Healthcare

Create a new section of Subtitle 17A of KRS Chapter 304 to require health plans to include a generic drug or biosimilar on the plan's formulary under specified circumstances; define terms; establish cost-sharing requirements when a generic drug or biosimilar is required to be placed on the health plan's formulary; prohibit a health plan from imposing any prior authorization, step therapy, or other limitation on coverage for a generic drug or biosimilar required to be placed on the health plan's formulary or imposing any restriction on a pharmacist or pharmacy that makes it more difficult for the insured to obtain coverage or access to the generic drug or biosimilar compared to the reference drug or product; amend KRS 304.17C-125, 164.2871, and 18A.225 to require limited health service benefit plans, self-insured group health plans offered by a state postsecondary education institution, and the state employee health plan to comply with the requirements for generic drugs and biosimilars; direct that the Act applies to health plans issued or renewed on or after January 1, 2027; EFFECTIVE, January 1, 2027.

Create a new section of KRS Chapter 160 to require school districts that elect to provide health care services through a school nurse to bill the school-based Medicaid program for medically necessary services provided to a student enrolled in Medicaid; establish requirements for third-party Medicaid billing vendors contracted by school districts; permit school nurses to receive preventative dental services training from the Department for Public Health; permit the school district to bill the school-based Medicaid program for preventative dental services that are within a school nurse's scope of practice.

Create a new section of KRS Chapter 314A to allow an advanced practice respiratory therapist employed by a health facility to declare a patient death and sign the provisional report of death; repeal and reenact KRS 314A.010, 314A.110, and 314A.220 to define terms; create a new license category for advanced practice respiratory therapists; deem the practice credential a license instead of a mandatory certificate; replace the term "respiratory care practitioner" with "respiratory therapist" or "advanced practice respiratory therapist"; establish education and training requirements; set procedures for license reinstatement and reactivation; amend KRS 314A.100 to authorize a respiratory therapist to perform services with the prescription of a physician, physician assistant, advanced practice registered nurse, or advanced practice respiratory therapist; describe services an advanced practice respiratory therapist may provide under prospective medical direction, including prescribing legend drugs; amend KRS 314A.112 to establish requirements for a limited student respiratory therapist license; amend KRS 314A.200 to make the Kentucky Board of Respiratory Care's meetings subject to Kentucky Open Meetings and Open Records laws; amend KRS 314A.215 to raise board members' daily pay from $50 to $100; amend KRS 314A.225 to expand avenues for board discipline of licensees; amend KRS 314A.990 to authorize the board to impose a civil penalty of up to $5,000 per violation; amend KRS 164.0401, 216.2920, 216.380, 217.015, 311.646, 314A.105, 314A.115, 314A.205, 314A.230, 353.510, and 405.024 to conform.

Amend KRS 214.450 to define "autologous donation," "directed donation," and "informed consent"; create a new section of KRS 214.450 to 214.466 to establish an individual's right to select a willing blood donor; establish related prohibitions for blood establishments, health facilities, health services, and health care providers; establish related requirements for blood establishments and health care facilities; prohibit misrepresentation of the availability, safety, or legality of directed or autologous donations; establish protections for physicians who facilitate directed or autologous donations; establish penalty for violations; require the Cabinet for Health and Family Services to establish a reporting mechanism to report obstructions to directed or autologous donations, complete investigations within 60 days, and promulgate administrative regulations to implement and enforce reporting; permit emergency transfusions with consent and provide exemption from liability; permit an individual to bring a civil action for violations of individual rights to directed or autologous donations; amend KRS 214.452, 214.456, and 214.990 to conform and make technical corrections; create a new section of Subchapter 17A of KRS Chapter 304 to require all health benefit plans to cover any autologous or directed transfusion of blood; amend KRS 205.522 and 205.6485 to require Medicaid coverage of any autologous or a directed transfusion of blood; amend KRS 18A.225 to require state health benefit plans coverage of any autologous or directed transfusion of blood; apply coverage mandates to health benefit plans issued or renewed on or after January 1, 2027; provide that sections of the Act may be cited as the Medical Autonomy and Directed Donation Act; require the Cabinet for Health and Family Services to seek federal approval if they determine that such approval is necessary; provide authorization from the General Assembly to make changes as required under KRS 205.5372(1); include provisions for cost defrayal requirements; EFFECTIVE, in part, January 1, 2027.

