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HB 315/FN/LM (BR 1059) - R. Damron, J. Barrows, L. Brandstetter, J. Callahan, S. Cave, B. DeWeese, J. Richards, G. Stumbo
AN ACT relating to health insurance, making an appropriation therefor, and declaring an emergency.
Create new sections of Subtitle 17A of KRS Chapter 304 to provide that insurers that provide health coverage for small employers must accept all individuals eligible for coverage in the group; the small group coverage must comply with provisions of the federal Health Insurance Portability and Affordability Act; require individual policies to be issued on a guaranteed issue basis; require all group plans to comply with federal law on pre-existing conditions and portability; prohibit pre-existing condition exclusions from applying to eligible individuals; require that coverage of individuals who do not meet the definition of eligible individual must comply with federal law for groups on pre-existing conditions; require guaranteed renewal of health insurance contracts; direct the commissioner to define a standard health benefit plan for the individual and small group markets; require insurers in the individual and small group markets to offer the standard plan; require guaranteed issuance of standard plan as allowed in Sections 2 and 3; require that applicants be given a benefits comparison that compares the standard plan with the policy being offered to the applicant; require the insurer that denies coverage in the individual market to issue a denial letter which includes a description of the Guaranteed Acceptance Program the name of a contact person; permit insurers that left the Commonwealth to apply to the Commissioner to reenter the health insurance market in the Commonwealth; amend KRS 304.17A-095 to require health insurers to submit a copy of rate filings to the Attorney General; allow the rate filing to be used after filing but before approval; require a rate hearing if one is requested by the Attorney General; create a new section of Subtitle 17A of KRS Chapter 304 to regulate rates for individual, small group, and association plans; create a new section of Subtitle 17A of KRS Chapter 304 to regulate rates for employer-organized association plans; prohibit the Health Purchasing Alliance from issuing or renewing any policies after the effective date of this Act and require the Alliance activities to terminate no later than June 30, 1999; prohibit issuance or renewal of standard plans approved under KRS 304.17A-160; prohibit an insurer from discriminating against providers willing to meet the terms and conditions for participation in the insurer's plans; authorize the commissioner to add to the statutory list of high-cost conditions; create the Kentucky Guaranteed Acceptance Program and require participation in the program by all insurers, reinsurers, and self-insured employer-controlled or bona fide associations; require insurers with 25 percent market share to be a program participating insurer; require insurers before July 1, 1998 that have less than 25 percent market share to advise the commissioner whether it will participate as a participating insurer or a supporting insurer; provide that a health benefit plan is a program plan if purchased by an individual who is not a state employee and who within the previous three years has been diagnosed with or treated for a high-cost condition and is not eligible for other coverage; provide that for a health benefit plan that is a program plan at the time of first issuance, an insurer may charge an annual premium up to 150 percent of the index rate charge to a person with similar characteristics but without a high-cost condition; require insurers to report certain information to the commissioner each fiscal year; require the department to calculate insurers' assessments and refunds each fiscal year; require the department to establish a risk assessment process, including a program account; provide that the program account shall be funded by appropriations from the General Assembly, premium taxes, annual assessments of reinsurers, assessments on health benefit plan premiums, special assessments, gifts and grants, and interest or other earnings on the fund investments; permit insurers to include amount of assessments in any rate filing; require the Commissioner to report on the program to each session of the General Assembly; require the Auditor of Public Accounts to audit the program; create patient protection provisions; require insurers to disclose to enrollees, among other things, covered services, prior authorization requirements, right to appeal, a current participating provider directory, financial incentives between providers under contract with the insurer and other providers to which participating providers refer patients; and the plan's standard for waiting times for appointments; require managed care plans to show it offers an adequate number of accessible hospital services and primary care providers; require insurers to establish standards for selection of providers; require for provision of continuity of care upon removal or withdrawal of provider; prohibit a provider being penalized for discussing with enrollee medically necessary or appropriate care; require managed care plans to have drug utilization programs; require disclosure of limits on coverage for any treatment, procedure, drug, or device; require managed care plan to appoint a medical director; provide for offer of out-of-network benefits; provide for patient's right of privacy; permit a employer-organized association to self-insure; create a new section of KRS Chapter 6 to require a financial impact statement for mandated health benefits; create a new section of Subtitle 2 of KRS Chapter 304 to create in the Department of Insurance a Consumer Protection and Education division; amend KRS 304.17A-150 on unfair trade practices; amend KRS 304.14-130 to make technical change; amend KRS 304.18-050 to delete association exemption; amend KRS 304.14-120, 304.38-200, 304.17A-145, 304.17A-170, 304.38-050, 216.2923, to make technical change; amend KRS 304.17A-080 to permit the Health Insurance Advisory Council to make recommendations on high-cost conditions; amend KRS 304.17A-010 to delete mandatory membership; amend KRS 304.12-085 to prohibit denial, cancellation, or refusal to renew coverage because of a genetics test; amend KRS 304.38-080 to delete open enrollment for health maintenance organizations; amend KRS 141.010 to allow individual income tax deductions for payments for health insurance; repeal KRS 304.17A-090 on commissioners review of rates; repeal as of July 1, 1999, 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-120 304.17A-160; appropriate $10,000,000 to the Kentucky Guaranteed Acceptance Program; EMERGENCY.
