| Last Action | 03/11/26: posted for passage in the Regular Orders of the Day for Thursday, March 12 2026 |
|---|---|
| Title | AN ACT relating to coverage for prostheses and orthoses. |
| Bill Documents | Introduced |
| Fiscal Impact Statements |
Actuarial Analysis
Health Mandate Local Mandate State Employee Health Plan Impact Additional Fiscal Impact Statements Exist |
| Bill Request Number | 1263 |
| Sponsors | R. Girdler, J. Adams, G. Elkins, S. Madon, A. Mays Bledsoe, M. Nunn, S. Rawlings, A. Reed, B. Storm, P. Wheeler |
| Summary of Original Version | Create a new section of Subtitle 17A of KRS Chapter 304 to require health benefit plans to provide coverage for prostheses and orthoses; establish minimum requirements for the required coverage; require utilizations review decisions to be made in a nondiscriminatory manner; require an insurer or its private review agent to provide notice of certain rights of the insured; establish notice requirements for denials; establish network adequacy requirements for the provision of a prosthesis or orthosis that is required to be covered; establish reporting requirements for insurers and the commissioner of the Department of Insurance relating to the required coverage; amend KRS 164.2871 and 18A.225 to require self-insured group health plans offering by the governing board of state postsecondary education institutions and the state employee health plan to comply with the requirements relating to coverage for prostheses and orthoses; provide that the Act applies to health benefit plans issued or renewed on or after January 1, 2027; EFFECTIVE January 1, 2027. |
| Index Headings of Original Version |
Disabilities - Prostheses and orthoses, coverage requirement Education, Higher - Self-insured group health plans, prostheses and orthoses, coverage, requirements Effective Dates, Delayed - Prostheses and orthoses, coverage requirement, January 1, 2027 Health And Medical Services - Prostheses and orthoses, coverage requirement Health Care Professionals - Prostheses and orthoses, insurance, network adequacy Insurance, Health - Prostheses and orthoses, coverage requirement, network adequacy Reports Mandated - Department of Insurance, prostheses and orthoses coverage Reports Mandated - Insurers, prostheses and orthoses coverage State Employees - Health plan, prostheses and orthoses, coverage requirement Actuarial Analysis - Prostheses and orthoses, coverage requirement, network adequacy Health Benefit Plan Mandate - Prostheses and orthoses, coverage requirement, network adequacy Local Mandate - Prostheses and orthoses, coverage requirement, network adequacy State Employee Health Plan Mandate - Prostheses and orthoses, coverage requirement, network adequacy |
| Jump to Proposed Amendments | Senate Committee Substitute 1 with Fiscal Impact Statements |
| 01/15/26 |
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| 03/06/26 |
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| 03/10/26 |
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| 03/11/26 |
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| Amendment | Senate Committee Substitute 1 |
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| Fiscal Impact Statements |
Actuarial Analysis to Senate Committee Substitute 1
Health Mandate to Senate Committee Substitute 1 Local Mandate to Senate Committee Substitute 1 State Employee Health Plan Impact to Senate Committee Substitute 1 |
| Summary | Retain original provisions, except delete short-term limited duration coverage from the definition of "health benefit plan"; modify minimum coverage and network adequacy requirements; suspend the coverage requirement's application to qualified health plans if the state would be required to make cost defrayal payments; make technical corrections; amend KRS 304.17A-099 to conform; require the Department of Insurance to make a determination as to whether any requirement in Section 1 is in addition to essential health benefits, make submissions to the federal Department of Health and Human Services, and consider the determination accepted if a response is not received within 365 days; EFFECTIVE, January 1, 2028. |
| Index Headings |
State Employees - Health plan, prostheses and orthoses, coverage requirement Education, Higher - Self-insured group health plans, prostheses and orthoses, coverage, requirements Effective Dates, Delayed - Prostheses and orthoses, coverage requirement, January 1, 2028 Health Care Professionals - Prostheses and orthoses, insurance, network adequacy Insurance, Health - Prostheses and orthoses, coverage requirement, network adequacy State Agencies - Department of Insurance, essential health benefit determination |
Last updated: 3/11/2026 6:52 PM (EDT)