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HB 608/FN (BR 1777) - R. Palmer
AN ACT relating to the public good.
Amend KRS 304.17A-005 to define "at the time of enrollment;" amend KRS 304.17A-300 to make technical change and to delete provision that requires a provider-sponsored integrated health delivery network to demonstrate to the Department of Insurance that services covered by the network are available to all enrollees within 50 miles of place of residence; amend KRS 304.17A-330 to require health self-insurers to annually submit certain information to the department by July 31 rather than March 30; amend KRS 304.18-120 to require a converted policy to not impose a lifetime maximum benefit of less than $500,000; authorize the commissioner to establish minimum benefits for converted policies; amend KRS 304.43-030 to establish grounds on which the commissioner can disapprove a form; create a new section of Subtitle 43 of KRS Chapter 304 to require a prepaid dental plan to file rates with the commissioner before use; establish grounds for approval or disapproval of rates; amend KRS 304.18-110 to make technical changes; repeal KRS 304.17-410, 304.18-025, and 304.18-055.
HB 608 - AMENDMENTS
SCS/FN - Retain original provisions; amend KRS 304.17A-095 to exempt an insurer that issues policies to a large group from the rate filing and approval process; provide that each insurer that issues, delivers, or renews any health benefit plan to a large group shall file the rating methodology with the commissioner and the Attorney General; create a new section of KRS 304.17A-500 to 304.17A-570 to provide that a contract executed after January 1, 2001, between a managed care plan and a physician shall not require the mandatory use of a hospitalist; amend KRS 304.17A-540 to provide that it is an unfair claims settlement practice for any person to make a claims payment to an insured or beneficiary that is not accompanied by a statement setting forth the coverage under which the payments are being made in instance in which the insured has a liability under the policy beyond his or her copayment or deductible.
SFA (1, J. Rose) - Retain original provisions; establish Subtitle 17B of KRS Chapter 304 and create new sections thereof to create the Kentucky Health Care Improvement Authority; designate 13 members and name the Insurance Commissioner as chair; provide that 70 percent of moneys in the fund be placed in the Kentucky Access Fund, 20 percent be spent on collaborative partnership between the University of Louisville and the University of Kentucky dedicated to lung cancer research, and 10 percent be spent to discourage the use of harmful substances by minors; create Kentucky Access to assure health coverage is made available to each Kentucky resident; provide that Kentucky Access shall operate under the supervision of the Department of Insurance; provide that the department select a third-party administrator to administer Kentucky Access; direct the department to establish the schedule of rates, premiums, deductibles, copayments amounts, coinsurance amounts, and other cost-sharing amounts; provide that health coverage begin no sooner than January 1, 2001; require the department to separate its duties and responsibilities in operating the department from its duties and responsibilities in operating Kentucky Access; require a statewide provider network; provide that initial premium rates shall not exceed 150% of the applicable individual standard risk rates, and that premium rates in no event shall exceed 175% of the rates applicable to individual standard risks; provide that an "eligible individual" is eligible for coverage if the person has been a Kentucky resident for at least 12 months if the person has been rejected by at least 2 insurers or has been offered coverage substantially similar to Kentucky Access coverage at a premium greater than the Kentucky Access premium or the person has a high-cost condition; direct that a Kentucky Access enrollee whose premiums have exceeded claims for 3 years be given a notice of insurability to be used to obtain insurance in the regular individual market; prohibit certain persons from eligibility for Kentucky Access, including persons eligible for Medicare or Medicaid, persons terminated by Kentucky Access less than 12 months ago, persons who have received $2 million in Kentucky Access benefits, and prisoners; to provide that the department evaluate and revise as necessary rates to be charged to enrollees; require Kentucky Access to provide at least 3 health benefit plans, at least one of which must be the standard plan and at one of which must be a traditional fee-for-service form; prohibit pre-existing condition exclusions for "eligible individuals" but permit them for others; permit the department to assess all insurers to fund GAP loses prior to September 30, 2002, and to fund Kentucky Access; provide as funding sources for Kentucky Access the premiums paid by enrollees, funds designated in the Kentucky Health Care Improvement Fund, appropriations, premium taxes, annual