HB 315 - AMENDMENTS
HCS (1/FN/LM) - Retain provisions of the bill as introduced and make the following changes: delete definition of purchasing cooperative in Section 1; amend KRS 304.12-085 in Section 55 to clarify that the provisions apply only to health benefit plan coverage.
HCS (2/FN/LM) - Retain the provisions of first committee substitute and make the following changes: amend the definition of "guaranteed acceptance program qualified individual" to delete requirement that the individual does not hold a valid certificate of insurability; delete all references to reinsurer and replace with "stop-loss carrier"; add "provider sponsored integrated health delivery network" as a "health benefit plan"; amend provisions relating to the offering of health benefit plan coverage; amend required issuance provisions; clarify provisions relating to nonrenewability; require applications for health benefit plans to be retained for 5 years rather than 1 year; allow services to be obtained from health departments; make technical corrections to rate filing provisions; amend provisions relating to rate increases; include the Medicaid program as a willing provider; clarify provisions relating to the establishment of the Kentucky Guaranteed Acceptance Program; delete definition of "first issuance"; amend assessment provisions to apply to a calendar year rather than a fiscal year; amend provisions relating to plans included in determining assessments and refunds; amend provisions relating to maximum premiums that may be charged; clarify the ability of the department of insurance to assess insurers; amend provisions relating to the duties of the Health Insurance Advisory Council.
HFA (1/FN, B. Crall) - Require a health facility to include itemized statement with invoice; repeal provider tax on hospital services.
HFA (2, H. Anderson) - Require an assessment of $1 per month per covered life on insurers, stop-loss carriers, and third party administrators to fund the guaranteed acceptance program.
HFA (3, H. Anderson) - Delete the appropriation for the guaranteed acceptance plan.
HFA (4/FN, H. Anderson) - Delete the provisions of the Act 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 (5, R. Damron) - Establish a deadline of September 1, 1998 for health insurers that have left the state to apply for approval to reenter the Kentucky market.
HFA (6, H. Anderson) - Amend KRS 161.158, relating to insurance provided through the local board of education, to authorize a school district to contract for health insurance if the county is served by fewer than 3 different carriers under the state contract, and transfer the allotment for state employee health insurance to the district for employees selecting that option; amend KRS 304.17A-010, relating to definitions for health benefit plans, to delete elected and salaried employees of local school districts from the definition of mandatory alliance member and include those employees in the definition of voluntary alliance member; amend KRS 18A.225, relating to state employee health insurance coverage, to delete from the definition of state employee those elected and salaried employees who elect coverage provided through the local board of education.
HFA (7, R. Damron) - Exempt from the guaranteed acceptance plan all self-insured plans covering employees of institutions of higher education and self-insured plans covering elected and salaried employees of cities, counties, urban-counties, charter counties, and special districts.
HFA (8, B. Crall) - Require a health care facility to include an itemized statement of services rendered and charges incurred by the patient with the invoice sent to the patient.
HFA (9, B. Crall) - Make title amendment.
HFA (10, H. Anderson) - Delete the appropriation and establish an assessment of $1 per month per covered life from each insurer, stop-loss carrier, and third party administrator.
