 214.450[214.452] to 8
214.466 shall be guilty of a Class D felony. Each violation shall constitute a 9
separate offense. 10
SECTION 6. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 11
IS CREATED TO READ AS FOLLOWS: 12
(1) All health benefit plans shall provide coverage for any directed or autologous 13
blood transfusion. 14
(2) Except as provided in subsection (3) of this section, the coverage required by this 15
section shall not be subject to co payments, coinsurance, deductibles, or any other 16
cost-sharing requirements. 17
(3) If the application of any requirement of this section would be the sole cause of a 18
health benefit plan's failure to qualify as a Health Savings Account -qualified 19
High Deductibl e Health Plan under 26 U.S.C. sec. 223, as amended, then the 20
requirement shall not apply to that health benefit plan until the minimum 21
deductible under 26 U.S.C. sec. 223, as amended, is satisfied. 22
Section 7. KRS 205.522 is amended to read as follows: 23
(1) With respect to the administration and provision of Medicaid benefits pursuant to 24
this chapter, the Department for Medicaid Services, any managed care organization 25
contracted to provide Medicaid benefits pursuant to thi s chapter, and the state's 26
medical assistance program shall be subject to, and comply with, the following, as 27
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applicable: 1
(a) KRS 304.17A-129; 2
(b) KRS 304.17A-145; 3
(c) KRS 304.17A-163; 4
(d) KRS 304.17A-1631; 5
(e) KRS 304.17A-167; 6
(f) KRS 304.17A-235; 7
(g) KRS 304.17A-257; 8
(h) KRS 304.17A-259; 9
(i) KRS 304.17A-263; 10
(j) KRS 304.17A-264; 11
(k) KRS 304.17A-515; 12
(l) KRS 304.17A-580; 13
(m) KRS 304.17A-600, 304.17A-603, and 304.17A-607;[ and] 14
(n) KRS 304.17A-740 to 304.17A-743; and 15
(o) Section 6 of this Act. 16
(2) A managed care organization contracted to provide Medicaid benefits pursuant to 17
this chapter shall comply with the reporting requirements of KRS 304.17A-732. 18
Section 8. KRS 205.6485 is amended to read as follows: 19
(1) As used in this section, "KCHIP" means the Kentucky Children's Health Insurance 20
Program. 21
(2) The Cabinet for Health and Family Services shall: 22
(a) Prepare a state child health plan, known as KCHIP, meeting the requirements 23
of Title XXI of the Federal Social Security Act, for submission to the 24
Secretary of the United States Department of Health and Human Services 25
within such time as will permit the state to receive the maximum amounts of 26
federal matching funds available under Title XXI; and 27
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(b) By administrative regulation promulgated in accordance with KRS Chapter 1
13A, establish the following: 2
1. The eligibility criteria for children covered by KCHIP, which shall 3
include a provision that no person eligible for services under Title XIX 4
of the Social Security Act, 42 U.S.C. secs. 1396 to 1396v, as amended, 5
shall be eligible for services under KCHIP, except to the extent that 6
Title XIX coverage is expanded by KRS 205.6481 to 205.6495 and KRS 7
304.17A-340; 8
2. The schedule of benefits to be covered by KCHIP, which shall: 9
a. Be at least equivalent to one (1) of the following: 10
i. The standard Blue Cross/Blue Shield preferred provider 11
option under the Federal Employees Health Benefit Plan 12
established by 5 U.S.C. sec. 8903(1); 13
ii. A mid-range health benefit coverage plan that is offered and 14
generally available to state employees; or 15
iii. Health insurance coverage offered by a health maintenance 16
organization that has the largest insured commercial, non -17
Medicaid enrollment of covered lives in the state; and 18
b. Comply with subsection (6) of this section; 19
3. The premium contribution per family for health insurance coverage 20
available under KCHIP, which shall be based: 21
a. On a six (6) month period; and 22
b. Upon a sliding scale relating to family income not to exceed: 23
i. Ten dollars ($10), to be paid by a family with income 24
between one hundred percent (100%) to one hundred thirty -25
three percent (133%) of the federal poverty level; 26
ii. Twenty dollars ($20), to be paid by a family with income 27
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between one hundr ed thirty -four percent (134%) to one 1
hundred forty -nine percent (149%) of the federal poverty 2
level; and 3
iii. One hundred twenty dollars ($120), to be paid by a family 4
with income between one hundred fifty percent (150%) to 5
two hundred percent (200%) of the federal poverty level, and 6
which may be made on a partial payment plan of twenty 7
dollars ($20) per month or sixty dollars ($60) per quarter; 8
4. There shall be no copayments for services provided under KCHIP; and 9
