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HB 440/HM (BR 1349) - B. DeWeese, R. Palumbo, S. Brinkman, T. Couch, R. Crimm, R. 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
AN ACT relating to health insurance.
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.
HB 440 - AMENDMENTS
HCS/HM - 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.
HFA (1, B. DeWeese) - Change the maximum age of an unmarried dependent child from age 26 to age 25 in Sections 7 and 8 of the Act.
HFA (2, M. Marzian) - Include advanced registered nurse practitioners and psychologists in Sections 1 and 3 of the Act.
HFA (3, B. DeWeese) - 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.
SCS/HM - 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.
SFA (1, D. Ridley) - 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)."
SFA (2, D. Roeding) - 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.
Jan 31-introduced in House
Feb 1-to Banking & Insurance (H)
Feb 21-posted in committee
Feb 27-reported favorably, 1st reading, to Calendar with Committee Substitute
Feb 28-2nd reading, to Rules; floor amendment (1) filed to Committee Substitute
Mar 5-posted for passage in the Regular Orders of the Day for Thursday, March 6, 2008
Mar 6-floor amendments (2) and (3) filed to Committee Substitute
Mar 10-3rd reading, passed 97-0 with Committee Substitute, floor amendments (2) and (3)
Mar 11-received in Senate
Mar 13-to Banking & Insurance (S)
Mar 18-reported favorably, 1st reading, to Calendar with Committee Substitute
Mar 19-2nd reading, to Rules; floor amendment (1) filed to Committee Substitute
Mar 24-floor amendment (2) filed to Committee Substitute
Apr 2-3rd reading; floor amendments (1) and (2) withdrawn ; passed 37-0 with Committee Substitute ; received in House; to Rules (H); taken from Rules; posted for passage for concurrence in Senate Committee Substitute on April 2, 2008 ; House concurred in Senate Committee Substitute ; passed 81-13
Apr 14-enrolled, signed by Speaker of the House
Apr 15-enrolled, signed by President of the Senate; delivered to Governor
Apr 24-signed by Governor (Acts Ch. 169)
Vote History
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