HFA (11, R. Damron) - Restrict participation of the state employee health insurance fund in the guaranteed acceptance program.
SCS/FN/LM - Retain the original provisions and allow insurer renewing a nonstandard health benefit plan issued prior to July 15, 1995 to limit the renewal of that nonstandard plan, and require that the insurer not be considered as doing business in the individual market, as further defined in the Act; delete the definition of "health status"; establish a cap on the number of persons with high cost conditions that must be accepted by insurers who were not writing coverage in Kentucky on January 1, 1998; permit health insurer to use their own underwriting criteria for high cost conditions; permit insurers to re-enter the Kentucky health insurance market without penalty, if they apply to the commissioner by January 1, 1998; prohibit the alliance from writing any new business after June 1, 1998; provide that the sum of the first and second assessment shall not exceed one percent (1%) of the total amount of all assessable health benefit plan premiums written during the prior assessment period; exclude an employer-sponsored self-insurance health benefit plan exempted by ERISA from the definition of "guaranteed acceptance plan supporting insurer"; require disclosure of certain information to a small employer when a health benefit plan is offered to a small employer; amend KRS 304.18-200 to include directors as employees under the definition of group health insurance; repeal KRS 304.17A-130 on risk adjustment process.
SCA (1, G. Neal) - Establish a cap on the number of persons with high cost conditions that must be accepted by insurers who were not writing coverage in Kentucky on January 1, 1998; permit health insurer to use their own underwriting criteria for high cost conditions; permit insurers to re-enter the Kentucky health insurance market without penalty if they apply to the commissioner by September 1, 1998; prohibit the alliance from writing any new business after June 1, 1998; provide that the sum of the first and second assessment shall not exceed one percent of the total amount of all assessable health benefit plan premiums written during the prior assessment period.
SCA (2, J. Pendleton) - Provide that a guaranteed acceptance plan supporting insurer covered under ERISA not include an employer-sponsored self-insured health benefit plan.
SFA (3, E. Scorsone) - Require plans to provide patients with easily understood information, and the opportunity to decide among treatment options; prohibit discrimination against consumers of health services and applicants for coverage based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, genetic information, or source of payment; require health care providers to provide consumers with considerate, respectful care at all times and under all circumstances.
SFA (4, E. Scorsone) - Require that qualified health care providers be available to women to provide routine and preventative women's health services; require direct access to specialists for persons with complex or serious medical conditions; require continuity of care from specialty health care providers.
SFA (5, E. Scorsone) - Provide that consumers have the right to communicate with health care providers in confidence and have the confidentiality of their individually identifiable health care information protected.
SFA (6, E. Scorsone) - Require plans to educate insureds about availability of and appropriate use of emergency care; require plans to cover emergency department screening and stabilization services.
SFA (7, E. Scorsone) - Require that health insurers disclose a general summary of all covered benefits and types of dispute resolution procedures; require insurers that offer a managed care plan to disclose information on primary care providers and specialists, provider compensation methods, rules for out-of-network services, and access to urgent care centers, names of contracting health care facilities, preauthorization and utilization requirements, use of clinical protocols, special disease programs, whether a drug is included in a formulary, and qualifications of reviewers at the primary and appeal levels.
SFA (8, E. Scorsone) - Require an insurer that offers a managed care plan to exercise ordinary care and hold liable for damages for harm to an insured or enrollee caused by its failure to exercise ordinary care.
SFA (9, N. Kafoglis) - Allow insurer renewing a nonstandard health benefit plan issued prior to July 15, 1995 to limit the renewal of that nonstandard plan, and require that the insurer not be considered as doing business in the individual market as further defined in the Act.
SFA (10, D. Boswell) - Require a health facility to provide a summary statement of services and charges rather than an itemized statement; require each invoice to indicate that an itemized statement may be obtained upon request.
SFA (11, J. Rose) - Amend to delete certain prohibitions regarding genetic tests.
SFA (12, J. Rose) - Delete Section 55 and insert a provision that prohibits an insurer from requesting or requiring an individual to submit to a genetic test as a condition of issuance or renewal; prohibit disclosure of genetic test results if the individual is insured or the applicant is applying for coverage substantially similar to prior coverage and the prior coverage was continuous to a date not more than 63 days prior to the effective date of new coverage; permit insurer to require applicant to disclose genetic test results if the applicant is not insured for more than 63 days immediately preceding the effective date of the coverage for which the applicant applied.