5. a. The criteria for health services pro viders and insurers wishing to 10
contract with the Commonwealth to provide coverage under 11
KCHIP. 12
b. The cabinet shall provide, in any contracting process for coverag e 13
of preventive services, the opportunity for a public health 14
department to bid on preventive health services to eligible children 15
within the public health department's service area. A public health 16
department shall not be disqualified from bidding because the 17
department does not currently offer all the services required by 18
this section. The criteria shall be set forth in administrative 19
regulations under KRS Chapter 13A and shall maximize 20
competition among the providers and insurers. The Finance and 21
Administration Cabinet shall provide oversight over contracting 22
policies and procedures to assure that the number of applicants for 23
contracts is maximized. 24
(3) Within twelve (12) months of federal approval of the state's Title XXI child health 25
plan, the Cabinet f or Health and Family Services shall assure that a KCHIP 26
program is available to all eligible children in all regions of the state. If necessary, 27
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in order to meet this assurance, the cabinet shall institute its own program. 1
(4) KCHIP recipients shall have d irect access without a referral from any gatekeeper 2
primary care provider to dentists for covered primary dental services and to 3
optometrists and ophthalmologists for covered primary eye and vision services. 4
(5) KCHIP shall comply with KRS 304.17A-163 and 304.17A-1631. 5
(6) The schedule of benefits required under subsection (2)(b)2. of this section shall 6
include: 7
(a) Preventive services; 8
(b) Vision services, including glasses; 9
(c) Dental services, including sealants, extractions, and fillings; and 10
(d) The coverage required under: 11
1. KRS 304.17A-129; [and] 12
2. KRS 304.17A-145; and 13
3. Section 6 of this Act. 14
Section 9. KRS 164.2871 is amended to read as follows: 15
(1) The governing board of each state postsecondary educational in stitution is 16
authorized to purchase liability insurance for the protection of the individual 17
members of the governing board, faculty, and staff of such institutions from liability 18
for acts and omissions committed in the course and scope of the individual's 19
employment or service. Each institution may purchase the type and amount of 20
liability coverage deemed to best serve the interest of such institution. 21
(2) All retirement annuity allowances accrued or accruing to any employee of a state 22
postsecondary educat ional institution through a retirement program sponsored by 23
the state postsecondary educational institution are hereby exempt from any state, 24
county, or municipal tax, and shall not be subject to execution, attachment, 25
garnishment, or any other process wha tsoever, nor shall any assignment thereof be 26
enforceable in any court. Except retirement benefits accrued or accruing to any 27
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employee of a state postsecondary educational institution through a retirement 1
program sponsored by the state postsecondary educati onal institution on or after 2
January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 3
provided in KRS 141.010 and 141.0215. 4
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 5
members of governing boa rds, faculty and staff of institutions of higher education 6
in this state shall not be construed to be a waiver of sovereign immunity or any 7
other immunity or privilege. 8
(4) The governing board of each state postsecondary education institution is authorized 9
to provide a self -insured employer group health plan to its employees, which plan 10
shall: 11
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 12
(b) Except as provided in subsection (5) of this section, be exempt from 13
conformity with Subtitle 17A of KRS Chapter 304. 14
(5) A self-insured employer group health plan provided by the governing board of a 15
state postsecondary education institution to its employees shall comply with: 16
(a) KRS 304.17A-129; 17
(b) KRS 304.17A-133; 18
(c) KRS 304.17A-145; 19
(d) KRS 304.17A-163 and 304.17A-1631; 20
(e) KRS 304.17A-261; 21
(f) KRS 304.17A-262; 22
(g) KRS 304.17A-264;[ and] 23
(h) KRS 304.17A-265; and 24
(i) Section 6 of this Act. 25
(6) (a) A self-insured employer group health plan provided by the governing board of 26
a state postsecondary education institution to its employees shall provide a 27
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special enrollment period to pregnant women who are eligible for coverage in 1
accordance with the requirements set forth in KRS 304.17-182. 2
