Healthcare

Amend KRS 304.17A-660 to specify classifications to be included in the term "classification of benefits"; specify requirements, standards, and methodologies to be included in the term "nonquantitative treatment limitation"; change the definition of "mental health condition" to the definition of "mental health or substance use disorder condition"; amend KRS 304.17A-661 to require an insurer's mental health parity analysis to include an evaluation of standards relating to network composition, out-of-network utilization rates, and medical management techniques; require insurers to submit a remediation plan for the commissioner's approval if its mental health parity analysis indicates noncompliance; require insurer's annual mental health parity report to be submitted to the Legislative Research Commission; delete language applying remedies under Subtitle 12 of KRS Chapter 304 to violations; authorize the Attorney General to enforce the mental health parity law; establish duties, remedies, and penalties for enforcement by the Attorney General; authorize a private cause of action by any person directly injured by a violation or likely violation of the mental health parity law; establish duties, remedies, and penalties for a private right of action under the mental health parity law; establish construction clauses; authorize the Attorney General to promulgate administrative regulations for proper enforcement of mental health parity law; create new sections of KRS 304.17A-660 to 304.17A-669 to define "health care professional"; require insurers to comply with KRS 304.17A-700 to 304.17A-730 for claims submitted by health care professionals for the diagnosis or treatment of mental health or substance use disorder conditions; authorize the Attorney General to enforce the requirement to comply with KRS 304.17A-700 to 304.17A-730; create the Advisory Council on Mental Health and Substance Use Disorder Parity; establish duties and membership; amend KRS 304.17A-665 to require the commissioner of insurance to publish a summary of each insurer's mental health parity report and report findings to specified legislative committees; amend KRS 304.17A-669 to conform; amend KRS 18A.225 to require the state employee health plan to comply with KRS 304.17A-660 to 304.17A-669; provide terms for initial appointment of members of the Advisory Council on Mental Health and Substance Use Disorder Parity; provide that certain sections apply to contracts issued or renewed on or after January 1, 2027; EFFECTIVE, January 1, 2027.

Create a new section of KRS Chapter 367 to define terms; prohibit a health care professional from furnishing medical debt to a consumer reporting agency; require a contract between a health care professional and collection entity to include a provision prohibiting the reporting of medical debt to a consumer reporting agency; provide that medical debt that is reported in violation of the section is void and unenforceable; make a violation of the section an unfair, false, misleading, or deceptive act or practice in violation of KRS 367.170; establish remedies for a violation of the section; provide that section shall not be construed to limit or restrict any powers, duties, remedies, or penalties available; direct that provisions apply to contracts entered into or renewed on or after the effective date of the Act.

Establish the Infant Mortality Task Force; list duties and members of the task force; require the task force to meet monthly during the 2026 Interim of the General Assembly and to submit a report by December 1, 2026.

Direct the Legislative Research Commission to procure a vendor to conduct a feasibility study for an Accountable Communities for Health Medicaid delivery model pilot project; require the results of the study to be submitted to the Legislative Research Commission by November 1, 2026; strongly encourage the Legislative Research Commission to begin the procurement process immediately upon the adoption of this Resolution; establish that a pilot project resulting from the feasibility study shall be known as the 20 by 30 Accountable Care Pilot Project.

Create a new section of Subtitle 17A of KRS Chapter 304 to define terms; require health plans to provide coverage for scalp cooling systems used in connection with chemotherapy treatment for breast cancer; suspend the coverage requirement's application to qualified health plans if the state would be required to make cost defrayal payments; amend KRS 304.17A-099 to conform; amend KRS 304.17C-125, 164.2871, and 18A.225 to require limited health service benefit plans, self-insured employer plans provided by the governing board of a state postsecondary education institution, and the state employee health plan to comply with the coverage requirement for scalp cooling systems; provide that certain provisions apply to health plans issued or renewed on or after January 1, 2027; EFFECTIVE, in part, January 1, 2027.

