| Last Action | 01/10/19: to Banking & Insurance (S) |
|---|---|
| Title | AN ACT relating to out-of-network balance billing. |
| Bill Documents | Introduced |
| Fiscal Impact Statement | Health Mandate |
| Bill Request Number | 477 |
| Sponsors | R. Alvarado, D. Parrett |
| Summary of Original Version | Amend KRS 304.17A-005 to incorporate definitions of terms used in the Act, including "balance billing," "cost sharing", and "usual, customary, and reasonable rate"; create a new section of Subtitle 17A of KRS Chapter 304 to require the insurance commissioner or a designated nonprofit organization to establish and maintain a database of billed health care services charges collected from insurers; amend KRS 304.17A-254 to require certain health insurers to ensure that their networks of participating providers are adequate to meet the health care needs of covered persons; amend KRS 304.17A-510 to consolidate requirements in the insurance code for participating provider directories, to establish specific requirements for content, updates, and access, to require that directories be made available on insurer's Web sites, and to require an annual audit of a reasonable sample size of an insurer's provider directories; create a new section of Subtitle 17A of KRS Chapter 304 to require health benefit plans to provide coverage for access to a nonparticipating provider with prior plan authorization in certain circumstances, for access, without the need for a referral, to primary and preventive obstetric and gynecologic services, and for access to certain specialists; create a new section of Subtitle 17A of KRS Chapter 304 to require the insurance commissioner to review health benefit plans for network adequacy; amend KRS 304.17A-550 to require certain insurers that offer a group health benefit plan that provides comprehensive coverage of health care services by nonparticipating providers to offer that coverage at a rate of at least 80% of the usual, customary, and reasonable rate; amend KRS 304.17A-580 to consolidate requirements in the insurance code for coverage of emergency health care services and to require insurers to ensure that covered persons incur no greater out-of-pocket costs for emergency health care services provided by a nonparticipating provider than the covered person would incur if services were provided by a participating provider; amend KRS 304.17A-607, 304.17A-617, 304.17A-621, and 304.17A-625 to establish utilization review and appeal requirements for nonparticipating provider coverage that requires prior authorization; create a new section of Subtitle 17A of KRS Chapter 304 to establish notice requirements for health benefit plans relating to the coverage requirements established in the Act and reimbursement for health care services provided by a nonparticipating provider; create a new section of Subtitle 17A of KRS Chapter 304 to establish a binding independent dispute resolution program for disputed charges for covered health care services provided by a nonparticipating provider; create a new section of KRS Chapter 367 to require health care providers and health facilities to make certain disclosures to covered persons, to post certain information on their Web sites, and to comply with certain requirements if they balance bill a covered person; amend KRS 304.17A-096, 304.17A-430, 304.17A-500, 304.17A-527, 304.17A-600, 304.17B-001, 304.17B-015, 304.17B-033, 304.17C-010, 304.18-114, 304.38A-010, 304.39-241, and 18A.225 to conform; repeal KRS 304.17A-590, 304.17A-640, 304.17A-641, 304.17A-645, 304.17A-647, and 304.17A-649; cite as the Out-of-Network Balance Billing Transparency Act; EFFECTIVE January 1, 2020. |
| Index Headings of Original Version |
Effective Dates, Delayed - January 1, 2020 Health and Medical Services - Access to health care providers, requiring insurance coverage for Hospitals and Nursing Homes - Access to health care providers, requiring insurance coverage for Hospitals and Nursing Homes - Binding independent dispute resolution program, nonparticipating provider bills, establishing Hospitals and Nursing Homes - Health care charges and billing rights, requiring disclosure of Insurance, Health - Access to health care providers, requiring insurance coverage for Insurance, Health - Binding independent dispute resolution program, nonparticipating provider bills, establishing Insurance, Health - Database of billed health care services charges, Insurance Commissioner, establishing Insurance, Health - Network adequacy of health benefit plans, Insurance Commissioner, requiring review of Insurance, Health - Network adequacy of health benefit plans, amending requirements for Insurance, Health - Participating provider directories, amending requirements for Physicians and Practitioners - Access to health care providers, requiring insurance coverage for Physicians and Practitioners - Binding independent dispute resolution program, nonparticipating provider bills, establishing Physicians and Practitioners - Health care charges and billing rights, requiring disclosure of State Agencies - Binding independent dispute resolution program, nonparticipating provider bills, establishing State Agencies - Database of billed health care services charges, Insurance Commissioner, establishing State Agencies - Network adequacy of health benefit plans, Insurance Commissioner, requiring review of Short Titles and Popular Names - Out-of-Network Balance Billing Transparency Act Health Benefit Mandate - Network adequacy of health benefit plans, Insurance Commissioner, requiring review of |
| 12/14/18 |
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| 01/08/19 |
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| 01/10/19 |
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Last updated: 11/9/2023 3:08 PM (EST)