97S2 SB1
SB 1/FN/LM (BR 21) - T. Shaughnessy
AN ACT relating to health insurance, making an appropriation therefor, and declaring an emergency.
Create new sections of Subtitle 17A of KRS Chapter 304 on health insurance to require guarantee issue for small groups; require group plans to comply with federal law on pre-existing conditions; prohibit use of pre-existing conditions exclusions for eligible individuals under federal law; restrict individual plans for individuals who are not eligible individuals to pre-existing condition provision in federal law for small groups; provide for guaranteed renewal of all health insurance policies with exceptions; require the commissioner to define one standard plan by December 31, 1997 for use in the individual and small group markets; require individual and small group insurers to offer the standard plan; permit insurers to offer other plans; require applicants in the individual and small group markets be given a benefits comparison of the standard plan to the plan being offered to the applicant; permit insurers that on or after July 15, 1995, sold standard plans and then stopped doing business in the state to return to the state without penalty; amend KRS 304.17A-095 to require a copy of rate filings be submitted to the Attorney General; delete the requirement of a mandatory rate hearing if premium increase exceeds increase in consumer price index; require a hearing upon written request of the Attorney General; permit immediate use of rates if filing includes a minimum loss ratio guarantee of 65 percent for individuals and groups of 2 to 10 and 70 percent for groups of 11 to 50; create a new section of Subtitle 17A of KRS Chapter 304 to establish health insurance rating methodology for individuals, small groups, associations, and alliances; provide that premium rates for individuals with similar case characteristics for same coverage cannot vary from the index rate by more than 35 percent of the index rate; provide rating methodology for percentage increase in premium rates charged to an individual for a new rating period; provide rating methodology for plans issued to high risk individuals from July 15, 1995 until the effective date of this Act; provide that premium rates for small group and association members with similar case characteristics for the similar coverage cannot vary from the index rate by more than 25 percent of the index rate; provide rating methodology for percentage increase in premium rates charged to small groups and association members for a new rating period; prohibit use of case characteristics other than age, gender, occupation or industry, geographic area, family composition, and group size without prior approval of the commissioner; provide that the ratio of the highest rate factor to the lowest rate factor within a class of business cannot exceed 5 to 1; provide that the index rate for any class of business cannot exceed the index rate for any other class of business in that market segment by more than 20 percent; allow commissioner to approve additional classes of business; prohibit rate adjustments for claims experience, health status, and duration of coverage for an individual group member or his dependents; create a new section of Subtitle 17A of KRS Chapter 304 to create a rating methodology for employer-organized association health plans; prohibit the Kentucky Health Purchasing Alliance from issuing or renewing any business after January 1, 1998; require commissioner to assist Alliance members with finding coverage in the private market; prohibit a health insurer from discriminating against any provider who is willing to meet the terms and conditions for participation in the plan; establish the Kentucky Comprehensive Health Insurance Plan; require the Governor to appoint a six-member board for the plan and require the commissioner to serve as chair of the board; require all health insurers to participate in the plan; require the plan to issue policies no later than 6 months after the effective date of the Act; require policies to be guaranteed issue to eligible individuals; provide that eligible individuals under federal law are eligible for the plan and other individuals must be a resident of the state for 12 months and be rejected by two insurers or offered coverage by two insurers at a premium higher than the plan premium or have a high-cost condition; require the commissioner to establish a list of high-cost conditions; limit lifetime benefits under plan coverage to $1,000,000; require the board to establish and annually update provider reimbursement rates and prohibit board from authorizing contracts that allow health care providers to bill insureds for plan services in excess of that amount; require the board to select an insurer to administer the plan; require the plan to offer three health benefit plans; provide that rates for plan coverage for previously insured individuals cannot exceed 135 percent of individual standard risk rate and 150 percent for persons without previous coverage; establish the Kentucky Comprehensive Health Insurance Plan Fund in the State Treasury; require premium taxes in excess of those collected in 1997 to be remitted to the board; amend KRS 304.17A-130 to establish a risk adjustment process to collect and distribute funds from insurers to equalize risks between insurers and the Kentucky Comprehensive Health Insurance Plan; prohibit non-state employee small groups from renewing coverage under the state self-insured plan; allow non-state employee individuals to renew coverage under the state self-insured plan; permit renewal of plans under the state buy-in program at specified rates; require the Department of Personnel to establish a fund separate from the state employee benefit fund for persons covered under the state self-insured fund who are not state employees; require insurers to disclose certain information to enrollees; require managed care plans to provide telephone access, reasonable standards for waiting times for appointments, coverage for emergency room screening and stabilization without prior authorization, and a policy for termination of providers; prohibit providers from being penalized for disclosure of certain information; require plans to have drug utilization review; require a denial letter be sent to enrollee within 20 days of denial of coverage for experimental services; require plans to appoint a physician as medical director; establish a patient's right of privacy; require employer-organized associations to obtain a certificate of filing to self-insure; require all health insurers and employer-organized associations that self insure that write health insurance to submit certain data, to the Department of Insurance; require the sponsor of a bill or amendment that contains a mandate health benefit to submit to the standing committee a financial impact statement; amend KRS 304.14-130, 304.18-050, 304.14-120, 304.38-050, 304.38-200, 304.17A-080, 304.17A-145, 304.17A-150, 304.17A-170 and 216.2923 to conform; repeal KRS 304.17A-090 on the effective date of this Act; repeal effective January 1, 1999 the following statutes: KRS 304.17A-010, 304.17A-020, 304.17A-030, 304.17A-040, 304.17A-050, 304.17A-060, 304.17A-070, 304.17A-100, 304.17A-110, 304.17A-120, and 304.17A-160; appropriate $5 million per fiscal year for fiscal year 1997-98 and direct Governor to include same amount in his budget recommendation for fiscal years 1998-99 and 1999-2000; EMERGENCY.