assessments of insurers, second assessment of insurers, gifts and grants, interest on earnings, and funds in GAP account on October 1, 2000; allow insurers to include assessments in any rate filing; require GAP participating insurers to report certain information; direct that GAP be terminated on October 1, 2000; exempt Kentucky Access and the department from state and local taxes; provide that GAP participating insurers shall be reimbursed for actual guaranteed acceptance program losses only if money is available after funding Kentucky Access; require the department to submit an annual report to the General Assembly 60 days prior to each regular session; amend KRS 304.17A-005 to conform, amend KRS 304.17A-080 to increase number of members on Health Insurance Advisory Council from 7 to 9, by adding 2 agents' representatives; amend KRS 304.17A-0952 to provide that premium rates charged to an individual may vary from the index rate by 50 percent or less for two consecutive years from the date of implementation of Kentucky Access; permit an adjustment of 20 percent for individual, small group, or association rates; provide that the premium rate charged to a small group or association shall not vary from the index rate by more than 40 percent for 2 consecutive years; allow insurers to establish a separate class of business to separate guaranteed acceptance program qualified individuals from other individuals; amend KRS 304.17A-150 to conform; amend KRS 304.17A-250 to require in the individual market that the insurer must offer the standard plan; require the denial letter after October 1, 2000, to include a description of Kentucky Access; amend KRS 304.17A-260 to permit insurers who ceased operating in Kentucky to reenter until January 1, 2001; amend KRS 304.17A-320 to conform; specify requirements for minimum loss ratio filing; require audit of minimum loss ratio results; require insurers to refund premiums necessary to bring actual loss ratio up to the guaranteed minimum loss ratio; amend KRS 304.17A-080, KRS 304.17A-095, KRS 304.17A-150, KRS 304.17A-250, KRS 304.17A-290, and KRS 304.17A-320 to conform; repeal the following statutes: KRS KRS 147A.130, 304.17-410, 304.17A-210, 304.17A-400, KRS 304.17A-410, KRS 304.17A-420, KRS 304.17A-430, KRS 304.17A-440, KRS 304.17A-450, KRS 304.17A-460, KRS 304.17A-470, and KRS 304.17A-480, 304.18-025, and 304.18-055.
SFA (2/P, J. Rose) - Attach the provisions of HB 517.
SFA (3/P, J. Rose) - Retain original provisions; attach provisions of HB 517/GA; establish Subtitle 17B of KRS Chapter 304 and create new sections thereof to create the Kentucky Health Care Improvement Authority; designate 13 members and name the Insurance Commissioner as chair; provide that 70 percent of moneys in the fund be placed in the Kentucky Access Fund, 20 percent be spent on collaborative partnership between the University of Louisville and the University of Kentucky dedicated to lung cancer research, and 10 percent be spent to discourage the use of harmful substances by minors; create Kentucky Access to assure health coverage is made available to each Kentucky resident; provide that Kentucky Access shall operate under the supervision of the Department of Insurance; provide that the department select a third-party administrator to administer Kentucky Access; direct the department to establish the schedule of rates, premiums, deductibles, copayments amounts, coinsurance amounts, and other cost-sharing amounts; provide that health coverage begin no sooner than January 1, 2001; require the department to separate its duties and responsibilities in operating the department from its duties and responsibilities in operating Kentucky Access; require a statewide provider network; provide that initial premium rates shall not exceed 150% of the applicable individual standard risk rates, and that premium rates in no event shall exceed 175% of the rates applicable to individual standard risks; provide that an "eligible individual" is eligible for coverage if the person has been a Kentucky resident for at least 12 months if the person has been rejected by at least 2 insurers or has been offered coverage substantially similar to Kentucky Access coverage at a premium greater than the Kentucky Access premium or the person has a high-cost condition; direct that a Kentucky Access enrollee whose premiums have exceeded claims for 3 years be given a notice of insurability to be used to obtain insurance in the regular individual market; prohibit certain persons from eligibility for Kentucky Access, including persons eligible for Medicare or Medicaid, persons terminated by Kentucky Access less than 12 months ago, persons who have received $2 million in Kentucky Access benefits, and prisoners; to provide that the department evaluate and revise as necessary rates to be charged to enrollees; require Kentucky Access to provide at least 3 health benefit plans, at least one of which must be the standard plan and at one of which must be a traditional fee-for-service form; prohibit pre-existing condition exclusions for "eligible