Create a new section of Subtitle 17A of KRS Chapter 304 to require coverage for emergency ground ambulance services; establish minimum allowable reimbursement for out-of-network emergency ground ambulance services; establish requirements for reimbursement of out-of-network ground ambulance providers; prohibit balance billing by out-of-network ground ambulance providers; establish construction clause in the event of conflicts; amend KRS 18A.225 to require the state employee health plan to comply with emergency ground ambulance coverage and payment requirements; provide that Act applies to health benefit plans issued or renewed on or after January 1, 2027; EFFECTIVE January 1, 2027.
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.
Amend KRS 205.5371 to require the Cabinet for Health and Family Services to condition eligibility for enrollment or continued enrollment in the Medicaid program on demonstrated community engagement as required under federal law; require the cabinet to continue to condition eligibility on demonstrated community engagement if federal requirements are abolished, repealed, or otherwise diminished; amend KRS 205.6312 to require the cabinet and any contracted Medicaid managed care organization to impose cost-sharing requirements for Medicaid enrollees as required under federal law no later than January 1, 2027; establish minimum cost-sharing amounts; amend KRS 205.556 and 205.618 to conform; create new sections of KRS Chapter 205 to require the cabinet to, no later than July 1, 2026, begin conducting Medicaid eligibility redeterminations once every 6 months as required under federal law; require the cabinet to access and review certain data when conducting eligibility redeterminations; establish a process for identifying and, when appropriate, disenrolling individuals who are concurrently enrolled in the Kentucky Medicaid program and a Medicaid program administered by another state or states; amend KRS 205.178 to require the cabinet to receive and review information from the Kentucky Lottery Corporation, Department of Corrections, and the Kentucky Horse Racing and Gaming Corporation on at least a monthly basis, the Kentucky Department of Revenue on at least an annual basis, and the Kentucky Transportation Cabinet on a quarterly basis; require the Department for Medicaid Services to enter into a data sharing agreement with the Social Security Administration to receive the full file of death information on at least a quarterly basis; prohibit the cabinet from seeking or requesting an exemption or waiver from federal community engagement requirements related to county unemployment rates unless specifically authorized by the General Assembly to do so; amend KRS 205.5375 to require hospitals to assist presumptively eligible individuals in submitting a full Medicaid application; amend KRS 205.200 to prohibit the cabinet from accepting self-attestation of income, residency, or age for the purpose of determining eligibility for Medicaid or compliance with community engagement requirements; create new sections of KRS Chapter 205 to establish Medicaid managed care organization contracting requirements and penalties; establish the Medicaid managed care organization compliance fund within the State Treasury; establish that amounts in the fund not appropriated at the close of a fiscal year shall not lapse and shall be carried forward; prohibit the expenditure of funds in the account unless expressly appropriated by the General Assembly; require the Department for Medicaid Services to submit recommendations for use of monies in the fund to the Legislative Research Commission by November 1, 2027, and November 1, of each following odd-numbered year; amend KRS 205.533 to require Medicaid managed care organizations to include certain information for providers on their websites; amend KRS 205.534 to require managed care organizations to allow providers 120 days to file an appeal or grievance related to a reduction of denial of a claim; establish penalties for a managed care organization's failure to ensure the timely disposition of any appeal or grievance; require payment of any amount owed to a provider following an appeal to be paid within 30 days; require payments made following an appeal to include interest and reasonable attorney's fees; establish standards and requirements for provider audits; require the inclusion of additional information in the monthly report filed by managed care organizations; require the Department for Medicaid Services to submit an annual report to the Legislative Research Commission related to Medicaid claims, appeals, and grievances; authorize the Department for Medicaid Services to promulgate administrative regulations; create new sections of KRS Chapter 205 to establish requirements for administration of the Medicaid-covered nonemergency medical transportation services; establish requirements for the administration of 1915(c) Medicaid waiver programs; require the Department for Medicaid Services to develop and implement a tiered priority system for assigning 1915(c) Medicaid waiver program slots by January 1, 2027; require administration of Medicaid-covered dental services by an administrative service organization; establish that the administrative service organization shall not assume any financial or insurance risk; limit compensation paid to the administrative service organization to no more than 2% of the actual Medicaid-covered dental service claims paid on an annual basis; require the Department for Medicaid Services to establish a Dental Program Advisory Panel; require the Department for Medicaid Services to employ a dental director; require the Department for Medicaid Services to submit an annual report on the Medicaid dental program to the Legislative Research Commission; create new sections of KRS 7A.270 to 7A.290 to establish legislative findings; require the cabinet to provide the Legislative Research Commission with access to all databases, datasets, electronic records, and files pertaining to any aspect of the Medicaid program determined by the director of the Legislative Research Commission to be necessary for the meaningful and effective discharge of the General Assembly's legislative duties; require the Legislative Research Commission, the University of Kentucky, and the University of Louisville to enter into a partnership to design and develop a web-based healthcare transparency dashboard; require the dashboard be overseen by a subcommittee of the Medicaid Oversight and Advisory Board; require the dashboard be maintained and operated by the Legislative Research Commission; amend KRS 7A.283 to allow the appointment of individuals who are not members of the board to advisory committees or subcommittees upon approval of the Legislative Research Commission; create a new section of KRS Chapter 43 to require the Auditor of Public Accounts to conduct an examination of the state's Medicaid program and Kentucky Children's Health Insurance Program; establish audit reporting requirements; require the Auditor to conduct a review of the Medicaid program and Kentucky Children's Health Insurance Program to assess progress in addressing issues identified in previous examinations; establish that the Office of Program Performance in the Commonwealth Office of the Ombudsman shall conduct all quality control reviews of the Department for Community Based Services for the Medicaid program, Supplemental Nutrition Assistance Program, and Temporary Assistance for Needy Families to comply with federal law and regulations; establish that no other state agency shall conduct these quality control reviews unless otherwise authorized by the General Assembly; amend KRS 7A.286 to establish that examinations conducted by the Auditor may constitute fulfillment of certain duties assigned to the Medicaid Oversight and Advisory Board at the discretion of the Legislative Review Commission; repeal KRS 205.515 related to administration of the Medicaid program; repeal KRS 311A.172 related to nonemergency medical transportation services; appropriate $500,000 in General Fund moneys in fiscal year 2025-2026 for staffing and technology needs in the Office of the Auditor of Public Accounts; create a new section of KRS Chapter 6 to establish a Medicaid impact statement; require any legislation that makes or directs a change to the Medicaid program to be accompanied by a Medicaid impact statement; require certain factors to be analyzed and included in a Medicaid impact statement; require Medicaid impact statements to be completed by an economic consulting firm retained by the Legislative Research Commission; create a new section of KRS Chapter 13A to require the cabinet to provide a draft copy of certain administrative regulations related to the Medicaid program to the Medicaid Oversight and Advisory Board for comment at least 30 days before filing the administrative regulation with the regulations compiler; direct the Medicaid Oversight and Advisory Board to establish a Dental Services Transition Subcommittee; establish membership and duties of the Dental Services Subcommittee; require any contract between the Department for Medicaid Services and a Medicaid managed care organization entered into, renewed, or extended after the effective date of this Act to include notice to the managed care organization of the department's intent to transition to an administrative service organization delivery model for Medicaid-covered dental services; require the cabinet 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); direct the Medicaid Oversight and Advisory Board to evaluate the nonemergency medical transportation program and submit findings and recommendations to the Legislative Research Commission by December 31, 2026; APPROPRIATION; EMERGENCY.
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.