SB 1 - AMENDMENTS
SCS - Retain original provisions of the bill, except provide the information prescribed in the administrative regulations promulgated by the commissioner must relate to rates, fees, and dues and be necessary; add definitions for "bona fine association" and "church plan"; provide that "credible coverage" is that defined under 42 U.S.C. 300gg(c)(1); provide that credible coverage shall not be counted if there was a 63 day period of time during all of which the individual was not covered under credible coverage; add definition of "governmental plan"; provide that the provisions of Chapter 216B that relate to the issuance of certificate of need shall not apply to services provided on site in an existing health facility when the amortization cost per year is less than $600,000 and the provider gives notice of intent to provide the services; provide that the provisions of Chapter 216B that relate to the issuance of certificate of need shall not apply to open heart surgery where cardiac catheterization services are provided on site; allow insurers who took high-cost insureds since 1995 to get refunds beyond the first two renewals; repeal HMO open enrollment after 1998; create a consumer protection and education division, including an ombudsman within the Department of Insurance; change the requirements regarding the governing board; establish immunity from liability for board members; limit administrative expenses of administrating insurer to 15% of claims paid; require rate filings to identify allocation of assessments among clients; allow insurers to provide incentives for disease prevention programs; clarify language regarding people who can participate in plan; make technical changes to insure HIPPA compliance; preclude the use of genetic information alone as a pre-existing condition; require the board to have a statistically valid sample of individual market rates in setting plan rate; remove language that allows possibility of second general fund appropriation; make technical amendments to accommodate reporting and refunding to insurers who accepted buy-in citizens; allow state employees, schools, and courts to become voluntary members of the alliance during 1998 to accommodate current enrollment period; allow participation in pool by any willing provider; add providers other than physicians and hospitals to HMO directory of providers given to members; make technical definitional corrections; cap any second assessment at the amount of the first assessment; recognize entities organized under KRS 247.240 to 247.370 that have actively marketed health insurance to their members and which is not insurance controlled; delete requirement that automobile insurance information be collected; clarify language to provide for only two possible assessments; establish controls for the deposit of funds; and establish a procedure for selecting a plan administering insurer.
SFA (1, T. Buford) - Amend KRS 18A.225 to provide contributions to assist state employees with household incomes at or below 200% of the federal poverty guidelines with the purchase of family health insurance coverage offered through the state.
SFA (2, T. Buford) - Amend KRS 205.6320 to require secretary to promulgate administrative regulations for HMOs, and any risk-bearing managed care plans; require such plans to demonstrate the capacity to meet standards; require HMOs and any risk-bearing managed care plans to limit administrative costs to 8% of the total contract costs; require any HMO or risk-bearing managed care plan to provide annual audited cost and operations reports; require annual actuarial report and other data as department determines necessary to administer programs; require all reports prior to any contract renewal or newly contracted business.
SFA (3, B. Metcalf) - Require a residency of eighteen months for the high risk pool.
SFA (4, D. Karem) - Prohibit health insurance plan from denying, cancelling, or refusing to renew benefits or coverage, or varying premiums, terms, or conditions for the benefits or coverage for any participant or beneficiary under the plan on the basis of genetic information or on the basis that the participant or beneficiary has requested or received genetic services.
SFA (5, B. Metcalf) - Establish a surcharge of one dollar ($1) for each visit to a hospital emergency room to obtain primary medical care; hospital staff will decide if the emergency room visit was to receive emergency treatment or primary medical care.