SFA (13, G. Neal) - Delete the definition of "health status"; establish a cap on the number of persons with high cost conditions that must be accepted by insurers who were not writing coverage in Kentucky on January 1, 1998; permit health insurer to use their own underwriting criteria for high cost conditions; permit insurers to re-enter the Kentucky health insurance market without penalty if they apply to the commissioner by September 1, 1998; prohibit the alliance from writing any new business after June 1, 1998; provide that the sum of the first and second assessment shall not exceed one percent (1%) of the total amount of all assessable health benefit plan premiums written during the prior assessment period; exclude an employer-sponsored self-insured health benefit plan exempted by ERISA from the definition of "guaranteed acceptance plan supporting insurer"; require disclosure of certain information to a small employer when a health benefit plan is offered to a small employer; amend KRS 304.18-020 to include directors as employees under the definition of group health insurance; repeal KRS 304.17A-130 on risk adjustment process.
SFA (14, R. Roeding) - Delete the deadline of September 1, 1998 for notification to the Commissioner of an insurer's intent to reenter the Kentucky insurance market.
SFA (15, D. Nunnelley) - Add a new section which requires that the provisions of KRS 142.311 as they relate to the tax on prescription drugs will stay in effect until June 30, 1999.
SFA (16, E. Scorsone) - Require health benefit plans to educate insureds on availability of emergency and other medical services; require health benefit plans to cover emergency department screening and stabilizations services both in and out of network; require that emergency department personnel contact the patient's primary care provider or health benefit plan as quickly as possible for follow-up and post stabilization services to promote a continuity of care.
SFA (17, E. Scorsone) - Require that an enrollee undergoing a course of treatment be allowed to continue treatment with specialty health care provider for up to 90 days, in the event that the enrollee must make a change in the plan, either through the provider's termination from the plan or other cause; require the specialty health care provider to accept the new health plan's rates as payment in full; require the specialty health care provider to provide necessary information to the new plan; and require the prompt transfer of all the patient's medical records.
SFA (18, E. Scorsone) - Allow enrollee in health benefit plan who requires specialty care to have direct access to a qualified specialist of his or her choice within a plan's network of health care providers.
SFA (19, E. Scorsone) - Require that women shall be able to choose a qualified health care provider offered by a plan for the provision of covered care necessary to provide routine and preventive women's health care services.
SFA (20, J. Rose) - Create a new section of KRS 141 to provide an exclusion from gross income for amounts paid for health insurance for taxable years beginning after December 31, 1997.
SFA (21, J. Rose) - Amend KRS 141.010 to allow an exclusion from gross income for amounts paid for health insurance for taxable years beginning after December 31, 1998.
SFA (22, J. Rose) - Amend KRS 141.010 to allow an exclusion from gross income for amounts paid for health insurance equal to 80% of the amounts paid for the 1998 taxable years and equal to 100% of the amounts paid for taxable years beginning after December 31, 1998.
SFA (23, D. Nunnelley) - Add a new section which requires that the provisions of KRS 142.311 as they relate to the tax on prescription drugs will stay in effect until June 30, 1999.
SFA (24, D. Boswell) - Require a health care facility to provide a summary statement of services and charges;
penalty.
SFA (25, E. Scorsone) - Require health benefit plans to educate insureds on availability of emergency and other medical services; require health benefit plans to cover emergency department screening and stabilizations services both in and out of network; require that emergency department personnel contact the patient's primary care provider or health benefit plan as quickly as possible for follow-up and post-stabilization services to promote a continuity of care.
SFA (26, E. Scorsone) - Allow enrollee in health benefit plan who requires specialty care to have direct access to a qualified specialist of his or her choice within a plan's network of health care providers.
SFA (27, E. Scorsone) - Require that an enrollee undergoing a course of treatment be allowed to continue treatment with specialty health care provider for up to 90 days, in the event that the enrollee must make a change in the plan, either through the provider's termination from the plan or other cause; require the specialty health care provider to accept the new health plan's rates as payment in full; require the specialty health care provider to provide necessary information to the new plan, and require the prompt transfer of all the patient's medical records.