individuals" but permit them for others; permit the department to assess all insurers to fund GAP loses prior to September 30, 2002, and to fund Kentucky Access; provide as funding sources for Kentucky Access the premiums paid by enrollees, funds designated in the Kentucky Health Care Improvement Fund, appropriations, premium taxes, annual assessments of insurers, second assessment of insurers, gifts and grants, interest on earnings, and funds in GAP account on October 1, 2000; allow insurers to include assessments in any rate filing; require GAP participating insurers to report certain information; direct that GAP be terminated on October 1, 2000; exempt Kentucky Access and the department from state and local taxes; provide that GAP participating insurers shall be reimbursed for actual guaranteed acceptance program losses only if money is available after funding Kentucky Access; require the department to submit an annual report to the General Assembly 60 days prior to each regular session; amend KRS 304.17A-005 to conform, amend KRS 304.17A-080 to increase number of members on Health Insurance Advisory Council from 7 to 9, by adding 2 agents' representatives; amend KRS 304.17A-0952 to provide that premium rates charged to an individual may vary from the index rate by 50 percent or less for two consecutive years from the date of implementation of Kentucky Access; permit an adjustment of 20 percent for individual, small group, or association rates; provide that the premium rate charged to a small group or association shall not vary from the index rate by more than 40 percent for 2 consecutive years; allow insurers to establish a separate class of business to separate guaranteed acceptance program qualified individuals from other individuals; amend KRS 304.17A-150 to conform; amend KRS 304.17A-250 to require in the individual market that the insurer must offer the standard plan; require the denial letter after October 1, 2000, to include a description of Kentucky Access; amend KRS 304.17A-260 to permit insurers who ceased operating in Kentucky to reenter until January 1, 2001; amend KRS 304.17A-320 to conform; specify requirements for minimum loss ratio filing; require audit of minimum loss ratio results; require insurers to refund premiums necessary to bring actual loss ratio up to the guaranteed minimum loss ratio; amend KRS 304.17A-080, KRS 304.17A-095, KRS 304.17A-150, KRS 304.17A-250, KRS 304.17A-290, and KRS 304.17A-320 to conform; repeal the following statutes: KRS KRS 147A.130, 304.17-410, 304.17A-210, 304.17A-400, KRS 304.17A-410, KRS 304.17A-420, KRS 304.17A-430, KRS 304.17A-440, KRS 304.17A-450, KRS 304.17A-460, KRS 304.17A-470, and KRS 304.17A-480, 304.18-025, and 304.18-055.
SFA (4, J. Rose) - Provide that eligibility for the guaranteed acceptance program does not include a person who is eligible for or covered by other health plan coverage or who is a spouse or dependent of an individual who waived coverage or did not elect family coverage that was available through the association or group market.
SFA (5, J. Rose) - Delete amendment to KRS 304.17A-540; amend KRS 304.17A-150 to provide that it is an unfair trade practice for an insurer to pay a claim without sending an explanation of benefits if financial responsibility of the enrollee is involved for an amount other than a copayment, or to deny a claim without sending an explanation of benefits.
SFA (6, J. Rose) - Provide that, in the case of specified replacement coverage, the replaced policy and insurer shall terminate continued group health coverage in the same manner that coverage is terminated for active employees; provide that, if an employer's group policy is terminated and replaced by a new group policy, persons under the continued policy shall be offered continued group health coverage under the subsequent policy under rules that are no less favorable to the person than are available to similarly situated eligible employees; provide that provisions shall not be construed to begin a new 18 month period of eligibility.
SFA (7, J. Rose) - Amend KRS 205.5632 to provide that FDA-approved prescription drugs that have been determined to be in the same pharmacological category, that have comparable clinical application, efficacy, and safety, and that are of comparable cost to other FDA-approved drugs that have been placed on the Kentucky Medicaid nonprior-authorized drug file shall be placed on the Kentucky Medicaid nonprior-authorized drug file; provide that a drug that is removed from prior authorization shall be returned to prior authorization status if the comparable drug becomes prior authorized; require Department for Medicaid Services to file, no later than October 1, 2000, administrative regulations that describe the process that will be employed to describe drug comparability with regard to efficacy, safety, and cost; and define "pharmacological category."
SFA (8, J. Rose) - Attach the provisions of SB 98.
SFA (9, J. Rose) - Attach the provisions of SB 343/GA.
SFA (10, J. Rose) - Attach the provisions of HB 371/SCS to HB 608/SCS.