SFA (6, T. Buford) - Amend KRS 18A.225 to provide contributions to assist state employees with household incomes at or below 200% of the federal poverty guidelines with the purchase of family health insurance coverage offered through the state.
SFA (7, T. Buford) - Amend KRS 205.6320 to require secretary to promulgate administrative regulations for HMOs, and any risk-bearing managed care plans; require such plans to demonstrate the capacity to meet standards; require HMOs and any risk-bearing managed care plans to limit administrative costs to 8% of the total contract costs; require any HMO or risk-bearing managed care plan to provide annual audited cost and operations reports; require annual actuarial report and other data as department determines necessary to administer programs; require all reports prior to any contract renewal or newly contracted business.
SFA (8, N. Kafoglis) - Amend provisions relating to expenditures of over $1,000,000 per individual to allow an individual to purchase additional coverage upon application to the board.
SFA (9, N. Kafoglis) - Prohibit insurers from excluding part-time employees who work at least 10 hours per week from group health insurance coverage made available by the employer to all full-time employees.
SFA (10, D. Nunnelley) - Require individuals who do not meet the federal definition of eligible individual to have a high cost condition to enter the Kentucky comprehensive health insurance plan; provide that coverage for individuals not qualified for the plan shall be made available consistent with the provisions of 42 U.S.C. sec. 300gg-41.
SFA (11, D. Nunnelley) - Require individuals who do not meet the federal definition of eligible individual to have a high cost condition to enter the comprehensive health insurance plan.
SFA (12, J. Pendleton) - Retain provisions of original bill, except amend the assessment procedure to provide that the maximum assessment amount shall remain the same as in 1998 in future years.
SFA (13, J. Pendleton) - Delete references to "physicians" and replace with references to "health care providers" or "providers" in relation to managed care plans.
SFA (14, D. Williams) - Restore mandatory rate hearing if rates exceed the percentage change in the medical care consumer price index; restore role of Attorney General in rate hearing process; delete provisions related to guarantee loss ratio.
SFA (15, D. Williams) - Retain provisions of original bill, except delete the second assessment against insurers and include an additional appropriation, so that the total appropriated amount is $12,800,000.
SFA (16, D. Williams) - Amend to provide that health utilization review be made by a Kentucky licensed physician.
SFA (17, D. Williams) - Retain provisions of original bill, except add an additional assessment of up to $5,000,000 against insurers, and delete the general fund appropriation.
SFA (18, G. Williams) - Make technical corrections; and change the formula regarding the limitation on administrative costs from 15% of the claims expenses to 20% of the premium.
SFA (19, G. Williams) - Retain the provisions of the original bill, except amend the definition of "health benefit plan" to exclude "medical expense reimbursement", and amend the definitions of "large group" and "small group".
SFA (20, G. Williams) - Amend the assessment procedure to provide that the maximum assessment amount shall remain the same in future years as in 1998.
SFA (21, B. Metcalf) - Establish three standard health benefit plans instead on one health benefit plan.
SFA (22, B. Metcalf) - Delete risk adjustment funding mechanism and GA appropriation for high risk plan and provide funding based on a 1.5% assessment on health insurance premiums; create the Ky. perennial health insurance trust fund for investing a portion of the assessment to provide supplemental funding for annual expenditures of the high risk plan and to provide future funding for the plan; and repeal KRS 304.17A-130 to conform.
SFA (23, J. Pendleton) - Provide that patient protection standards in managed care plans apply to health care providers, instead of just to physicians, except where otherwise specified.
SFA (24, D. Karem) - Prohibit individual or group health plans from denying, canceling, or refusing to renew benefits or coverage or varying premiums, terms, or conditions for any plan participant or beneficiary on the basis of a genetic test, for which symptoms have not manifested or on the basis that the participant or beneficiary has requested or received genetic services; prohibit a group or individual health plan from requesting or requiring a participant or beneficiary to disclose to the plan or issuer any genetic test about the participant, beneficiary, or applicant; prohibit a group or individual health plan from disclosing any genetic test about a participant or beneficiary without prior authorization by the participant; require authorization for each disclosure.
SFA (25, N. Kafoglis) - Allow an individual, upon application to the Board of Directors of the Kentucky Comprehensive Health Insurance Plan, to purchase at an actuarially justified rate, additional coverage through the plan.
