SB 154 (BR 1475) - R. Alvarado

     AN ACT relating to health care transparency.
     Amend KRS 304.17A-005 to define "covered service," "emergency medical condition," "health care service," and "insured" or "covered person"; create a new section of Subtitle 17A of KRS Chapter 304 to define "allowed amount," "average allowed amount," "comparable health care service," "nonemergency health care service," "nonparticipating provider," and "participating provider"; require, for all health benefit plans, insurers to develop and implement an incentive program for covered persons who elect to receive a comparable health care service; require insurers to establish an interactive mechanism on a publicly accessible Web site that enables covered persons to obtain information about amounts paid for health care services by their insurer and a good-faith estimate of out-of-pocket costs for a nonemergency health care service; require health benefit plans to provide coverage for certain nonemergency services provided by a nonparticipating provider at prices that are the same or less than the average allowed amount for participating providers; amend KRS 304.17A-254 and 304.17A-527 to require insurers to obtain approval of the incentive program offered by that insurer from the Department of Insurance; require contracts with participating providers to include a clause requiring the provider to provide sufficient information to covered persons for the person to receive a good-faith estimate pursuant to the Act; amend KRS 304.17A-505 to conform; create a new section of KRS Chapter 367 to require nonparticipating providers to disclose the price of nonemergency health care services to covered persons; require health care providers to post notice to patients of their rights under this Act and to disclose prices charged for the most common health care services; create a new section of KRS Chapter 205 to require the Department for Medicaid Services or a managed care organization contracted to provide Medicaid services to develop, implement, establish, and provide the same incentive program, interactive mechanism, and coverage to Medicaid recipients that are required for insurers under the Act; amend KRS 304.17A-096, 304.17A-430, 304.17B-001, 304.17B-015, 304.17B-033, 304.17C-010, 304.38A-010, and 304.39-241 to conform; EFFECTIVE January 1, 2019.