Create a new section of KRS 42.720 to 42.742 to define terms; establish the Kentucky Health Command in the Commonwealth Office of Technology; require the Kentucky Health Command to contract with a private sector entity to develop and provide standards and qualifications for the utilization of an artificial intelligence-assited virtual health platform; establish a process by which rural health care providers and facilities may contract for use of the aritificial intelligence-assisted virtual health platform; establish a process for distribution of net advertising revenue; establish activities the virtual health platform may perform; prohibit the virtual health platform from engaging in the practice of medicine or diagnosing or treating any disease, illness, or medical condition; amend KRS 42.724 to conform.

Amend KRS 304.17A-660 to define "health professional"; amend KRS 304.17A-661 to require that annual mental health parity reports be submitted to the Legislative Research Commission on or before June 1 of each year for referral to certain committees and be published by the insurance commissioner on the Department of Insurance's website; require insurers to have an independent audit conducted to evaluate mental health parity compliance upon request of the commissioner or Attorney General; require the commissioner to establish and operate a hotline that allows health professionals and insureds to submit complaints regarding mental health parity compliance; prohibit insurers from retaliating against a health professional for submitting a complaint; 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 a new section of KRS 304.17A-660 to 304.17A-669 to establish requirements for review criteria used by insurers to determine the medical necessity and appropriateness of a claim submitted for the diagnosis or treatment of a mental health condition; require that the review criteria be publicly available on the insurer's website; require insurers to comply with KRS 304.17A-600 to 304.17A-633 with respect to claims submitted by health professionals for the diagnosis of treatment of mental health conditions except as provided in the section; amend KRS 304.17A-617 and 304.17A-623 to conform; amend KRS 205.522 to require the Department for Medicaid Services, Medicaid managed care organizations, and the state' medical assistance program to comply with mental health parity law; require the Department for Medicaid Services or the Cabinet for Health and Family Services to obtain federal approval, if necessary, and comply with notice requirements; provide authorization from the General Assembly to make changes as required under KRS 205.5372(1); EFFECTIVE, in part, January 1, 2027; EMERGENCY.

Create a new section of KRS Chapter 200 to define terms; establish procedures for a child charged with a public offense or subject to a court order to determine if the child is a high acuity youth; establish procedures for securing a treatment plan, and dispute resolution through a review process and the court if the parties cannot agree to a plan; require a 24-hour protocol for health facilities, the Cabinet for Health and Family Services, the Department of Juvenile Justice, and the courts to direct care; establish reimbursement rates for inpatient and outpatient psychiatric care of a child by psychiatric hospitals and pediatric teaching hospitals; establish procedures for discharge of the child from inpatient admission under specific circumstances.

Amend KRS 205.592 to extend Medicaid eligibility for new parents from 12 months to 24 months postpartum; require the Cabinet for Health and Familly 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 to the Medicaid program as required under KRS 205.5372(1).

Create a new section of KRS Chapter 217 to define terms; permit a manufacturer operating within an eligible facility to make available to an eligible patient an individualized investigational drug, biological product, or device; permit the manufacturer to provide the individualized investigational drug, biological product, or device or require the patient to cover the costs; provide that if a patient dies while being treated his or her heirs are not liable for costs; provide that health care provider licensing boards may not take actions against licensees for their recommendations relating to an individualized investigational drug, biological product, or device; provide that official attempts shall not be made to block an eligible patient's access to an individualized investigational drug, biological product, or device; prohibit private actions against a manufacturer of an individualized investigational drug, biological product, or device that has exercised reasonable care in accordance with this section; preclude any conclusion that health insurance coverage is required or that hospitals are required to provide new or additional services.

Direct state agencies to deploy policies that support a focus on healthy lifestyles and evidence-based nutrition interventions in all health and medical education for students and active health professionals; specifically direct the Kentucky Board of Medical Licensure, the Kentucky Board of Nursing, the Kentucky Department for Public Health, and the Kentucky Department of Education to collaborate with the Kentucky Hospital Association, the Kentucky Primary Care Association, and the American College of Lifestyle Medicine to take actions; require reports to the General Assembly by December 1, 2026, and December 1, 2027.