HCS - Retain provisions of the original bill except limit the reimbursement on high-risk individual claims to the first two policy renewals; define "high risk individuals" as used in Section 9 of the bill relating to rates and the development of index rates by insurers; change the rate filing method from a "guaranteed loss ratio" approach to a "file and use" approach; require insurance companies who have left the state to apply for re-admittance prior to June 30, 1998; reword the assessment language to clarify how and when assessments may be levied; establish voluntary "Purchasing Cooperatives" for individuals to band together to purchase insurance; establish a procedure for certification for purchasing cooperatives with the commissioner; allow the commissioner to contract with insurers during the transition period to provide coverage for individuals who will be in the pool; require commissioner to receive input from providers that deal with high-cost conditions and review current medical documentation; define when coverage of a person ceases in the Plan; establish a grievance procedure when coverage in the Plan is terminated; specify that the 12 month waiting period shall not apply to dependents; allow claims to be submitted electronically; clarify language regarding reduction of benefits due to other insurance payments; require the commissioner to submit a report regarding the Plan to the Board; require the commissioner to collect certain data to determine the effectiveness of the Plan; allow individuals to go to health departments for covered medical services, and for health departments to be paid for those services;. provide that an insurer must make upon request from enrollee, the financial arrangements with prescription drug manufacturers; require the determination of whether treatment is medically necessary to be made by an individual in the same profession as the provider rendering the service; require the commissioner to appoint appropriate staff to service the ombudsman, including 1 director, 3 enforcement officers, 2 office persons and 4 support staff; apply any willing provider language to the Kentucky State Medicaid program and Medicaid partnerships; require the issuance of individual policies to individual employees of a small group employer to be guaranteed issue to all full-time employees; require an insurer to offer the option to purchase any other health benefit plan currently being offered by the insurer in that market, if the insurer wants to modify a policy at the time of renewal and the modification significantly reduces benefits or otherwise alters the protections; require an insurer to issue a quote within 30 days of receiving a completed application or else issue coverage with no pre-existing condition exclusions; prohibit insurers from using family history in determining an individual's health status; prohibit the use of tobacco products alone constituting a high-cost condition; delete pregnancy as a preexisting condition; provide that the Secretary of the Personnel Cabinet may negotiate with insurers on behalf of state employees for health insurance; provide that premium rates under Kentucky Kare will be frozen at the rates in existence for 1997 with a composite 5% increase; appropriate $15,000,000 in FY 1997-98 to the state employee benefit fund; remove suggested amount for governor's budget request beyond the current fiscal year, and expresses the intent of the general assembly that assessment revenues be utilized before the general fund appropriation is accessed.
HFA (1, M. Long) - Delete Section 60 of the bill, relating to certificates of need.
HFA (2, J. Crenshaw) - Delete board's ability to modify benefits and cost containment provisions after the Commissioner of Insurance has set the plan.
HFA (3, J. Wayne) - Provide that utilization review for mental health or substance abuse cases shall be made by a mental health professional licensed in any state.
HFA (4, K. Stein) - Amend to provide that individuals shall be able to purchase additional coverage.
HFA (5, J. Crenshaw) - Prohibit occupation from being treated as a pre-existing condition.
HFA (6, J. Crenshaw) - Prohibit any delay, limit, or eligibility for benefits provided under KRS Chapter 342.
HFA (7, F. Nesler) - Change notice requirement from ninety (90) days to one hundred and eighty (180) days; and notice also to be made to the commissioner.
HFA (8, R. Thomas) - Permit part-time state employees and university employees who work at least 10 hours per week after 6 months of employment to be member of group health insurance made available to full-time employees; provide that employer does not have to pay premium of part-time employee.
HFA (9, M. Marzian) - Amend to lower allowable administrative costs from 20% to 10%.
HFA (10, J. Richards) - Amend to delete the provisions that a health benefit plan issued as an individual policy to individual employees through or with the permission of a small employer be guarantee issued to all full-time employees of the employer.
HFA (11, J. Coleman) - Require insurers to report to the commissioner the name and address of each enrollee with a high-cost condition who terminates or nonrenews coverage.
HFA (12, J. Coleman) - Require each association holding a certificate of filing from the insurance commissioner to retain ultimate financial responsibility for the plan obligations; Require health benefit plans provided by an employer-organized association be made available only through employers who are bona fide members of the association; Require licensure of contract or third-party administrators of an employer-organized association plan; Require contract or third-party administrators of an employer-organized association plan to post a performance bond equal to 50% of the administrator's annual premium income from the plan as a condition of licensure; Require each employer-organized association to maintain an active life reserve and actuarially determined claim reserve pursuant to KRS 304.6-070.
HFA (13, J. Gooch) - Amend to conform to definition of health benefit plan; exclude long-term care policies; define genetic testing in regulations.
HFA (14, J. Gray) - Require that rate filings be simultaneously transmitted to the DOI Commissioner and the Attorney General.
HFA (15, J. Gooch) - Require that all responses to and denials of premium rate quotes shall include all information reasonably necessary to assess the insurability of the applicant.