(b) The governing board of a state postsecondary education institution shall, at or 3
before the time an employee is initially offered the opportunity to enroll in the 4
plan or coverage, provide the employee a notice of th e special enrollment 5
rights under this subsection. 6
Section 10. KRS 18A.225 is amended to read as follows: 7
(1) (a) The term "employee" for purposes of this section means: 8
1. Any person, including an elected public officia l, who is regularly 9
employed by any department, office, board, agency, or branch of state 10
government; or by a public postsecondary educational institution; or by 11
any city, urban -county, charter county, county, or consolidated local 12
government, whose legislative body has opted to participate in the state -13
sponsored health insurance program pursuant to KRS 79.080; and who 14
is either a contributing member to any one (1) of the retirement systems 15
administered by the state, including but not limited to the Kentuck y 16
Retirement Systems, County Employees Retirement System, Kentucky 17
Teachers' Retirement System, the Legislators' Retirement Plan, or the 18
Judicial Retirement Plan; or is receiving a contractual contribution from 19
the state toward a retirement plan; or, in th e case of a public 20
postsecondary education institution, is an individual participating in an 21
optional retirement plan authorized by KRS 161.567; or is eligible to 22
participate in a retirement plan established by an employer who ceases 23
participating in the Kentucky Employees Retirement System pursuant to 24
KRS 61.522 whose employees participated in the health insurance plans 25
administered by the Personnel Cabinet prior to the employer's effective 26
cessation date in the Kentucky Employees Retirement System; 27
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2. Any certified or classified employee of a local board of education or a 1
public charter school as defined in KRS 160.1590; 2
3. Any elected member of a local board of education; 3
4. Any person who is a present or future recipient of a retirement 4
allowance from th e Kentucky Retirement Systems, County Employees 5
Retirement System, Kentucky Teachers' Retirement System, the 6
Legislators' Retirement Plan, the Judicial Retirement Plan, or the 7
Kentucky Community and Technical College System's optional 8
retirement plan authorized by KRS 161.567, except that a person who is 9
receiving a retirement allowance and who is age sixty -five (65) or older 10
shall not be included, with the exception of persons covered under KRS 11
61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is active ly 12
employed pursuant to subparagraph 1. of this paragraph; and 13
5. Any eligible dependents and beneficiaries of participating employees 14
and retirees who are entitled to participate in the state -sponsored health 15
insurance program; 16
(b) The term "health benefit plan" for the purposes of this section means a health 17
benefit plan as defined in KRS 304.17A-005; 18
(c) The term "insurer" for the purposes of this section means an insurer as defined 19
in KRS 304.17A-005; and 20
(d) The term "managed care plan" for the purpose s of this section means a 21
managed care plan as defined in KRS 304.17A-500. 22
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 23
recommendation of the secretary of the Personnel Cabinet, shall procure, in 24
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 25
from one (1) or more insurers authorized to do business in this state, a group 26
health benefit plan that may include but not be limited to health maintenance 27
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organization (HMO), preferred provider organization (PPO), po int of service 1
(POS), and exclusive provider organization (EPO) benefit plans 2
encompassing all or any class or classes of employees. With the exception of 3
employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 4
all employers of any class of employees or former employees shall enter into 5
a contract with the Personnel Cabinet prior to including that group in the state 6
health insurance group. The contracts shall include but not be limited to 7
designating the entity responsible for filing any fed eral forms, adoption of 8
policies required for proper plan administration, acceptance of the contractual 9
provisions with health insurance carriers or third -party administrators, and 10
adoption of the payment and reimbursement methods necessary for efficient 11
administration of the health insurance program. Health insurance coverage 12
provided to state employees under this section shall, at a minimum, contain 13
the same benefits as provided under Kentucky Kare Standard as of January 1, 14
