AN ACT relating to chronic pain treatments.

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AN ACT relating to chronic pain treatments. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
SECTION 1. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 3
IS CREATED TO READ AS FOLLOWS: 4
(1) Any health benefit plan that provides coverage for hospital, medical, or surgical 5
expenses shall include coverage for twenty (20) visits of chronic pai n treatments 6
per event when provided to an insured by a licensed professional specializing in 7
any of the following: 8
(a) Acupuncture; 9
(b) Chiropractic services; 10
(c) Chronic pain management; 11
(d) Hyperbaric oxygen therapy; 12
(e) Massage therapy; 13
(f) Occupational therapy; 14
(g) Osteopathic manipulation; 15
(h) Physical therapy; or 16
(i) Psychotherapy. 17
(2) An insured may seek treatment for chronic pain from a licensed professional 18
described in subsection (1) of this section prior to seeking treatment from a health 19
care provider, and a health care provider referral shall not be required as a 20
condition of the coverage required under this section. 21
(3) Any deductible, coinsurance, or copay required for any chronic pain treatments 22
provided by a licensed professional described in subsection (1) of this section 23
shall not be greater than the deductible, coinsurance, or copay required for a 24
primary care visit. 25
(4) Nothing in this section should be construed to require: 26
(a) That all of the chronic pain treatments provided by a licensed professional 27
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described in subsection (1) of this section be exhausted prior to the insured 1
receiving a prescription for an opioid; or 2
(b) Coverage under Subtitle 39 of KRS Chapter 304 for chronic pain treatments 3
provided by a licensed professional. 4
Section 2. 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 Medicaid Services, any managed care org anization 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 and[ ; 13
(d) ]KRS 304.17A-1631; 14
(d)[(e)] KRS 304.17A-167; 15
(e)[(f)] KRS 304.17A-235; 16
(f)[(g)] KRS 304.17A-257; 17
(g)[(h)] KRS 304.17A-259; 18
(h)[(i)] KRS 304.17A-263; 19
(i)[(j)] KRS 304.17A-264; 20
(j)[(k)] KRS 304.17A-515; 21
(k)[(l)] KRS 304.17A-580; 22
(l)[(m)] KRS 304.17A-600, 304.17A-603, and 304.17A-607;[ and] 23
(m)[(n)] KRS 304.17A-740 to 304.17A-743; and 24
(n) Section 1 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 3. KRS 218A.172 is amended to read as follows: 1
(1) Administrative regulations promulgated under KRS 218A.205(3) shall require that, 2
prior to the initial prescribing or dispensing of any Schedule II controlled substance 3
or a Schedule III controlled substance containing hydrocodone to a human patient, a 4
practitioner shall: 5
(a) Obtain a medical history and conduct a physical or mental health examination 6
of the patient, as appropriate to the patient's medical complaint, and document 7
the information in the patient's medical record; 8
(b) Query the electronic monitor ing system established in KRS 218A.202 for all 9
available data on the patient for the twelve (12) month period immediately 10
preceding the patient encounter and appropriately utilize that data in the 11
evaluation and treatment of the patient; 12
(c) Make a written plan stating the objectives of the treatment and further 13
diagnostic examinations required; 14
(d) Discuss the risks and benefits of the use of controlled substances with the 15
patient, the patient's parent if the patient is an unemancipated minor child, or 16
the patient's legal guardian or health care surrogate, including the risk of 17
tolerance and drug dependence;[ and] 18
(e) Discuss and refer or prescribe, if appropriate based on the practitioner's 19
clinical judgment and treatment availability, chronic pain treatme nts 20
provided by a licensed professional specializing in at least one (1) of the 21
following: 22
1. Acupuncture; 23
2. Chiropractic services; 24
3. Chronic pain management; 25
4. Hyperbaric oxygen therapy; 26
5. Massage therapy; 27
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6. Occupational therapy; 1
7. Osteopathic manipulation; 2
8. Physical therapy; or 3
9. Psychotherapy; and 4
(f) Obtain written consent for the treatment. 5
(2) (a) Administrative regulations promulgated under KRS 218A.205(3) shall require 6
that a practitioner prescribing or dispensing additional amounts of Sche dule II 7
controlled substances or Schedule III controlled substances containing 8
hydrocodone for the same medical complaint and related symptoms shall: 9
1. Review, at reasonable intervals based on the patient's individual 10
circumstances and course of treatment, the plan of care; 11
2. Provide to the patient any new information about the treatment; and 12
3. Modify or terminate the treatment as appropriate. 13
(b) If the course of treatment extends beyond three (3) months, the administrative 14
regulations shall also require that the practitioner: 15
1. Query the electronic monitoring system established in KRS 218A.202 16
no less than once every three (3) months for all available data on the 17
patient for the twelve (12) month period immediately preceding the 18
query; and 19
2. Review that data before issuing any new prescription or refills for the 20
patient for any Schedule II controlled substance or a Schedule III 21
controlled substance containing hydrocodone. 22
(3) Administrative regulations promulgated under KRS 218A.205(3) shall r equire that, 23
for each patient for whom a practitioner prescribes any Schedule II controlled 24
substance or a Schedule III controlled substance containing hydrocodone, the 25
practitioner shall keep accurate, readily accessible, and complete medical records 26
which include, as appropriate: 27
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(a) Medical history and physical or mental health examination; 1
(b) Diagnostic, therapeutic, and laboratory results; 2
(c) Evaluations and consultations; 3
(d) Treatment objectives; 4
(e) Discussion of risk, benefits, and limitations of treatments; 5
(f) Treatments; 6
(g) Medications, including date, type, dosage, and quantity prescribed or 7
dispensed; 8
(h) Instructions and agreements; and 9
(i) Periodic reviews of the patient's file. 10
(4) Administrative regulations promulgated under KRS 218A.205 (3) may exempt, in 11
