Healthcare (Insurance)

Create a new section of Subtitle 17A of KRS Chapter 304 to prohibit insurers offering or providing health benefit plans from changing a participating provider's reimbursement, payment methodology, fee schedule, or claim adjudication terms through any provider manual, policy update, or other document incorporated by reference in the agreement; provide that a change to a material term affecting reimbursement shall be effective only by written amendment executed by both parties; provide that the requirements are in addition to any requirement under other laws; provide that any modification, reduction, or other change adopted in violation of the section is void and unenforceable; amend KRS 304.17A-235 to conform; direct that the Act applies to contracts issued or renewed on or after the effective date of the Act.

Amend KRS 304.17C-085 to modify the definition of "covered services" to exclude services and materials for which reimbursement would be available but for the application of the enrollee's contractual limitation of an annual maximum benefit; prohibit contractual waivers; make technical amendments; direct that the Act applies to contracts issued or renewed on or after the effective date of the Act.

Amend KRS 304.17A-163 to modify the definition of "health plan"; require insurers, health plans, private review agents, and pharmacy benefit managers to disclose certain information about step therapy protocols on their website and ensure that the electronic process for requesting and transmitting prior authorization for a drug includes the ability for prescribing providers to electronically transmit a complete request for a step therapy exception; require coverage for a prescription drug on the date the provider submits a step therapy exception request; provide that requirements apply to Medicaid and KCHIP benefits to the extent authorized by federal law; 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); provide that the Act applies to policies, certificates, contracts, and plans issued or renewed on or after the effective date of the Act.

Create a new section of Subtitle 17A of KRS Chapter 304 to define terms; require health plans to provide coverage for an annual mental health wellness examination provided by a mental health professional; require the coverage to be no less extensive than coverage for medical and surgical benefits, comply with the Mental Health Parity and Addiction Equity Act of 2008, and not be subject to any cost-sharing requirements; amend KRS 304.17C-125, 164.2871, and 18A.225 to require limited health service benefit plans, 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 mental health wellness examination coverage requirement; state purpose of the Act; direct that provisions apply to health plans issued or renewed on or after the effective date of the Act; provide that Section 1 of the Act may be cited as the Kentucky Mental Health Wellness Act; EFFECTIVE, January 1, 2027.

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.

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 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.

Create a new section of KRS Chapter 311 to define terms; prohibit health care providers from accepting payment or reimbursement for gender transition services from a state or local government or Medicare; prohibit use of state or local government funds for the provision or subsidy of gender transition services; require licensing or certifying agencies to revoke a health care provider's license for a violation; direct that intentional violation by a public servant shall be a violation of KRS 522.030; amend KRS 15.241 to authorize the Attorney General to seek injunctive relief and penalties for a violation of gender transition services prohibitions; amend KRS 156.496 to prohibit family resource or youth services centers from providing or making referrals for gender transition services; amend KRS 39A.180 to prohibit suspension of gender transition services laws during an emergency; create new sections of Subtitle 17A of KRS Chapter 304, and KRS 205.6481 to 205.6495, and amend KRS 205.5365, 18A.225, 164.2871, and 304.17C-125, to prohibit publicly funded health plans, Medicaid, the Kentucky Children's Health Insurance Program (KCHIP), publicly funded limited health service benefit plans, the state employee health plan, and state postsecondary education institution self-insured health plans from providing payment or coverage for gender transition services; amend KRS 605.110 to direct that gender transition services are not authorized for a child committed to the custody of the Department of Juvenile Justice; state findings of the General Assembly relating to the purpose of the Act; apply certain provisions to health plans issued or renewed on or after the effective date of Act.

Create a new section of Subtitle 17A of KRS Chapter 304 to require health benefit plans to provide coverage for prosthetic devices and orthotic devices when medically necessary for certain purposes; establish minimum requirements for the required coverage; prohibit any limitation or requirements with respect to out-of-network coverage unless the limitation or requirement is not more restrictive than the restrictions or requirements applicable to out-of-network coverage for medical or surgical benefits; require the commissioner of insurance to submit a report to the Legislative Research Commission regarding implementation of the required coverage; require insurers to provide data requested by the commissioner for purposes of completing the report; require the commissioner to promulgate any necessary administrative regulations; amend KRS 164.2871 and 18A.225 to require self-insured group health plans offered by the governing board of state postsecondary education institutions and the state employee health plan to comply with prosthetic and orthotic device coverage requirements; provide that the 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 17A of KRS Chapter 304 to require health benefit plans to provide coverage for prostheses and orthoses; establish minimum requirements for the required coverage; require utilizations review decisions to be made in a nondiscriminatory manner; require an insurer or its private review agent to provide notice of certain rights of the insured; establish notice requirements for denials; establish network adequacy requirements for the provision of a prosthesis or orthosis that is required to be covered; establish reporting requirements for insurers and the commissioner of the Department of Insurance relating to the required coverage; amend KRS 164.2871 and 18A.225 to require self-insured group health plans offering by the governing board of state postsecondary education institutions and the state employee health plan to comply with the requirements relating to coverage for prostheses and orthoses; provide that the Act applies to health benefit plans issued or renewed on or after January 1, 2027; EFFECTIVE January 1, 2027.