HFA (16, J. Gray) - Require insurers to include part-time employees in a group health benefit plan if the part-time employee notifies the employer in writing of his/her desire to be covered.
HFA (17, M. Marzian) - Amend to decrease allowable premium increases from 35% to 25% for health status, and decrease the allowable annual increase from 10% to 5%.
HFA (18, P. Clark) - Amend to provide a deduction from income tax for health insurance.
HFA (19, K. Hogancamp) - Amend to provide a deduction from income tax for health insurance and health care and medical services.
HFA (20, K. Hogancamp) - Amend to provide a deduction from income tax for health insurance.
HFA (21, J. Gooch) - Permit utilization management decisions to be made by chiropractor when services were rendered by a chiropractor.
HFA (22, J. Gooch) - Delete certain powers of board and permit board to obtain stop loss coverage for the plan.
HFA (23, L. Napier) - Provide that any insurers that ceased doing business in the state must reapply with the commissioner before March 1, 1998 to resume doing business in the state, or the insurer must wait two years to reapply.
HFA (24, R. Cox) - Add language to a new subtitle of KRS 304 that the board established to administer the Kentucky comprehensive health insurance plan shall not include abortion as a covered benefit.
HFA (25, R. Cox) - Add language to a new subtitle of KRS 304 that the board established to administer the Kentucky comprehensive health insurance plan shall not include "dilation and extraction" as a covered benefit.
HFA (26, T. Riner) - Define "Medicare" and "Medicare supplement policy"; provide that insurers must market the standard health benefit plan as a Medicare supplement policy, if the insurer sells such policies.
HFA (27, T. Riner) - Define "Medicare; establish lower rate factor ratio for individuals aged 50 - 64 who are not eligible for Medicare.
HFA (28, G. Stumbo) - Amend to provide that mental health and substance abuse utilization management decisions shall be made by a mental health professional licensed in any state.
HFA (29, G. Stumbo) - Provide that a person whose insurance is terminated for any reason may reapply for coverage if the board has reviewed all grievance responses and determines reapplication is a remedy, or 6 months have elapsed since the original termination or cancellation of the policy.
HFA (30, G. Stumbo) - Require rate filings to be simultaneously transmitted to the DOI commissioner and the Attorney General.
HFA (31, G. Stumbo) - Appropriate out of the general fund to the Finance and Administration Cabinet to establish a pool of funds in the amount of $300,000 in fiscal year 1997-98 to be used for expert witnesses if the Attorney General determines a rate hearing is necessary; Require the governor to include in budget recommendations for the executive branch and in the draft executive branch budget bill for fiscal years 1999-2000, a recommendation for appropriations to the Finance and Administration Cabinet for personal services contracts with expert witnesses in rate hearings if the Attorney General determines a rate hearing is necessary; Require the amount recommended to be $400,000 out of the general fund for each fiscal year.
HFA (32/Title, K. Hogancamp) - Make title amendment
HFA (33, H. Anderson) - Delete the general fund appropriation for the high risk pool.
HFA (34, H. Anderson) - Provide a nonrefundable credit against the individual income tax for insurance premiums paid by individuals; delete the appropriation from the general fund for the high risk pool.
HFA (35, H. Anderson) - Prohibit insurers from excluding part-time employees who work at least 10 hours per week from group health insurance coverage made available by an employer who employs 10 or more full-time employees.
HFA (36, A. Maricle) - Amend to appropriate lottery proceeds to the state employee benefit fund.
HFA (37, P. Mason) - Create a new section to limit the amount a consumer can be charged for health care services to no more than 10% above the Medicare reimbursement rate for the same set of health care services.
HFA (38, S. Nunn) - Include a consideration of underwriting criteria of insurers that offer individual coverage in establishing the list of high-cost conditions; limit access to the high risk pool to those individuals who have been rejected by 2 insurers for coverage because of a high-cost condition.
HFA (39, A. Maricle) - Create a Catastrophic Health Insurance Program for Working Kentuckians to be operated by the Department of Insurance; define "eligible individual" and "high-deductible"; create a fund which will receive an amount not to exceed twenty million dollars ($20,000,000) from the Kentucky lottery trust account.
HFA (40, A. Maricle) - Authorize an amount not to exceed five million dollars ($5,000,000) to be transferred from the lottery trust account to the Kentucky comprehensive health insurance plan fund from the 1997-1998 fiscal year through the 1999-2000 fiscal year.
HFA (41, P. Mason) - Amend to require that all small group and group insurers offer coverage in the individual market as a condition of doing business in the state; require group insurers to offer the standard benefit plan to individuals.
HFA (42, P. Mason) - Require that any rebate resulting from a contractual arrangement between a health plan and a participating provider be passed along to enrollees in the form of premium reductions.