1994, and shall include a mail -order drug option as provided in subsection 15
(13) of this section. All employees and other persons for whom the health care 16
coverage is provided or made available shall annually be given an option to 17
elect health care coverage through a self -funded plan off ered by the 18
Commonwealth or, if a self -funded plan is not available, from a list of 19
coverage options determined by the competitive bid process under the 20
provisions of KRS 45A.080, 45A.085, and 45A.090 and made available 21
during annual open enrollment. 22
(b) The policy or policies shall be approved by the commissioner of insurance 23
and may contain the provisions the commissioner of insurance approves, 24
whether or not otherwise permitted by the insurance laws. 25
(c) Any carrier bidding to offer health care coverage to employees shall agree to 26
provide coverage to all members of the state group, including active 27
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employees and retirees and their eligible covered dependents and 1
beneficiaries, within the county or counties specified in its bid. Except as 2
provided in subsection (20) of this section, any carrier bidding to offer health 3
care coverage to employees shall also agree to rate all employees as a single 4
entity, except for those retirees whose former employers insure their active 5
employees outside the state -sponsored health insurance program and as 6
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 7
(d) Any carrier bidding to offer health care coverage to employees shall agree to 8
provide enrollment, claims, and utilization data to the Commonwealth in a 9
format specified by the Personnel Cabinet with the understanding that the data 10
shall be owned by the Commonwealth; to provide data in an electronic form 11
and within a time frame specified by the Personnel Cabinet; and to be subject 12
to penalties for noncomplia nce with data reporting requirements as specified 13
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 14
to protect the confidentiality of each individual employee; however, 15
confidentiality assertions shall not relieve a carrier from the requirement of 16
providing stipulated data to the Commonwealth. 17
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 18
for timely analysis of data received from carriers and, to the extent possible, 19
provide in the request -for-proposal specifics relating to data requirements, 20
electronic reporting, and penalties for noncompliance. The Commonwealth 21
shall own the enrollment, claims, and utilization data provided by each carrier 22
and shall develop methods to protect the confidentiali ty of the individual. The 23
Personnel Cabinet shall include in the October annual report submitted 24
pursuant to the provisions of KRS 18A.226 to the Governor, the General 25
Assembly, and the Chief Justice of the Supreme Court, an analysis of the 26
financial stabi lity of the program, which shall include but not be limited to 27
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loss ratios, methods of risk adjustment, measurements of carrier quality of 1
service, prescription coverage and cost management, and statutorily required 2
mandates. If state self -insurance was av ailable as a carrier option, the report 3
also shall provide a detailed financial analysis of the self -insurance fund 4
including but not limited to loss ratios, reserves, and reinsurance agreements. 5
(f) If any agency participating in the state -sponsored employee health insurance 6
program for its active employees terminates participation and there is a state 7
appropriation for the employer's contribution for active employees' health 8
insurance coverage, then neither the agency nor the employees shall receive 9
the s tate-funded contribution after termination from the state -sponsored 10
employee health insurance program. 11
(g) Any funds in flexible spending accounts that remain after all reimbursements 12
have been processed shall be transferred to the credit of the state -sponsored 13
health insurance plan's appropriation account. 14
(h) Each entity participating in the state-sponsored health insurance program shall 15
provide an amount at least equal to the state contribution rate for the employer 16
portion of the health insurance premium. For any participating entity that used 17
the state payroll system, the employer contribution amount shall be equal to 18
but not greater than the state contribution rate. 19
(3) The premiums may be paid by the policyholder: 20
(a) Wholly from funds contributed by the employee, by payroll deduction or 21
otherwise; 22
(b) Wholly from funds contributed by any department, board, agency, public 23
postsecondary education institution, or branch of state, city, urban -county, 24
