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HB 617/FN (BR 2050) - G. Stumbo, S. Riggs
AN ACT relating to health insurance.
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 Kentucky Health Care Improvement Authority; provide that the Kentucky Health Care Improvement Authority select a third-party administrator to administer Kentucky Access; direct the authority to establish the schedule of rates, premiums, deductibles, copayment amounts, coinsurance amounts, and other cost-sharing amounts; provide that initial rates for Kentucky Access coverage cannot be less than 150 percent of the applicable individual standard risk rates as established by the authority with approval of the commissioner; prohibit rates in excess of 200 percent of the rates applicable to individual standard risks; provide that an "eligible individual" is eligible for coverage under Kentucky Access; provide that an individual who is not 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 1 million dollars in Kentucky Access benefits, and prisoners; require the authority to evaluate and revise rates at least annually; require Kentucky Access to provide at least 3 health benefit plans, at least one of which must be the standard plan and at least one of which must be in a traditional fee-for-service form; prohibit pre-existing condition exclusions for "eligible individuals" but permit them for others; restrict Kentucky Access plans to a lifetime limit of $1,000,000 but allow the authority to amend this limit; permit the authority 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 until December 31, 2002; direct that GAP be terminated on October 1, 2000; prohibit the authority from reimbursing a GAP participating insurer for GAP losses incurred on or after October 1, 2002; exempt Kentucky Access and the Authority from state and local taxes; require the authority 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 require the Health Insurance Advisory Council to review the list of high-cost conditions and report to the commissioner, who shall report the recommendations of the Council to the Authority; 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 15 percent, rather than 10 percent, for health conditions for individual, small group, and association rates; 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; repeal, effective October 1, 2000, KRS 304.17A-210 on guaranteed issuance in the individual market and KRS 304.17A-280 on additions to high-cost conditions list; amend KRS 304.17A-080, 302.17A-095, 304.17A-150, 304.17A-250, 304.17A-290, and 304.17A-320 to conform; repeal, effective October 1, 2002, the following statutes: KRS 304.17A-400, 304.17A-410, 304.17A-420, 304.17A-430, 304.17A-440, 304.17A-450, 304.17A-460, 304.17A-470, and 304.17A-480.
HB 617 - AMENDMENTS
HFA (1/P, M. Marzian) - Retain original provisions; delete all language related to funding of Kentucky Access; designate 70% of the funds appropriated to the Kentucky Health Care Improvement Authority to be used to expand Medicaid coverage to low-income families up to 100% of the federal poverty level and fund the Kentucky Prescription Drug Assistance Program for low-income elderly instead of Kentucky Access; designate the Commissioner of the Department for Medicaid Services as the chair of the board to administer the Kentucky Health Care Improvement Authority; create a new section of KRS 205.510 to 205.630 to expand Medicaid coverage to low-income families up to 100% of the federal poverty level; require the Cabinet for Health Services to apply a resource limit of no less than $4,000 per household and exempt 2 cars for families with 2 parents and 1 car for families with 1 parent; require the Cabinet for Health Services to submit a waiver to the federal Health Care Financing Administration to exclude adults with employer-offered health benefit plans in which the total of employer-required premium shares is less than 10% of gross household income and to apply a copayment of $3 to physician office visits, laboratory services, radiology services, prescription drugs, hospital admissions, outpatient surgery, and nonemergency use of the emergency room for adults; require the cabinet to permit families to apply for coverage using the same application form used in determining eligibility for the Kentucky Children's Health Insurance Program; create new sections of KRS Chapter 194A to create within the Cabinet for Health Services the Kentucky Prescription Drug Assistance Program by January 1, 2001; require program to expire on December 31, 2003, unless extended by the General Assembly; define "cabinet," "eligible consumer," "eligible drug," and "program"; require the cabinet to provide assistance in the program to eligible consumers, subject to a five hundred ($500) cap; require payment to be made to the pharmacy, health care provider, or consumer upon presentation of a receipt; require the cabinet to promulgate administrative regulations to implement the program; establish a copayment of $5 per prescription to be collected and retained by the pharmacist; require the cabinet to project expenditures of the program and report various findings to LRC; require dispensing pharmacist to be reimbursed at the average wholesale price of the drug less 10%; require the cabinet to provide drugs to consumers through a manufacturer rebate arrangement; require the cabinet to maintain and collect data to evaluate the cost effectiveness of the program; make technical corrections to conform; appropriate $7,000,000 for the fiscal year 2000-2001 and $7,000,000 for the fiscal year 2001-2002 from the tobacco settlement to fund the Kentucky Prescription Drug Assistance Program for low-income elderly; appropriate $10,700,000 for fiscal year 2000-2001 and $14,300,000 for fiscal year 2001-2002 from the tobacco settlement to expand Medicaid to low-income parents; EMERGENCY.