HFA (43, J. Gray) - Requires health insurance plans to base decisions to pay for trteatment of emergency medical conditions on the prudent layperson standard.
HFA (44, J. Richards) - Make technical corrections.
HFA (45, G. Stumbo) - Restrict amnesty to insurers who seek to reenter the state by February 1, 1998, rather than June 30, 1998.
HFA (46, G. Stumbo) - Delete the risk adjustment mechanism and general fund appropriation for the Kentucky Comprehensive Health Insurance Plan; add provision requiring assessment of insurers in proportion to shares of total health insurance premiums.
HFA (47, G. Stumbo) - Delete the Kentucky Comprehensive Health Insurance Plan and replace it with the Guaranteed Issue Funding Program.
HFA (48, G. Stumbo) - Delete the general fund appropriation for the Kentucky Comprehensive Health Insurance Plan.
HFA (49, M. Treesh) - Amend to delete the provisions that a health benefit plan issued as an individual policy to individual employees through or with the permission of a small employer be guarantee issued to all full-time employees of the employer.
HFA (50, M. Treesh) - Delete all provisions of SB1/GA/HCS and insert the following: Define terms for Subtitle 17 of KRS Chapter 304; define terms for Subtitle 18 of KRS Chapter 304; provide guaranteed issuance to eligible individuals, and modified guaranteed issuance to individuals who are not "eligible individuals"; require guaranteed issuance for small group market and eligible individuals; require compliance with HIPPA; prohibit preexisting condition exclusions for eligible individuals; provide for guaranteed renewability subject to limited exceptions; establish conditions under which an insurer can stop offering coverage in the individual market in Kentucky; provided for guaranteed renewability in the group market, subject to limited conditions; establish conditions under which an insurer can stop offering group coverage; provide amnesty for insurers who ceased doing business in Kentucky; establish a loss ratio guarantee for the filing and approval of rates; delete association provisions in KRS 304.18-050; subject HMOs to the provisions of this Act; provide that dependent benefits cover legally adopted children or any child for which the insured is a court appointed guardian; establish requirements for maternity coverage; prohibit the Kentucky Health Purchasing Alliance from renewing any business after January 1, 1998; prohibit provider sponsored integrated health delivery network from accepting new business from the effective date of the Act; remove references to standard health benefit plans; repeal various sections of KRS; provide for an emergency effective date.
HFA (51, P. Mason) - Create a new section of subtitle 17A, 17, 18, 32 and 38 of KRS Chapter 304 to require that 1997 premium rates for all health benefit plans issued under these subtitles remain in effect for calendar 1998 plus a composite rate increase of five percent.
HFA (52, B. Crall) - Delete the file and use provisions for health insurance rates; permit use of rates upon filing a guaranteed loss ratio.
HFA (53, B. Crall) - Delete all provisions of bill and restore health insurance statutes in existence prior to 1994 General Assembly Session; provide for guaranteed issuance, pre-existing conditions, portability, and renewability as required by federal law; provide for patient protections.
HFA (54, P. Mason) - Require the Finance and Administration Cabinet secretary on a quarterly basis to certify to the Interim Committee on Appropriations and Revenue the general fund savings realized from any managed care program for Medicaid recipients; Set forth the form of the certification report; Require certified savings be transferred to a trust account for utilization to improve the health care delivery system by providing health care coverage for additional categories of individuals and families with incomes up to 100% of federal poverty guidelines; Require the Medicaid commissioner to provide cost estimates for the plan, Require funds be utilized to make payment for a basic health benefit plan, limited to medically necessary acute care hospitalization, in-hospital physician care, and other necessary in-hospital services; Provide for individual and family financial contribution to the plan; Require the Medicaid commissioner to expand the plan to 200% of poverty as funds become available.
HFA (55, H. Anderson) - Delete all provisions of bill and restore health insurance statutes in existence prior to 1994 General Assembly Session; provide for guaranteed issuance, pre-existing conditions, portability, and renewability as required by federal law; provide for patient protections.
HFA (56, P. Mason) - Amend to require that all small group and group insurers, not exempt from ERISA, offer coverage in the individual market as a condition of doing business in the state; require group insurers to offer the standard benefit plan to individuals.
HFA (57, P. Mason) - Require that any subsequent savings from rebates due to a financial agreement between health plans and drug manufacturers be passed along as reduced premiums to enrollees.
HFA (58, S. Riggs) - Make technical changes; include long term care policies in definition of health insurance.