charter county, county, or consolidated local government; or 25
(c) Partly from each, except that any premium due for health care coverage or 26
dental coverage, if any, in excess of the premium amount contributed by any 27
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department, board, agency, postsecondary education institution, or branch of 1
state, city, urban -county, charter county, county, or consolidated local 2
government for any other health care coverage shall be paid by the employee. 3
(4) If an employee moves his or her place of residence or employment out of the 4
service area of an insurer offering a managed health care plan, under which he or 5
she has elected coverage, into either the service area of another managed health care 6
plan or into an area of the Commonwealth not within a managed health care plan 7
service area, the emp loyee shall be given an option, at the time of the move or 8
transfer, to change his or her coverage to another health benefit plan. 9
(5) No payment of premium by any department, board, agency, public postsecondary 10
educational institution, or branch of state, city, urban -county, charter county, 11
county, or consolidated local government shall constitute compensation to an 12
insured employee for the purposes of any statute fixing or limiting the 13
compensation of such an employee. Any premium or other expense incurre d by any 14
department, board, agency, public postsecondary educational institution, or branch 15
of state, city, urban -county, charter county, county, or consolidated local 16
government shall be considered a proper cost of administration. 17
(6) The policy or policies may contain the provisions with respect to the class or classes 18
of employees covered, amounts of insurance or coverage for designated classes or 19
groups of employees, policy options, terms of eligibility, and continuation of 20
insurance or coverage after retirement. 21
(7) Group rates under this section shall be made available to the disabled child of an 22
employee regardless of the child's age if the entire premium for the disabled child's 23
coverage is paid by the state employee. A child shall be considered disa bled if he or 24
she has been determined to be eligible for federal Social Security disability benefits. 25
(8) The health care contract or contracts for employees shall be entered into for a 26
period of not less than one (1) year. 27
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(9) The secretary shall appoint thirty-two (32) persons to an Advisory Committee of 1
State Health Insurance Subscribers to advise the secretary or the secretary's 2
designee regarding the state -sponsored health insurance program for employees. 3
The secretary shall appoint, from a list of nam es submitted by appointing 4
authorities, members representing school districts from each of the seven (7) 5
Supreme Court districts, members representing state government from each of the 6
seven (7) Supreme Court districts, two (2) members representing retiree s under age 7
sixty-five (65), one (1) member representing local health departments, two (2) 8
members representing the Kentucky Teachers' Retirement System, and three (3) 9
members at large. The secretary shall also appoint two (2) members from a list of 10
five (5) names submitted by the Kentucky Education Association, two (2) members 11
from a list of five (5) names submitted by the largest state employee organization of 12
nonschool state employees, two (2) members from a list of five (5) names submitted 13
by the Kentuc ky Association of Counties, two (2) members from a list of five (5) 14
names submitted by the Kentucky League of Cities, and two (2) members from a 15
list of names consisting of five (5) names submitted by each state employee 16
organization that has two thousand (2,000) or more members on state payroll 17
deduction. The advisory committee shall be appointed in January of each year and 18
shall meet quarterly. 19
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 20
provided to employees pu rsuant to this section shall not provide coverage for 21
obtaining or performing an abortion, nor shall any state funds be used for the 22
purpose of obtaining or performing an abortion on behalf of employees or their 23
dependents. 24
(11) Interruption of an establis hed treatment regime with maintenance drugs shall be 25
grounds for an insured to appeal a formulary change through the established appeal 26
procedures approved by the Department of Insurance, if the physician supervising 27
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the treatment certifies that the change is not in the best interests of the patient. 1