HFA (2/Title, M. Marzian) - Make title amendment.
HFA (3, G. Stumbo) - Retain original provisions; provide that health coverage shall begin no sooner than January 1, 2001; Require Department of Insurance, rather than the authority, to operate and administer Kentucky Access; require the department to separate its duties and responsibilities in operating the department from its duties and responsibilities in operating Kentucky Access; delete creation of Kentucky Access Advisory Board; 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%, rather than 200%; increase limit on eligibility from $1 million to $2 million, and provide that the department may increase, but not decrease, the limit; provide that GAP participating insurers shall be reimbursed for actual guaranteed acceptance program losses only if money is available after funding Kentucky Access; increase number of members on Health Insurance Advisory Council from 7 to 9 by adding 2 agents' representatives; permit 20%, rather than 10%, adjustment 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% for 2 consecutive years; allow insurers to establish a separate class of business to separate guaranteed acceptance program qualified individuals from other individuals; 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; make technical corrections.
HFA (4, H. Collins) - Amend to require health benefit plans to provide coverage for treatment of a congenital condition and to define "congenital condition".
HFA (5, R. Damron) - Create a new section of KRS Chapter 164 to create the Lung Cancer Research Fund to receive tobacco settlement agreement funds; authorize the fund to receive funds allocated to it by the Kentucky Health Care Improvement Authority; establish the Governance Board of the Lung Cancer Research Project as a research consortium between the University of Louisville and the University of Kentucky.
HFA (6, R. Damron) - Amend to create new sections of KRS Chapter 194A to authorize the Cabinet for Health Services to develop and establish a program for educating students in the public schools on prevention, reduction, and cessation of tobacco, alcohol, and drug use; to establish the State Advisory Council On The Prevention of Tobacco, Alcohol., and Drug Use By Youth; and to set forth that 95 percent of funds allocated from the Kentucky Health Care Improvement Authority for the program be available to fund school or community-based grants to support prevention, reduction, and cessation programs and 5 percent of funds to be used for the administration of the program and for the evaluation of the effectiveness of the prevention programs receiving grants.
HFA (7, R. Damron) - Amend to establish that when funds are no longer designated to the Commonwealth from the master settlement agreement, or if Kentucky Access exceeds its available funds, the maximum limits on assessments will not apply to insurance companies and HMOs, and to require the department to calculate the amount of revenue necessary for Kentucky Access's continued operation and to increase assessments accordingly.
HFA (8, R. Damron) - Amend to delete guaranteed loss ratio provisions.
HFA (9, R. Damron) - Define "insurer'' for purposes of assessments for Kentucky Access losses.
HFA (10, G. Stumbo) - Create new sections of Subtitle 17B of KRS Chapter 304 to permit the commissioner of insurance to create a statewide provider network; provide that the network shall be used for Kentucky Access and may be leased by insurers and associations; direct the department to operate and administer the network; require the department to develop provider contracts; require the department to establish provider reimbursement rates; establish the contract review advisory committee to advise the department on terms of the provider contracts; authorize the department to lease the network; provide that Kentucky Access may offer policies no later than April 1, 2001, or prior to that date but not before January 1, 2001 if the commissioner certifies the statewide provider network.
HFA (11, R. Damron) - Provide that Kentucky Access may offer policies 90 days after the statewide provider network is certified.
HFA (12, R. Damron) - Provide that Kentucky Access may issue policies 180 days after the statewide provider network is certified.
HFA (13, R. Damron) - Create two new sections of Subtitle 17B of KRS Chapter 304 to require the Department of Insurance to create a statewide provide network; provide for reimbursement rates for providers; require the network to have certain policies and procedures.
