Last Action | signed by Governor (Acts Ch. 169) |
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Title | AN ACT relating to health insurance. |
Bill Documents |
Bill
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Impact Statements | Health Mandate |
Bill Request Number | 1349 |
Sponsors | B. DeWeese, R. Palumbo, S. Brinkman, T. Couch, R. Crimm, B. Damron, M. Denham, D. Graham, J. Hoover, M. Marzian, T. Moore, F. Nesler, J. Stewart III, T. Thompson, D. Watkins, A. Webb-Edgington, S. Westrom, A. Wuchner, B. Yonts |
Summary of Original Version | Create new sections of Subtitle 17A of KRS Chapter 304 to provide for payment by a managed care plan to a physician seeking expedited credentialing; require insurers to provide payment or fee schedules to health care providers when contracting or renewing contracts with providers to enable providers to determine the manner and amount of payments under the contract prior to final execution or renewal of the contract; require any change to payment or fee schedules applicable to providers be made available to providers at least 30 days prior to the effective date of the amendment; provide that if an insurer issuing a managed care plan modifies an agreement it has entered into with a participating provider, the insurer must provide the provider with at least 30 days notice of the modification and notify the provider that the provider has the option to withdraw from the agreement at the end of the 30 day period prior to the modification becoming effective; require such provider who opts to withdraw to send written notice to the insurer at least 10 days prior to the effective date of modification; amend KRS 304.17A-254 to require an insurer that offers a health benefit plan that is not a managed care plan but which provides financial incentives for covered persons to access a network of providers to include in agreements with providers that the insurer will provide or make available to providers when contracting or renewing contracts with providers the payment or fee schedules to enable providers to determine the manner and amount of payments under the contract prior to final execution or renewal of the contract and shall provide any change in schedules at least 30 days prior to the effective date of the amendment pursuant to Section 2 of the Act; amend KRS 304.17A-527 to require a manage care plan to include in agreements with providers that the insurer will provide or make available to providers when contracting or renewing contracts with providers the payment or fee schedules to enable providers to determine the manner and amount of payments under the contract prior to final execution or renewal of the contract and shall provide any change in schedules at least 30 days prior to the effective date of the amendment pursuant to Section 2 of the Act; amend KRS 304.17A-230 to deem it is an unfair claims settlement practice for an insurer to fail to comply with KRS 304.17A-714 on collection of claim overpayments from providers or to fail to comply with KRS 304.17A-708 on resolution of payment errors and retroactive denial of claims; create a new section of Subtitle 17A of KRS Chapter 304 to require health insurers to include an actuarial memorandum with its rate filings which must contain such information as required by the executive director of the Office of Insurance and information to reasonably support the reasonableness of the relationship of the projected benefits to projected premiums, information to identify the percentage of projected earned premiums attributable to specified categories, and information to project the loss ratio over the rating period both with and without the requested rate change; create a new section of Subtitle 17A of KRS Chapter 304 to require all group health benefit plans to offer the master policyholder the option to purchase coverage for unmarried dependent children to age 26 or to cover children to age 19 and from 19 to 25 if enrolled in an accredited educational institution; require the insurer to include with the offer of coverage of unmarried dependent children to age 26 a written explanation of tax consequences of selecting such coverage for persons participating in a cafeteria plan pursuant to 26 U.S.C. sec. 125; amend KRS 304.17-310 to require insurers offering family expense health insurance to offer the option of coverage of dependents until age 26. |
Index Headings of Original Version |
Health Benefit Mandate - Health care providers, payment or fee schedules provided to Insurance, Health - Physician, expedited credentialing Insurance, Health - Health care providers, payment or fee schedules provided to Insurance, Health - Rate filing, actuarial memorandum included in Insurance, Health - Group, option to cover dependents to age 26 Health and Medical Services - Health care providers, payment or fee schedules provided to Physicians and Practitioners - Managed care plans, expedited credentialing |
Proposed Amendments |
House Committee Substitute 1 House Floor Amendment 1 House Floor Amendment 2 House Floor Amendment 3 Senate Committee Substitute 1 Senate Floor Amendment 1 Senate Floor Amendment 2 |
Votes | Vote History |
01/31/08 |
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02/01/08 |
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02/21/08 |
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02/27/08 |
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02/28/08 |
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03/05/08 |
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03/06/08 |
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03/10/08 |
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03/11/08 |
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03/13/08 |
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03/18/08 |
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03/19/08 |
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03/24/08 |
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04/02/08 |
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04/14/08 |
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04/15/08 |
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04/24/08 |
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Amendment | House Committee Substitute 1 |
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Impact Statements | Health Mandate |
Summary | Retain original provisions; change references to "physician" and "provider" to include a licensed optometrist in Sections 1 and 3 of the Act; change 30 days to 60 days in Section 2(2), Section 3(2), Section 4(7), and Section 5(1)(d); delete reference to a 30 day notice period in Section 3(2); change 10 days to 20 days in Section 3(3); delete Section 7 of the Act. |
Index Headings |