(12) Any employee who is eligible for and elects to participate in the state health 2
insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 3
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 4
state health insurance contribution toward health care coverage as a result of any 5
other employment for which there is a public employer contribution. This does not 6
preclude a retiree and an active employee spo use from using both contributions to 7
the extent needed for purchase of one (1) state sponsored health insurance policy 8
for that plan year. 9
(13) (a) The policies of health insurance coverage procured under subsection (2) of 10
this section shall include a mail -order drug option for maintenance drugs for 11
state employees. Maintenance drugs may be dispensed by mail order in 12
accordance with Kentucky law. 13
(b) A health insurer shall not discriminate against any retail pharmacy located 14
within the geographic coverage a rea of the health benefit plan and that meets 15
the terms and conditions for participation established by the insurer, including 16
price, dispensing fee, and copay requirements of a mail -order option. The 17
retail pharmacy shall not be required to dispense by mail. 18
(c) The mail -order option shall not permit the dispensing of a controlled 19
substance classified in Schedule II. 20
(14) The policy or policies provided to state employees or their dependents pursuant to 21
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 22
aid-related services for insured individuals under eighteen (18) years of age, subject 23
to a cap of one thousand four hundred dollars ($1,400) every thirty -six (36) months 24
pursuant to KRS 304.17A-132. 25
(15) Any policy provided to state employees or their dependents pursuant to this section 26
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 27
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consistent with KRS 304.17A-142. 1
(16) Any policy provided to state employees or their dependents pursuant to this section 2
shall provide coverage for obtaining amino acid -based elemental formula pursuant 3
to KRS 304.17A-258. 4
(17) If a state employee's residence and place of employment are in the same county, 5
and if the hospital located within that county does no t offer surgical services, 6
intensive care services, obstetrical services, level II neonatal services, diagnostic 7
cardiac catheterization services, and magnetic resonance imaging services, the 8
employee may select a plan available in a contiguous county that does provide 9
those services, and the state contribution for the plan shall be the amount available 10
in the county where the plan selected is located. 11
(18) If a state employee's residence and place of employment are each located in 12
counties in which the hos pitals do not offer surgical services, intensive care 13
services, obstetrical services, level II neonatal services, diagnostic cardiac 14
catheterization services, and magnetic resonance imaging services, the employee 15
may select a plan available in a county con tiguous to the county of residence that 16
does provide those services, and the state contribution for the plan shall be the 17
amount available in the county where the plan selected is located. 18
(19) The Personnel Cabinet is encouraged to study whether it is fai r and reasonable and 19
in the best interests of the state group to allow any carrier bidding to offer health 20
care coverage under this section to submit bids that may vary county by county or 21
by larger geographic areas. 22
(20) Notwithstanding any other provision of this section, the bid for proposals for health 23
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 24
the statewide rating structure provided in calendar year 2003 and a bid scenario that 25
allows for a regional rating stru cture that allows carriers to submit bids that may 26
vary by region for a given product offering as described in this subsection: 27
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(a) The regional rating bid scenario shall not include a request for bid on a 1
statewide option; 2
(b) The Personnel Cabinet shall divide the state into geographical regions which 3
shall be the same as the partnership regions designated by the Department for 4
Medicaid Services for purposes of the Kentucky Health Care Partnership 5
Program established pursuant to 907 KAR 1:705; 6
(c) The request for proposal shall require a carrier's bid to include every county 7
within the region or regions for which the bid is submitted and include but not 8
be restricted to a preferred provider organization (PPO) option; 9
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 10
carrier all of the counties included in its bid within the region. If the Personnel 11