HFA (59, J. Gray) - Prohibit insurers from excluding any part-time employee from a group health benefit plan made available by the employer to all full-time employees if the part-time employee notifies the employer in writing during the enrollment period prior to the beginning of the policy period of the employee's desire for coverage; direct that nothing require an employer to pay all or part of the premium for a part-time employee requesting coverage under the group health benefit plan; define a part-time employee as an employee working at least 30 hours per week for the employer.
HFA (60, G. Stumbo) - Delete the Kentucky Comprehensive Health Insurance Plan and insert the Kentucky Guaranteed Issue Funding Program.
HFA (61, B. DeWeese) - Delete the Kentucky Comprehensive Health Insurance Plan and insert the Kentucky Guaranteed Issue Funding Program.
HFA (62, P. Mason) - Require the Finance and Administration Cabinet on a quarterly basis to certify to the Appropriations and Revenue Committee the general fund savings realized from any managed care program for Medicaid recipients; require the amount certified be transferred to a trust account to be utilized by the Human Resources Cabinet secretary to improve the health care delivery system by providing health care coverage for additional categories of individuals and families with incomes up to 100% of poverty; limit the benefit plan to fifteen days of medically necessary acute care hospitalization, in-hospital physician care, and laboratory and x-ray services; require individuals eligible for the basis benefit plan to make a $20 per month contribution to the plan; require families to make a $35 per month contribution; allow premium payments to be adjusted in accordance with family or individual incomes; Require the health benefit plan to be available when the savings achieved combined with applicants contributions are equivalent to the Medicaid commissioner's estimated cost for the plan.
HFA (63, M. Long) - Delete Section 60 of the bill, relating to certificates of need.
HFA (64, B. DeWeese) - Attach the provisions of HB 3.
HFA (65, B. Crall) - Delete all provisions of bill and restore health insurance statutes in existence prior to 1994 General Assembly Session; provide for guaranteed issuance, pre-existing conditions, portability, and renewability as required by federal law; provide for patient protections.
HFA (66, H. Anderson) - Delete the Kentucky Comprehensive Health Insurance Plan and insert the Kentucky Guaranteed Issue Funding Program.
HFA (67, P. Mason) - Require General Assembly members participating in the Kentucky Kare plan to have the option to accept or reject the rate freeze; require the Personnel Cabinet to provide enrolled and enrolling members of the General Assembly with a form for accepting or rejecting the rate freeze before the end of the current enrollment period.
HFA (68, P. Mason) - Clarify that every insurer participates in financing the Kentucky Comprehensive Health Insurance Plan instead of providing that every insurer participates in the Kentucky comprehensive Health Insurance Plan.
HFA (69, T. Riner) - Define "Medicare" and "Medicare supplement policy"; provide that insurers must market the standard health benefit plan as a Medicare supplement policy, if the insurer sells such policies.
HFA (70, T. Riner) - Define "Medicare" and "Medicare supplement policy"; provide that insurers must market standard health benefit plans as a Medicare supplement policy, if the insurer sells such policies.
CCR - Cannot agree and request appointment of free conference committee.
FCCR (Majority Report) - Adopt provisions of SB 1/GA Copy, rather than the House Committee Substitute; provide that the use of tobacco alone cannot constitute a high-cost condition; permit the creation of purchasing cooperatives by 100 or more individuals or organizations to purchase health insurance if they obtain a certificate of filing from the Commissioner; provide that a health benefit plan issued as an individual policy to individual employee or their dependents, through or with permission of a small employer, must be guarantee-issued to all full-time employees of the employer and comply with pre-existing exclusion provisions for group plans under federal law; allow health insurers to return to Kentucky without penalty, if they do so no later than June 30, 1998; provide that a rate filing must be approved or disapproved by the Commissioner within 60 days; allow rates to be used upon filing prior to action by the Commissioner; permit the Commissioner to hold a rate hearing; require the Commissioner to hold a hearing upon written request of the Attorney General; provide that if rates have been approved or deemed approved, the Commissioner may, if he determines the rates are in violation of the Insurance Code, withdraw approval and order a retroactive reduction of rates; permit reimbursement to insurers that wrote coverage for high risk persons between July 15, 1995 and the effective date of this Act for premium losses during the first five (5) renewals, to the extent funds are available; provide that high risk persons, for purposes of this provision, are individuals who enrolled in a modified community rated health benefit plan in the individual market and, at the time of enrollment, had a condition that would have caused the individual to be denied coverage under the insurer's underwriting guidelines in place immediately prior to July 15, 1995; require the Commissioner before he establishes the list of high-cost conditions to receive input from medical providers and specialists