HFA (14/P, M. Marzian) - Delete provisions of Floor Amendment 3; delete provisions of original bill, except retain the creation of the Kentucky Health Care Improvement Authority and terms and duties relating thereto; delete all language related to funding of Kentucky Access; designate 70% of the funds appropriated to the Kentucky Health Care Improvement Authority to be used to expand Medicaid coverage to low-income families up to 100% of the federal poverty level and fund the Kentucky Prescription Drug Assistance Program for low-income elderly instead of Kentucky Access; designate the Commissioner of the Department for Medicaid Services as the chair of the board to administer the Kentucky Health Care Improvement Authority; create a new section of KRS 205.510 to 205.630 to expand Medicaid coverage to low-income families up to 100% of the federal poverty level; require the Cabinet for Health Services to apply a resource limit of no less than $4,000 per household and exempt 2 cars for families with 2 parents and 1 car for families with 1 parent; require the Cabinet for Health Services to submit a waiver to the federal Health Care Financing Administration to exclude adults with employer-offered health benefit plans in which the total of employer-required premium shares is less than 10% of gross household income and to apply a copayment of $3 to physician office visits, laboratory services, radiology services, prescription drugs, hospital admissions, outpatient surgery, and nonemergency use of the emergency room for adults; require the cabinet to permit families to apply for coverage using the same application form used in determining eligibility for the Kentucky Children's Health Insurance Program; create new sections of KRS Chapter 194A to create within the Cabinet for Health Services the Kentucky Prescription Drug Assistance Program by January 1, 2001; require program to expire on December 31, 2003, unless extended by the General Assembly; define "cabinet", "eligible consumer", "eligible drug", and "program"; require the cabinet to provide assistance in the program to eligible consumers, subject to a five hundred ($500) cap; require payment to be made to the pharmacy, health care provider, or consumer upon presentation of a receipt; require the cabinet to promulgate administrative regulations to implement the program; establish a copayment of $5 per prescription to be collected and retained by the pharmacist; require the cabinet to project expenditures of the program and report various findings to LRC; require dispensing pharmacist to be reimbursed at the average wholesale price of the drug less 10%; require the cabinet to provide drugs to consumers through a manufacturer rebate arrangement; require the cabinet to maintain and collect data to evaluate the cost effectiveness of the program; make technical corrections to conform; appropriate $7,000,000 for the fiscal year 2000-2001 and $7,000,000 for the fiscal year 2001-2002 from the tobacco settlement to fund the Kentucky Prescription Drug Assistance Program for low-income elderly; appropriate $10,700,000 for fiscal year 2000-2001 and $14,300,000 for fiscal year 2001-2002 from the tobacco settlement to expand Medicaid to low-income parents; EMERGENCY.
HFA (15, R. Damron) - Amend to require the chairperson to be elected by the board membership; to change the board composition by replacing four citizen at large members with six consumers who purchase health insurance in the individual market and those members to be appointed by the Governor from each Congressional District to serve for various number of terms; to remove indemnification provisions regarding employees of the Department of Insurance; to create a new section in KRS Chapter 164 to establish the "Lung Cancer Research Fund"; to create new sections of KRS Chapter 194A to authorize the Cabinet for Health Services to develop and establish a program for educating students in the public schools on prevention, reduction, and cessation of tobacco, alcohol, and drug use; to establish the State Advisory Council On The Prevention of Tobacco, Alcohol, and Drug Use By Youth; to set forth that 95 percent of funds allocated from the Kentucky Health Care Improvement Authority for the program be available to fund school or community-based grants to support prevention, reduction, and cessation programs and 5 percent of funds to be used for the administration of the program and for the evaluation of the effectiveness of the prevention programs receiving grants; and amend to retain provisions permitting the commissioner to suspend or revoke, after notice and hearing, the certificate of authority of any insurer that fails to pay an assessment.
HFA (16, R. Damron) - Create new sections of Subtitle 17B of KRS Chapter 304 to create a statewide provider network; create a new section of KRS Chapter 194B to create the Kentucky Prescription Drug Assistance Program; create a new section of KRS 205.510 to 205.630 to direct the Cabinet for Health Services to exercise its option under federal law to apply less restrictive income and resource methodologies for the purpose of determining family eligibility for Medicaid.
HFA (17, R. Damron) - Create new sections of Subtitle 17B of KRS Chapter 304 to create a statewide provider network; create a new section of KRS Chapter 194B to create the Kentucky Prescription Drug Assistance Program; create a new section of KRS 205.510 to 205.630 to direct the Cabinet for Health Services to exercise its option under federal law to apply less restrictive income and resource methodologies for the purpose of determining family eligibility for Medicaid.
Feb 8-introduced in House
Feb 9-to Appropriations and Revenue (H)
Feb 18-posted in committee
Mar 9-reported favorably, 1st reading, to Calendar
Mar 10-2nd reading, to Rules; recommitted to Appropriations and Revenue (H)
Mar 14-reported favorably, to Rules; floor amendments (1) (2-title) and (3) filed ; posted for passage in the Regular Orders of the Day for Wednesday, March 15, 2000
Mar 15-floor amendments (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) and (17) filed to floor amendment (3); floor amendment (16) filed to bill
Mar 17-recommitted to Appropriations and Revenue (H)
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