Healthcare (Insurance)

Create a new section of Subtitle 12 of KRS Chapter 304 to define terms; consolidate and modify existing credentialing requirements; require insurers and providers to use the Council for Affordable Quality Healthcare (CAQH) credentialing form; prohibit insurers from requiring or otherwise requesting a provider to disclose any information that is not requested on the CAQH form or that relates to a provider's former or current health condition under certain circumstances; prohibit insurers from requiring a provider to be board certified; amend KRS 18A.225 to require the state employee health plan to comply with the credentialing requirements; amend KRS 205.560 to conform; amend KRS 216B.155 to conform and to prohibit health care facilities licensed under KRS Chapter 216B from requiring or otherwise requesting a provider to disclose a former or current health condition under certain circumstances; amend KRS 304.17A-545 and 311.6207 to conform; repeal KRS 304.17A-525 and 304.17A-576, relating to credentialing to consolidate provisions; direct that certain provisions apply to contracts issued or renewed on or after the effective date of the Act; require administrative bodies to amend any administrative regulations that conflict with the Act.

Create new sections of Subtitle 17A of KRS Chapter 304 to define terms; require health plans to provide coverage for the diagnosis and treatment of feeding or eating disorders; prohibit insurers from using certain standards, including body mass index, to deny, limit, or restrict coverage; authorize insurers to consider certain factors when determining medical necessity or the appropriate level of care for an individual diagnosed with a feeding or eating disorder; amend KRS 304.17C-125, 304.38A-115, 205.522, 205.6485, 164.2871, and 18A.225 to require limited health services benefit plans, limited health service organizations, Medicaid, KCHIP, self-insured employer group plans provided by the governing board of a state postsecondary education institution, and the state employee health plan to comply with the coverage requirements for feeding or eating disorders; 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 seek 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 Chapter 311 to establish reproductive rights and define terms; amend KRS 18A.225 to remove the prohibition of insurance coverage for abortion; amend KRS 39A.180 to allow the Governor to suspend statutes related to abortion during a declared emergency; amend KRS 156.496 to allow a school district to operate a family resource center that provides abortion counseling; amend KRS 205.010 to permit financial aid for an abortion; amend KRS 205.510 to include abortions or induced miscarriages as medical care; amend KRS 205.560 to allow medical aid payments for abortion; amend KRS 211.603 to allow money in the rape crisis center trust fund to be used for abortion services or education; amend KRS 212.275 to allow health departments to dispense medication for an abortion; amend KRS 213.101 to remove various reporting requirements; amend various sections to remove penalties associated with performing abortions; amend various sections to conform; repeal, reenact, and amend or repeal and reenact KRS 311.783, 311.7710, 311.820, 311.780, 311.810, to conform; repeal KRS 15.241, 213.098, 213.172, 213.174, 213.176, 216B.0435, 216B.200, 216B.202, 216B.204, 216B.206, 216B.208, 216B.210, 304.5-160, 311.710, 311.715, 311.720, 311.723, 311.724, 311.725, 311.727, 311.728, 311.731, 311.732, 311.733, 311.735, 311.750, 311.760, 311.765, 311.770, 311.7701, 311.7702, 311.7703, 311.7704, 311.7705, 311.7706, 311.7707, 311.7708, 311.7709, 311.7711, 311.772, 311.7731, 311.7733, 311.7734, 311.7735, 311.7736, 311.7737, 311.7739, 311.774, 311.7741, 311.7743, 311.781, 311.7811, 311.782, 311.784, 311.7841, 311.785, 311.786, 311.787, 311.790, 311.800, 311.821, 311.822, 311.823, 311.824, 311.825, 311.826, 311.827, 311.830, 311.992, and 315.315; EFFECTIVE, in part, January 1, 2027.

Amend KRS 304.17A-164 to define terms; prohibit insurers and administrators from requiring insureds to pay cost sharing for a prescription drug that is greater than the cash price; require insurers and administrators to count the amount paid for a covered prescription drug towards the insured's cost-sharing if certain requirements are met; establish requirements for insurers, administrators, and pharmacies for submission of cash price paid by an insured; exempt a state employee health plan from counting certain third-party payments towards the insured's cost-sharing; provide for construction of cost-sharing requirements; amend KRS 304.17C-125, 304.38A-115, 164.2871, and 18A.225 to apply cost-sharing requirements to limited health plans, self-insured state postsecondary education institution employer group health plans, and the state employee health plan; create a new section of KRS Chapter 315 to require pharmacies to comply with cost-sharing requirements; provide that cost-sharing requirements apply to health plans issued or renewed on or after effective date; EFFECTIVE, January 1, 2027.