that deal with high-cost conditions and review current medical documentation on possible high-cost conditions; provide that during the transition from the effective date of this Act until the Kentucky Comprehensive Health Insurance Plan becomes operative that the Commissioner must contract with insurers to act on behalf of the Plan and provide guaranteed-issue policies to individuals; require the Plan to assume responsibility for those individuals when it commences operations; provide that losses incurred by the insurers during the transition period will be paid according to terms of the contract and be covered by funds of the Plan; provide that if a person covered under the Plan terminates Plan coverage, the 12-month waiting period to again apply for coverage will not apply to dependents who had coverage under the policy of that person who terminated Plan coverage; provide that under the requirement that plan benefits be reduced to the extent there is other coverage, "automobile medical payment or liability insurance" be changed to "basic or added reparation benefits" and "any med-pay provisions of a liability insurance policy"; require the annual report of the Commissioner that evaluates the Plan to also include an evaluation of the viability of a pay-or-play system; require the Commissioner to assess insurers each calendar year based upon the percentage of health insurance premiums written during the assessment period, subject to the percentage limitation in the statute; provide that on or before March 31, 1999 and each March thereafter, the Board of the KCHIP must certify to the Commissioner the balance of funds in the KCHIP; provide that if the Plan has a deficit, the Commissioner may impose one additional assessment, but the amount generated from the assessment may not exceed the amount generated from the assessment in 1998; provide that in a managed care plan the medical director must ensure that any decision to deny, reduce, or terminate a benefit or deny payment for a service because the service is not medically necessary, must be made by a physician, except that in the case of a service rendered by a chiropractor or optometrist, that decision must be made respectively by a chiropractor or optometrist; permit the Commissioner of the Department of Personnel, with approval of the Insurance Commissioner, to contract with insurers on behalf of state employees; provide that it is the intent of the General Assembly that any appropriation after the initial $5,000,000 shall not be assessed until the Commissioner has utilized the funds generated through the initial assessment against insurers and any premium tax revenues collected in each calendar year; provide that the $15,000,0000 appropriation is to supplement the reserves of the State Employee Benefit Fund.
Sep 30-introduced in Senate; to Appropriations and Revenue (S); reported favorably, 1st reading, to Calendar
Oct 1-2nd reading, to Rules; recommitted to Appropriations and Revenue (S)
Oct 6-reported favorably, to Rules with Committee Substitute; posted for passage in the Regular Orders of the Day for October 7, 1997; floor amendments (1) and (2) filed to Bill; floor amendments (3) through (22) filed to Committee Substitute
Oct 7-floor amendments (23) (24) and (25) filed to Committee Substitute; 3rd reading; floor amendments (1) (2) (4) (8) (11) (13) (15) (17) (19) and (20) withdrawn; floor amendments (5) (6) and (7) ruled not germane; floor amendments (3) (9) (10) (14) (16) (21) and (22) defeated; passed 21-14 with Committee Substitute and floor amendments (12) (18) (23) (24) and (25)
Oct 8-received in House; to Appropriations and Revenue (H); posting waived; reported favorably, 1st reading, to Calendar; recommitted to Appropriations and Revenue (H)
Oct 9-reported favorably, to Rules with Committee Substitute; 2nd reading; posted for passage in the Regular Orders of the Day for October 10, 1997; floor amendments (1) through (31) and (33) through (57) filed to Committee Substitute; floor title amendment (32) filed
Oct 10-3rd reading; floor amendments (1) (13) (14) (16) (26) (27) (31) (33) (37) (39) (40) (47) (51) (52) (53) (54) (56) and (57) defeated; floor amendments (19) and (34) ruled not germane; defeated 49-47 with Committee Substitute and floor amendments (2) (3) (4) (5) (6) (7) (9) (11) (17) (29) (38) (43) (44) and (45); reconsidered, placed in the Orders of the Day for October 13, 1997; floor amendments (58) through (68) filed to Committee Substitute
Oct 13-floor amendments (69) and (70) filed to Committee Substitute
Oct 14-Bill reconsidered, floor amendment (1) reconsidered; floor amendments (59) and (62) defeated; passed 70-30 with Committee Substitute and floor amendments (1) (2) (3) (4) (5) (6) (7) (9) (11) (17) (29) (38) (42) (43) (44) (45) (60) (67) and (68); received in Senate; posted for passage for concurrence in House Committee Substitute and floor amendments; Senate refused to concur in House Committee Substitute and floor amendments; received in House; posted for passage for receding from House Committee Substitute and floor amendments; House refused to recede from Committee Substitute and floor amendments; Conference Committee appointed in Senate; Conference Committee appointed in House; Conference Committee report filed in House and Senate; Senate and House adopted Conference Committee report; Free Conference Committee appointed in House and Senate
Oct 15-Senate adopted Free Conference Committee report, passed Bill 21-15; House adopted Free Conference Committee report, defeated Bill 49-50
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