Create a new section of KRS Chapter 205 to allow perinatal mood and anxiety disorders screenings of an accompanying parent or legal guardian to be claimed as a service for the child as part of the early and periodic diagnostic, screening, and treatment benefit; amend KRS 205.6497 to require the Kentucky Children's Health Insurance Program to cover perinatal mood and anxiety disorders screenings; create a new section of Subtitle 17A of KRS Chapter 304 to require a health plan to cover perinatal mood and anxiety disorders screenings as part of a well-child or well-baby visit; suspend the coverage requirement for qualified health plans if the requirement results, or would result, in the state being required to defray the cost under federal law; amend KRS 164.2871 and 18A.225 to require self-insured employer group health plans offered by a state postsecondary education institution and the state employee health plan to comply with the perinatal mood and anxiety disorders screenings coverage requirement; provide that various sections apply to health plans issued or renewed on or after January 1, 2027; require the Cabinet for Health and Family Services or the Department for Medicaid Services to obtain federal approval if it is determined that such approval is necessary; provide authorization from the General Assembly to make changes in the Medicaid program as required under KRS 205.5372(1); EFFECTIVE, in part, January 1, 2027.

Create new sections of KRS 304.17A-600 to 304.17A-633 to define terms; prohibit insurers of health benefit plans from requiring prior authorization for a health care service for which the provider has an exemption; require insurers of health benefit plans to establish a program under which participating providers may qualify for exemptions from prior authorization; establish mandatory and permitted provisions of an insurer's prior authorization exemption program; establish requirements for sending forms and notices; require the commissioner of the Department of Insurance to submit an annual report relating to prior authorization, provide a detailed briefing upon request, and promulgate administrative regulations; amend KRS 304.17A-605 to conform; amend KRS 304.17A-611 to prohibit conducting a retrospective review that is based solely on a participating provider having a prior authorization exemption; provide that certain utilization review time frames do not apply to retrospective reviews conducted for the purposes of determining eligibility for a prior authorization exemption; create a new section of KRS Chapter 205 to require the commissioner of the Department for Medicaid Services to submit an annual report relating to prior authorization, provide a detailed briefing upon request, and promulgate administrative regulations; amend KRS 205.536 to conform; apply the provisions to contracts delivered, entered, renewed, extended, or amended on or after January 1, 2028; EFFECTIVE, in part, January 1, 2027, and January 1, 2028.

Amend KRS 205.520 to establish that it is the policy of the Commonwealth to provide Medicaid eligibility for all residents of the Commonwealth who may be eligible under federal law; amend KRS 205.6312 to require the establishment of cost-sharing requirements in the Medicaid program to the extent required under federal law; require the Governor to commission an independent third-party analysis of the current Medicaid expansion; require the Cabinet for Health and Family Services or the Department for Medicaid Services to seek federal approval if it is determined that such approval is necessary; provide authorization from the General Assembly to make changes the Medicaid program as required under KRS 205.5372(1).

Create new sections of KRS Chapter 218A to define terms; establish the ibogaine research and intellectual property fund to be administered by the Department of Agriculture for the purpose of allowing the department to enter a public-private partnership with a drug developer to conduct a clinical drug development trial or trials related to the use of ibogaine for the treatment of opioid use disorder, co-occurring substance use disorder, or any other neurological or mental health condition for which ibogaine demonstrates efficacy; establish requirements for the department related to how it contracts with a drug developer related to ibogaine research and intellectual property; appropriate $21 million from the opioid abatement trust fund to the ibogaine research and intellectual property development fund in fiscal year 2026-2027 and in fiscal year 2027-2028; APPROPRIATION; EMERGENCY.

Amend KRS 304.17A-164 to define and redefine terms; establish cost-sharing requirements for prescription drugs; require rebates to be passed through; establish confidentiality requirements for the rebate information; create a new section of KRS 365.880 to 365.900 to provide that the actual amount of rebates received is a trade secret; provide that compliance with prescription drug cost-sharing and rebate requirements shall not be in violation of the Uniform Trade Secrets Act; amend KRS 304.17C-125, 304.38A-115, 18A.225, and 164.2871 to apply the cost-sharing and rebate requirements for prescription drugs to limited health service benefit plans, limited health service organizations, the state employee health plan, and self-insured employer group health plans provided by the governing board of a state postsecondary education institution; apply provisions to health plans issued or renewed on or after January 1, 2027; EFFECTIVE January 1, 2027.