Create a new section of Subtitle 17A of KRS Chapter 304 to define terms; require health benefit plans to provide coverage for counseling interventions for pregnant and postpartum persons at increased risk of perinatal depression, including persons who have suffered a miscarriage or stillbirth; 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 205.522, 205.6485, 164.2871, and 18A.225 to require Medicaid, the Kentucky Children's Health Insurance Program, 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 counseling interventions; provide that certain provisions apply to health benefit plans issued or renewed on or after January 1, 2027; require the Cabinet for Health and Family Services or Department for Medicaid Services to obtain federal approval if it is determined that such approval is necessary and comply with notice requirements; 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.

Amend KRS 304.17A-258 to require health benefit plans to provide coverage for certain formulas; 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-145 to require coverage for breastfeeding and lactation services in conjunction with the birth and without a prescription; amend KRS 304.17A-099 to conform; amend KRS 205.522 to require Medicaid to comply with the coverage requirements for formulas; amend KRS 205.560 to conform; amend KRS 205.6485, 164.2871, and 18A.225 to require KCHIP, self-insured employer group health plans provided by the governing board of a state postsecondary education institution, and the state employee health plan to comply with the coverage requirements for formulas; provide that certain provisions apply to health benefit 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 seek federal approval, if necessary, and to comply with notice requirements; 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 a new section of Subtitle 17A of KRS Chapter 304 to require health benefit plans to provide coverage for in vitro fertilization, intrauterine insemination, and any other assisted reproductive technology; establish minimum requirements for the coverage; 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 164.2871 and 18A.225 to require 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 assisted reproductive technology coverage requirement; direct that certain provisions apply to health benefit plans issued or renewed on or after January 1, 2027; EFFECTIVE January 1, 2027.

Amend KRS 304.17-316 to define "breast examination"; provide for annual mammogram coverage for persons ages 40 to 49 years; eliminate cost sharing for any covered breast examination; provide for construction of section; create a new section of Subtitle 17A of KRS Chapter 304 to define terms; require health benefit plans to provide coverage of preventive screenings for the detection of breast cancer for certain individuals; establish requirements for coverage; provide for construction of section; amend KRS 164.2871 and 18A.225 to require self-insured state postsecondary education institution group health plans and the state employee health plan to comply with breast examination coverage requirements; apply sections to health insurance policies, plans, certificates, and contracts issued, renewed, or delivered on or after January 1, 2027; EFFECTIVE January 1, 2027.

Create a new section of Subtitle 17A of KRS Chapter 304 to require health benefit plans to cover at least 2 medically necessary epinephrine devices per covered person; limit a covered person's cost-sharing amount to $100 annually; amend KRS 304.17A-099 to exempt the epinephrine device coverage requirement from being suspended under state law due to the triggering of federal cost defrayment requirements; amend KRS 205.522, 205.6485, 164.2871, and 18A.225 to require Medicaid, KCHIP, self-insured employer group health plans offered by the governing board of a state postsecondary education institution, and the state employee health plan to comply with the epinephrine device coverage requirement; provide that various sections apply to health benefit plans issued or renewed on or after January 1, 2027; require the Department of Insurance to determine whether the epinephrine devices coverage requirement would be in addition to essential health benefits required under federal law; require the Department of Insurance to obtain federal approval, if necessary; require the Cabinet for Health and Family Services or the Department for Medicaid Services to obtain federal approval, if 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.

Amend KRS 304.17A-164 to define terms; prohibit insurers and administrators from requiring insureds to pay cost sharing for a prescription drug that is greater than the cash price; require insurers and administrators to count the amount paid for a covered prescription drug towards the insured's cost-sharing if certain requirements are met; establish requirements for insurers, administrators, and pharmacies for submission of cash price paid by an insured; exempt a state employee health plan from counting third-party payments unless a cash price was paid that is less than the plan's negotiated price; provide for construction of cost-sharing requirements; amend KRS 304.17C-125, 304.38A-115, 164.2871, and 18A.225 to apply cost-sharing requirements to limited health plans, self-insured state postsecondary education institution employer group health plans, and the state employee health plan; create a new section of KRS Chapter 315 to require pharmacies to comply with cost-sharing requirements; provide that cost-sharing requirements apply to health plans issued or renewed on or after effective date; EFFECTIVE, January 1, 2027.