SFA (11, B. Guthrie) - Create a new section of KRS Chapter 216B to require any hospital that provides intraoperative surgical care to have a written policy concerning that care by a certified surgical assistant; define terms; amend KRS 304.17A-150 to require any policy issued or renewed on or after July 15, 2000, that provides coverage for surgical first assisting or intraoperative surgical care to provide that coverage if it is provided by a certified surgical assistant.
SFA (12, J. Rose) - Create a new section of KRS 205.510 to 205.630 to define the scope of the material to be included in the annual report on the dispensing and acquiring of prescription medications in the Medicaid program; establish minimum research criteria for the report.
SFA (13/Title, J. Rose) - Make title amendment.
CCR - Conference Committee could not agree and requested Free Conference Committee be appointed.
FCCR (Majority Report) - Adopt the Senate Committee Substitute to HB 608/GA and Senate floor amendments 4, 6, 7, 8, and 9; amend KRS 304.17A-150 to provide that it is an unfair claims settlement practice for any person to make claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which the payments are being made if the insured has a liability under the policy beyond the copayment or deductible; provide that a contract provision is void if it requires a provider to participate in health benefit plans offered by an insurer other than the plan the provider chooses to participate in; create a new section of Subtitle 17A of KRS Chapter 304 on prompt payment of health insurance claims; amend KRS 304.17A-545 to require the medical director to sign any health insurance denial letter; amend KRS 507.040 to provide that a person is guilty of manslaughter in the second degree if death results from the person's operation of a motor vehicle or death results from leaving a child under the age of 8 years in a motor vehicle; amend KRS 165.160, 165.165, 160.180, 160.190, 165.190 and create a new section of KRS Chapter 165 to provide that it is a public purpose for a city of any class to support postsecondary education through the appropriation of funds for postsecondary educational facilities; create a new section of KRS Chapter 164 to create the lung cancer research fund to receive funds from the tobacco settlement; create a research consortium between the University of Kentucky and the University of Louisville to be known as the Governance Board of the Lung Cancer Research Project; make title amendment.
Feb 8-introduced in House
Feb 9-to Banking and Insurance (H)
Feb 14-posted in committee
Feb 24-reported favorably, 1st reading, to Calendar
Feb 25-2nd reading, to Rules
Feb 28-posted for passage in the Regular Orders of the Day for Tuesday, February 29, 2000
Feb 29-3rd reading, passed 94-0
Mar 1-received in Senate
Mar 3-to Health and Welfare (S)
Mar 16-reported favorably, 1st reading, to Calendar with Committee Substitute
Mar 17-2nd reading, to Rules; floor amendments (1) (2) and (3) filed to Committee Substitute
Mar 21-floor amendments (4) (5) and (6) filed to Committee Substitute
Mar 23-floor amendments (7) (8) (9) and (10) filed to Committee Substitute
Mar 24-posted for passage in the Regular Orders of the Day for Monday, March 27, 2000
Mar 27-passed over and retained in the Orders of the Day; floor amendments (11) and (12) filed to Committee Substitute, floor amendment (13-title) filed ; 3rd reading; floor amendments (1) and (3) withdrawn ; floor amendment (10) ruled out of order ; floor amendment (5) defeated ; passed 19-17 with Committee Substitute, floor amendments (2) (4) (6) (7) (8) and (9)
Mar 28-received in House; posted for passage for concurrence in Senate Committee Substitute, floor amendments (2) (4) (6) (7) (8) and (9)
Mar 29-House refused to concur in Senate Committee Substitute, floor amendments (2) (4) (6) (7) (8) and (9) ; received in Senate; posted for passage for receding from Senate Committee Substitute, floor amendments (2) (4) (6) (7) (8) and (9); Senate refused to recede from floor amendments (2) (4) (6) (7) (8) and (9) ; Conference Committee appointed in Senate
Apr 11-Conference Committee appointed in House; Conference Committee report filed in House and Senate; Conference Committee report adopted in House and Senate; Free Conference Committee appointed in House and Senate; Free Conference Committee report filed in House and Senate
Apr 14-Free Conference Committee report adopted in Senate; passed 34-0; received in House; Free Conference Committee report adopted in House; passed 94-0; enrolled, signed by each presiding officer, delivered to Governor
Apr 25-signed by Governor (Acts ch. 521)
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