Cabinet deems the bids submitted in accordance with this subsection to be in 12
the best interests of state employees in a region, t he cabinet may award the 13
contract for that region to no more than two (2) carriers; and 14
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 15
other requirements or criteria in the request for proposal. 16
(21) Any fully insured health benefit plan or self -insured plan issued or renewed on or 17
after July 12, 2006, to public employees pursuant to this section which provides 18
coverage for services rendered by a physician or osteopath duly licensed under KRS 19
Chapter 311 that are within the scope of practice of an optometrist duly licensed 20
under the provisions of KRS Chapter 320 shall provide the same payment of 21
coverage to optometrists as allowed for those services rendered by physicians or 22
osteopaths. 23
(22) Any fully i nsured health benefit plan or self -insured plan issued or renewed to 24
public employees pursuant to this section shall comply with: 25
(a) KRS 304.12-237; 26
(b) KRS 304.17A-270 and 304.17A-525; 27
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(c) KRS 304.17A-600 to 304.17A-633; 1
(d) KRS 205.593; 2
(e) KRS 304.17A-700 to 304.17A-730; 3
(f) KRS 304.14-135; 4
(g) KRS 304.17A-580 and 304.17A-641; 5
(h) KRS 304.99-123; 6
(i) KRS 304.17A-138; 7
(j) KRS 304.17A-148; 8
(k) KRS 304.17A-163 and 304.17A-1631; 9
(l) KRS 304.17A-265; 10
(m) KRS 304.17A-261; 11
(n) KRS 304.17A-262; 12
(o) KRS 304.17A-145; 13
(p) KRS 304.17A-129; 14
(q) KRS 304.17A-133; 15
(r) KRS 304.17A-264;[ and] 16
(s) Section 6 of this Act; and 17
(t) Administrative regulations promulgated pursuant to statutes listed in this 18
subsection. 19
(23) (a) Any fully insured health benefit plan or self-insured plan issued or renewed to 20
public employees pursuant to this section shall provide a special enrollment 21
period to pregnant women who are eligible for coverage in accordance with 22
the requirements set forth in KRS 304.17-182. 23
(b) The Department of Employee Insurance shall, at or before the time a public 24
employee is initially offered the opportunity to enroll in the plan or coverage, 25
provide the employee a notice of the special enrollment rights under this 26
subsection. 27
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Section 11. Sections 2 and 6 of this Act may be cited as the Medical Autonomy 1
and Directed Donation Act. 2
Section 12. Sections 6, 9, and 10 of this Act apply to health benefit plans issued 3
or renewed on or after January 1, 2027. 4
Section 13. Notwithstanding KRS 194A.099: 5
(1) Within 90 days of the effective date of this section, the Department of 6
Insurance shall identify, in accordance with 45 C.F.R. sec. 155.170(a)(3), whether the 7
application of any requirement of Section 6 of this Act to a qualified health plan (QHP) is 8
in addition to the essential health benefits required under federal law; 9
(2) If it is determined that the application of any requirement of Section 3 of this 10
Act to a QHP is in addition to the essential health benefits required under federal law, 11
then the department shall, within 180 days of the effective date of this section, apply for a 12
waiver under 42 U.S.C. sec. 18052, as amended, or any other applicable federal law of all 13
or any of the cost defrayal requirements under 42 U.S.C. sec. 18031(d)(3) and 45 C.F.R . 14
sec. 155.170, as amended; and 15
(3) The application required under subsection (2) of this section: 16
(a) Shall comply with the requirements of federal law for obtaining a waiver; and 17
(b) May propose changes to the state's EHB -benchmark plan, as defined in 45 18
C.F.R. sec. 156.20, that are not in conflict with existing state law. 19
Section 14. If the Cabinet for Health and Family Services or the Department for 20
Medicaid Services determines that a state plan amendment, waiver, or any other form of 21
authorization or approval from any federal agency to implement Section 7 and 8 of this 22
Act is nec essary to prevent the loss of federal funds or to comply with federal law, the 23
cabinet or department: 24
(1) Shall, within 90 days after the effective date of this section, request the 25
necessary federal authorization or approval to implement Sections 7 and 8 of this Act; 26
and 27
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(2) May only delay implementation of the provisions of Sections 7 and 8 of this 1
Act for which federal authorization or approval was deemed necessary until the federal 2
authorization or approval is granted. 3
Section 15. Sections 7, 8, and 14 of this Act shall constitute the specific 4
authorization required under KRS 205.5372(1). 5
Section 16. Sections 6 to 12 of this Act take effect January 1, 2027. 6