Healthcare (Insurance)

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.

Amend KRS 304.17A-132 to modify the definition of "hearing aid"; increase the coverage amount for hearing aids from $1,400 to $2,500; establish network adequacy requirements relating to the provision of hearing aids and related services that are required to be covered; amend KRS 18A.225 to increase the cap on hearing aids and hearing aid-related services under the state employee health plan from $1,400 to $2,500; direct that the Act applies to health benefit plans issued or renewed on or after January 1, 2027; EFFECTIVE January 1, 2027.

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.

Create a new section of Subtitle 1 of KRS Chapter 304 to limit the application of cost-sharing requirements that would result in a health insurance policy, certificate, plan, or contract losing its health savings account-qualified status under federal law; create a new section of KRS Chapter 18A to subject cost-sharing requirements in that chapter to applicability limitation; provide that applicability limitation applies to policies, certificates, plans, and contracts issued or renewed on or after the effective date of the Act; provide purpose of Section 1 of the Act; state the that Section 1 of the Act may be cited as the Health Savings Account State-Federal Regulatory Coordination Model Act.

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 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 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.