SFA (28, E. Scorsone) - Require that women shall be able to choose a qualified health care provider offered by a plan for the provision of covered care necessary to provide routine and preventive women's health care services.
SFA (29, J. Rose) - Delete Section 55 and insert a provision that prohibits an insurer from requesting or requiring an individual to submit to a genetic test as a condition of issuance or renewal; prohibit disclosure of genetic test results if the individual is insured or the applicant is applying for coverage substantially similar to prior coverage and the prior coverage was continuous to a date not more than 63 days prior to the effective date of new coverage; permit insurer to require applicant to disclose genetic test results if the applicant is not insured for more than 63 days immediately preceding the effective date of the coverage for which the applicant applied.
SFA (30, J. Rose) - Delete Section 55 on use of results of genetic tests.
SFA (31, J. Rose) - Define "genetic test."
SFA (32, J. Rose) - Amend KRS 142.311 to provide that the provider tax on prescription drugs shall be $0.15 after July 1, 1999; provide that there shall be no provider tax on prescription drugs after July 1, 2000; amend KRS 142.303 and 142.307 to conform; amend KRS 141.010 to allow an exclusion from gross income for amounts paid for health insurance equal to 70% of the amounts paid for the 1999 taxable year and equal to 100% of the amounts paid for taxable years beginning after December 31, 1999.
SFA (33, D. Nunnelley) - Add a new section which amends KRS 142.311 to require that the provisions of KRS 142.311, or any part of KRS 142.303 and 142.307 which may impose a tax on prescription drugs, expire on June 30, 1999.
SFA (34, J. Pendleton) - Amend KRS 142.301 to provide that hospital services does not include services provided to individuals covered under a federal employee health benefit plan.
Jan 16-introduced in House
Jan 20-to Banking and Insurance (H); posting waived
Jan 21-posted in committee
Jan 22-reported favorably, 1st reading, to Calendar with Committee Substitute
Jan 23-2nd reading, to Rules; recommitted to Appropriations and Revenue (H); posted in committee
Feb 3-reported favorably, to Rules with Committee Substitute (2); posted for passage in the Regular Orders of the Day for February 4, 1998
Feb 5-floor amendment (1) (2) (3) (4) (5) (6) and (7) filed to Committee Substitute (2)
Feb 6-floor amendments (8) (9 Title) (10) and (11) filed to Committee Substitute (2)
Feb 9-3rd reading, floor amendments (3) (4) (6) and (10) defeated; passed 68-30 with Committee Substitute (2) and Floor Amendments (7) (8) and (11)
Feb 10-received in Senate
Feb 11-to Health and Welfare (S)
Mar 5-reported favorably, 1st reading, to Calendar with Committee Amendment (1)
Mar 6-2nd reading, to Rules
Mar 9-recommitted to Appropriations and Revenue (S)
Mar 12-reported without opinion with committee amendment (2); to Rules (S)
Mar 13-floor amendments (3) (4) (5) (6) (7) (8) and (9) filed
Mar 16-posted for passage in the Regular Orders of the Day for March 18, 1998
Mar 17-floor amendments (10) (11) (12) (13) and (15) filed; floor amendment (14) filed to committee amendment (1)
Mar 18-recommitted to Appropriations and Revenue (S)
Mar 23-floor amendments (16) (17) (18) (19) and (23) filed; floor amendments (20) (21) (22) and (24) filed to Committee Substitute; reported favorably, to Rules with Committee Substitute
Mar 24-floor amendments (25) through (34) filed to Committee Substitute; posted for passage in the Regular Orders of the Day for March 25, 1998
Mar 25-3rd reading,; committee amendments (1) and (2) ruled out of order; floor amendments (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) and (23) ruled out of order; floor amendments (20) (22) (30) (32) and (34) withdrawn; floor amendments (26) (29) and (31) defeated; passed 27-5-4 with Committee Substitute and floor amendments (21) (24) (25) (28) and (33)
Mar 26-received in House; posted for passage for concurrence in Senate amendments
Mar 31-House concurred in Senate Committee Substitute and Senate floor amendments (21) (24) (25) (28) and (33); passed 86-12
Apr 1-enrolled, signed by each presiding officer, delivered to Governor
Apr 10-signed by Governor
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