Health Benefit Mandate - Health care providers, payment or fee schedules provided to Insurance, Health - Physician, expedited credentialing Insurance, Health - Health care providers, payment or fee schedules provided to Insurance, Health - Rate filing, actuarial memorandum included in Insurance, Health - Group, option to cover dependents to age 26 Health and Medical Services - Health care providers, payment or fee schedules provided to Physicians and Practitioners - Managed care plans, expedited credentialing |
Amendment | House Floor Amendment 1 |
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Sponsor | B. DeWeese |
Summary | Change the maximum age of an unmarried dependent child from age 26 to age 25 in Sections 7 and 8 of the Act. |
Index Headings |
Health Benefit Mandate - Health care providers, payment or fee schedules provided to Insurance, Health - Physician, expedited credentialing Insurance, Health - Health care providers, payment or fee schedules provided to Insurance, Health - Rate filing, actuarial memorandum included in Insurance, Health - Group, option to cover dependents to age 26 Health and Medical Services - Health care providers, payment or fee schedules provided to Physicians and Practitioners - Managed care plans, expedited credentialing |
Amendment | House Floor Amendment 2 |
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Sponsor | M. Marzian |
Summary | Include advanced registered nurse practitioners and psychologists in Sections 1 and 3 of the Act. |
Index Headings |
Health Benefit Mandate - Health care providers, payment or fee schedules provided to Insurance, Health - Physician, expedited credentialing Insurance, Health - Health care providers, payment or fee schedules provided to Insurance, Health - Rate filing, actuarial memorandum included in Insurance, Health - Group, option to cover dependents to age 26 Health and Medical Services - Health care providers, payment or fee schedules provided to Physicians and Practitioners - Managed care plans, expedited credentialing |
Amendment | House Floor Amendment 3 |
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Sponsor | B. DeWeese |
Summary | Require proof of licensure in Section 1(2)(a); require insurers to provide information upon request of the provider in Section 2(1)(a); change 60 days to 90 days in Sections 2(2), 3(2), 4(7) and 5(1)(d); change 20 days to 45 days in Section 3(3); change age 26 to age 25 in Sections 7 and 8. |
Index Headings |
Health Benefit Mandate - Health care providers, payment or fee schedules provided to Insurance, Health - Physician, expedited credentialing Insurance, Health - Health care providers, payment or fee schedules provided to Insurance, Health - Rate filing, actuarial memorandum included in Insurance, Health - Group, option to cover dependents to age 26 Health and Medical Services - Health care providers, payment or fee schedules provided to Physicians and Practitioners - Managed care plans, expedited credentialing |
Amendment | Senate Committee Substitute 1 |
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Impact Statements | Health Mandate |
Summary | Retain original provisions; create definitions in Section 1 and add definition of "nonparticipating provider;" delete subsections (2) and (3) of Section 1; create Section 2 to require an insurer issuing a managed care plan to notify an applicant for credentialing of its determination within 90 days of receipt of application; provide that following credentialing and upon signing of the contract the insurer must make payments to the applicant for services rendered during the credentialing process in accordance with reimbursement procedures for participating providers; provide that if credentialing is denied the insurer shall reimburse the applicant in accordance with procedures for reimbursement to nonparticipating providers; require in Section 3(1)(b) that an insurer issuing a managed care plan must provide, upon request of the provider, an example of the methodology used to determine actual payment for procedures frequently performed; specify what is to be included in the methodology disclosure; clarify in Section 3 that an insurer is an insurer issuing a managed care plan; define "material change" in Section 4(1); create subsection (4) in Section 4 to provide that if an insurer issuing a managed care plan changes its prior authorization, precertification, notification, referral program, or edit program in the agreement, the insurer must provide notice of the change to the participating provider at least 15 days prior to the change; require the provider to request information in Section 5(7) and Section 6(1)(d); add "knowingly and willfully" to subsections (16) and (17) of Section 7. |
Index Headings |
Health Benefit Mandate - Health care providers, payment or fee schedules provided to Insurance, Health - Physician, expedited credentialing Insurance, Health - Health care providers, payment or fee schedules provided to Insurance, Health - Rate filing, actuarial memorandum included in Insurance, Health - Group, option to cover dependents to age 26 Health and Medical Services - Health care providers, payment or fee schedules provided to Physicians and Practitioners - Managed care plans, expedited credentialing |
Amendment | Senate Floor Amendment 1 |
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Sponsor | D. Ridley |
Summary | Amend Sections 1 and 4 to add to the definitions of "applicant," "nonparticipating provider," and "participating provider" a "provider as defined in KRS 304.17A-005(23)." |
Index Headings |
Health Benefit Mandate - Health care providers, payment or fee schedules provided to Insurance, Health - Physician, expedited credentialing Insurance, Health - Health care providers, payment or fee schedules provided to Insurance, Health - Rate filing, actuarial memorandum included in Insurance, Health - Group, option to cover dependents to age 26 Health and Medical Services - Health care providers, payment or fee schedules provided to Physicians and Practitioners - Managed care plans, expedited credentialing |
Amendment | Senate Floor Amendment 2 |
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Sponsor | D. Roeding |
Summary | Amend the definition of "Applicant" and "Nonparticipating provider" in Section 1 to include a pharmacist or pharmacy licensed under KRS Chapter 315; amend the definition of "Participating provider" in Section 4 to include a pharmacist or pharmacy licensed under KRS Chapter 315. |
Index Headings |
Health Benefit Mandate - Health care providers, payment or fee schedules provided to Insurance, Health - Physician, expedited credentialing Insurance, Health - Health care providers, payment or fee schedules provided to Insurance, Health - Rate filing, actuarial memorandum included in Insurance, Health - Group, option to cover dependents to age 26 Health and Medical Services - Health care providers, payment or fee schedules provided to Physicians and Practitioners - Managed care plans, expedited credentialing |
Last updated: 8/28/2019 8:09 AM (EDT)