04RS HB650


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HB 650 (BR 2035) - J. Bruce, H. Cornett, B. Crall, M. Denham, B. Farmer, J. Gooch, J. Higdon, T. Thompson, K. Upchurch

     AN ACT relating to health benefit plans.
     Create new sections of Subtitle 17A of KRS Chapter 304 to require that a health benefit plan provided to individuals through an association not related to employment be considered coverage in the individual market; provide that an insurer issuing or renewing a health benefit plan on or after January 1, 2005 until December 31, 2007, not be required to include any additional mandated state benefits; require an insurer that is not a managed care plan but provides financial incentives for a person to access a network of providers must notify the covered person that certain information is available at the time of enrollment and upon request; amend KRS 304.17A-095 to restrict retroactive reduction of rates to filings containing misrepresentations or based on fraudulent information; amend KRS 304.17A-250 to permit, rather than require, insurers in the individual and small group market to offer the standard plan after July 15, 2004; delete the benefits comparison; amend KRS 304.17A-330 to exempt from the annual data reporting requirement insurers, employer-organized associations that self-insure, and health purchasing outlets that insure less than 500 persons; amend KRS 304.17A-500 to change the definition of "enrollee" and other terms; amend KRS 304.17A-527, 304.17A-550, 304.17A-520, and 304.17A-532 to make technical changes to eliminate certain requirements for non-HMO insurers; amend KRS 304.17A-545 to provide that the medical director of a managed care plan may be licensed in the state where the insurer is domiciled or in any state in which the insurer is licensed to do business; amend KRS 304.17A-600 to define "urgent care"; amend KRS 304.17A-607 to delete requirement of rendering written notice of utilization review decision within one (1) day of decision and delete other time requirements for preadmission review of hospital admission, preauthorization for a treatment, procedure, drug, or device, and receipt of requested information when a retrospective review is initiated; amend KRS 304.17A-617 as to the internal appeal determination letter to delete requirement that letter contain a description of alternative benefits, services, or supplies in cases retrospective review; amend KRS 304.17A-623 to provide that external reviews which are not expedited must be conducted by the review entity and a determination made within 21 days from the receipt of all information required from the insurer rather than from the receipt of the request for external review; amend KRS 304.17A-627 to delete requirement that the independent review entity annually submit certain information to the department in a form acceptable to the department; amend KRS 304.17A-722 to exempt, with approval of the commissioner, an insurer from the data reporting requirements if the total number of insureds is less than 500; amend KRS 304.17A-700 to conform; repeal KRS 304.17A-533.


     HCS - Retain original provisions; make technical changes; define "urgent care" as including all requests for hospitalization and outpatient surgery; clarify provision on utilization review decision as one relating to urgent and nonurgent care in accordance with 29 C.F.R. Part 2560; delete Section 19 and renumber subsequent sections.

     HFA (1, R. Damron) - Make the provisions of Section 1 apply to employer-organized associations in addition to associations.

     HFA (2, R. Damron) - Delete Section 1 of the bill that provides that health benefit plan coverage provided to individuals through an association that is not related to employment shall be considered coverage in the individual market.

     HFA (3, R. Damron) - Delete Sections 3 and 7 of the bill; amend subsection (2) of Section 11 to continue the current practice of having utilization management decisions that are made by chiropractors or optometrists be made by chiropractors and optometrists licensed in Kentucky.

     HFA (4, R. Damron) - Delete Sections 1 and 11 of the Act; require an insurer that offers a health benefit plan that is not a managed care plan but that provides financial incentives for a covered person to access a network of providers to be subject to certain patient protection provisions that apply to managed care plans.

     Mar 1-introduced in House
     Mar 2-to Banking and Insurance (H); posted in committee; posting waived
     Mar 3-reported favorably, 1st reading, to Calendar with Committee Substitute
     Mar 4-2nd reading, to Rules; posted for passage in the Regular Orders of the Day for Friday, March 5, 2004
     Mar 5-floor amendments (1) (2) and (3) filed to Committee Substitute
     Mar 9-floor amendment (4) filed to Committee Substitute
     Mar 10-3rd reading, passed 95-2 with Committee Substitute, floor amendment (4)
     Mar 11-received in Senate
     Mar 16-to Banking and Insurance (S)
     Mar 17-reported favorably, 1st reading, to Calendar
     Mar 18-2nd reading, to Rules; posted for passage in the Regular Orders of the Day for Tuesday, March 23, 2004
     Mar 23-3rd reading, passed 35-1; received in House
     Mar 24-enrolled, signed by each presiding officer; delivered to Governor
     Apr 2-signed by Governor (Acts ch. 59)

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