whole or in part, compliance with the mandatory diagnostic, treatment, review, and 12
other protocols and standards established in this section for: 13
(a) A licensee prescribing or administering a controlled substance immediately 14
prior to, du ring, or within the fourteen (14) days following an operative or 15
invasive procedure or a delivery if the prescribing or administering is 16
medically related to the operative or invasive procedure or the delivery and 17
the medication usage does not extend beyond the fourteen (14) days; 18
(b) A licensee prescribing or administering a controlled substance necessary to 19
treat a patient in an emergency situation; 20
(c) A licensed pharmacist or other person licensed by the Kentucky Board of 21
Pharmacy to dispense drugs or a licensed pharmacy; 22
(d) A licensee prescribing or dispensing a controlled substance: 23
1. For administration in a hospital or long -term-care facility if the hospital 24
or long-term-care facility with an institutional account, or a practitioner 25
in those hospita ls or facilities where no institutional account exists, 26
queries the electronic monitoring system established in KRS 218A.202 27
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for all available data on the patient or resident for the twelve (12) month 1
period immediately preceding the query within twelve (1 2) hours of the 2
patient's or resident's admission and places a copy of the query in the 3
patient's or resident's medical records during the duration of the patient's 4
stay at the facility; 5
2. As part of the patient's hospice or end-of-life treatment; 6
3. For the treatment of pain associated with cancer or with the treatment of 7
cancer; 8
4. In a single dose to relieve the anxiety, pain, or discomfort experienced 9
by a patient submitting to a diagnostic test or procedure; 10
5. Within seven (7) days of an initial pres cribing or dispensing under 11
subsection (1) of this section if the prescribing or dispensing: 12
a. Is done as a substitute for the initial prescribing or dispensing; 13
b. Cancels any refills for the initial prescription; and 14
c. Requires the patient to dispose o f any remaining unconsumed 15
medication; 16
6. Within ninety (90) days of an initial prescribing or dispensing under 17
subsection (1) of this section if the prescribing or dispensing is done by 18
another practitioner in the same practice or in an existing coverage 19
arrangement, if done for the same patient for the same medical 20
condition; or 21
7. To a research subject enrolled in a research protocol approved by an 22
institutional review board that has an active federalwide assurance 23
number from the United States Departmen t of Health and Human 24
Services, Office for Human Research Protections, where the research 25
involves single, double, or triple blind drug administration or is 26
additionally covered by a certificate of confidentiality from the National 27
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Institutes of Health; 1
(e) The prescribing of a Schedule III, IV, or V controlled substance by a licensed 2
optometrist to a patient in accordance with the provisions of KRS 320.240; or 3
(f) The prescribing of a three (3) day supply of a Schedule III controlled 4
substance following the performance of oral surgery by a dentist licensed 5
pursuant to KRS Chapter 313. 6
(5) (a) A state licensing board promulgating administrative regulations under KRS 7
218A.205(3) may promulgate an administrative regulation authorizing 8
exemptions supplemental or in addition to those specified in subsection (4) of 9
this section. Prior to exercising this authority, the board shall: 10
1. Notify the Kentucky Office of Drug Control Policy that it is considering 11
a proposal to promulgate an administrative regulation aut horizing 12
exemptions supplemental or in addition to those specified in subsection 13
(4) of this section and invite the office to participate in the board 14
meeting at which the proposal will be considered; 15
2. Make a factual finding based on expert testimony as well as evidence or 16
research submitted to the board that the exemption demonstrates a low 17
risk of diversion or abuse and is supported by the dictates of good 18
medical practice; and 19
3. Submit a report to the Governor and the Legislative Research 20
Commission o f its actions, including a detailed explanation of the 21
factual and policy basis underlying the board's action. A copy of this 22
report shall be provided to the regulations compiler. 23
(b) Within one (1) working day of promulgating an administrative regulation 24
authorizing an exemption under this section, the promulgating board shall 25
email[e-mail] to the Kentucky Office of Drug Control Policy: 26
1. A copy of the administrative regulation as filed, and all attachments 27
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required by KRS 13A.230(1); and 1
2. A request fro m the board that the office review the administrative 2
regulation in the same manner as would the Commission on Small 3
Business Innovation and Advocacy under KRS 11.202(1)(e), and submit 4
its report or comments in accordance with the deadline established in 5
KRS 13A.270(1)(c). A copy of the report or comments shall be filed 6
with the regulations compiler. 7
Section 4. Section 1 of this Act applies to health benefit plans issued or 8
renewed on or after January 1, 2027. 9
Section 5. If the Cabinet for Health and Family Services or the Department for 10
Medicaid Services determines that a state plan amendment, waiver, or any other form of 11
authorization or approval from any federal agency to implement Section 2 of this Act is 12
necessary to prevent the loss of federal funds or to comply with federal law, the cabinet 13
or department: 14
(1) Shall, w ithin 90 days after the effective date of this section, request the 15
necessary federal authorization or approval to implement Section 2 of this Act; and 16
(2) May only delay implementation of the provisions of Section 2 of this Act for 17
which federal authoriza tion or approval was deemed necessary until the federal 18
authorization or approval is granted. 19
Section 6. Sections 2 and 5 of this Act shall constitute the specific authorization 20
required under KRS 205.5372(1). 21
Section 7. This Act takes effect January 1, 2027. 22