00RS HB202


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HB 202/FN/HM (BR 981) - S. Westrom, C. Belcher, M. Cherry, H. Collins, B. Colter, R. Damron, J. Jenkins, T. McKee, R. Palmer, R. Palumbo, W. Scott, J. Turner, J. Wayne

     AN ACT relating to inherited metabolic disease.
     Amend KRS 205.560 to require medical coverage for special medical formulas for treatment of inherited metabolic disease; amend KRS 213.141 to increase birth certificate copy fee from $9 to $10 and to require $1 fee to provide coverage for inherited metabolic disease products to uninsured children; amend KRS 214.155 to require the Cabinet for Health Services to make available to families the names and addresses of health care providers when infants test positive for inborn errors of metabolism; create new section of Subtitle 17A of KRS Chapter 304 to require coverage of newborn child from the moment of birth, including care and treatment of medically diagnosed congenital defects and birth abnormalities, establish a time period of 31 days after the date of birth to pay the required fees or premiums necessary, require coverage for inherited metabolic disease drugs, and require that coverage apply to health benefit plans delivered on and after the effective date of Act.


     HCS/FN/HM - Retain original provisions; clarify that cabinet program shall pay for amino acid modified preparations and low-protein modified food products if those formulas and products are not covered under any public or private health benefit plan; remove cap on medical formulas.
     HFA (1, S. Westrom) - Define the specific inherited metabolic diseases that fall within prescription coverage of the public assistance program and health insurance.
     SCS/HM - Retain original provisions; clarify that the provisions only apply to the listed metabolic diseases; permit a health benefit plan to cap the benefit for metabolic food prescriptions and medical formulas at $4,000; clarify that provisions do not apply to the treatment of lactose intolerance, protein intolerance, food allergy, food sensitivity, or any other condition or disease other than the listed metabolic diseases.
     SFA (1, J. Rose) - Amend KRS 304.17A-545 to require the medical director to sign any denial letter required under KRS 304.17A-540.
     SFA (2/Title, J. Rose) - Make title amendment.
     SFA (3, J. Rose) - Retain original provisions; establish Subtitle 17B of KRS Chapter 304 and create new sections thereof to create the Kentucky Health Care Improvement Authority; designate 13 members and name the Insurance Commissioner as chair; provide that 70 percent of moneys in the fund be placed in the Kentucky Access Fund, 20 percent be spent on collaborative partnership between the University of Louisville and the University of Kentucky dedicated to lung cancer research, and 10 percent be spent to discourage the use of harmful substances by minors; create Kentucky Access to assure health coverage is made available to each Kentucky resident; provide that Kentucky Access shall operate under the supervision of the Department of Insurance; provide that the department select a third-party administrator to administer Kentucky Access; direct the department to establish the schedule of rates, premiums, deductibles, copayments amounts, coinsurance amounts, and other cost-sharing amounts; provide that health coverage begin no sooner than January 1, 2001; require the department to separate its duties and responsibilities in operating the department from its duties and responsibilities in operating Kentucky Access; require a statewide provider network; provide that initial premium rates shall not exceed 150% of the applicable individual standard risk rates, and that premium rates in no event shall exceed 175% of the rates applicable to individual standard risks; provide that an "eligible individual" is eligible for coverage if the person has been a Kentucky resident for at least 12 months if the person has been rejected by at least 2 insurers or has been offered coverage substantially similar to Kentucky Access coverage at a premium greater than the Kentucky Access premium or the person has a high-cost condition; direct that a Kentucky Access enrollee whose premiums have exceeded claims for 3 years be given a notice of insurability to be used to obtain insurance in the regular individual market; prohibit certain persons from eligibility for Kentucky Access, including persons eligible for Medicare or Medicaid, persons terminated by Kentucky Access less than 12 months ago, persons who have received $2 million in Kentucky Access benefits, and prisoners; to provide that the department evaluate and revise as necessary rates to be charged to enrollees; require Kentucky Access to provide at least 3 health benefit plans, at least one of which must be the standard plan and at one of which must be a traditional fee-for-service form; prohibit pre-existing condition exclusions for "eligible individuals" but permit them for others; permit the department to assess all insurers to fund GAP loses prior to September 30, 2002, and to fund Kentucky Access; provide as funding sources for Kentucky Access the premiums paid by enrollees, funds designated in the Kentucky Health Care Improvement Fund, appropriations, premium taxes, annual assessments of insurers, second assessment of insurers, gifts and grants, interest on earnings, and funds in GAP account on October 1, 2000; allow insurers to include assessments in any rate filing; require GAP participating insurers to report certain information; direct that GAP be terminated on October 1, 2000; exempt Kentucky Access and the department from state and local taxes; provide that GAP participating insurers shall be reimbursed for actual guaranteed acceptance program losses only if money is available after funding Kentucky Access; require the department to submit an annual report to the General Assembly 60 days prior to each regular session; amend KRS 304.17A-005 to conform, amend KRS 304.17A-080 to increase number of members on Health Insurance Advisory Council from 7 to 9, by adding 2 agents' representatives; amend KRS 304.17A-0952 to provide that premium rates charged to an individual may vary from the index rate by 50 percent or less for two consecutive years from the date of implementation of Kentucky Access; permit an adjustment of 20 percent for individual, small group, or association rates; provide that the premium rate charged to a small group or association shall not vary from the index rate by more than 40 percent for 2 consecutive years; allow insurers to establish a separate class of business to separate guaranteed acceptance program qualified individuals from other individuals; amend KRS 304.17A-150 to conform; amend KRS 304.17A-250 to require in the individual market that the insurer must offer the standard plan; require the denial letter after October 1, 2000, to include a description of Kentucky Access; amend KRS 304.17A-260 to permit insurers who ceased operating in Kentucky to reenter until January 1, 2001; amend KRS 304.17A-320 to conform; specify requirements for minimum loss ratio filing; require audit of minimum loss ratio results; require insurers to refund premiums necessary to bring actual loss ratio up to the guaranteed minimum loss ratio; amend KRS 304.17A-080, KRS 304.17A-095, KRS 304.17A-150, KRS 304.17A-250, KRS 304.17A-290, and KRS 304.17A-320 to conform; repeal the following statutes: KRS 304.17A-400, KRS 304.17A-410, KRS 304.17A-420, KRS 304.17A-430, KRS 304.17A-440, KRS 304.17A-450, KRS 304.17A-460, KRS 304.17A-470, and KRS 304.17A-480.
     SFA (4, J. Rose) - Create a new section of KRS Chapter 304.17A to prohibit an insurer that offers multiple health plans from requiring a health care provider from participating in another plan as a condition of participating in any plan; declare the practice to be an unfair trade practice and the contract provision to be void and subject to cease and desist remedy.
     SFA (5, R. Leeper) - Amend KRS 304.17A-150 to provide that it is an unfair trade practice for an insurer to pay a claim without sending an explanation of benefits if financial responsibility of the enrollee is involved for an amount other than a copayment; provide that it is an unfair trade practice for an insurer to deny a claim without sending an explanation of benefits.

     (Prefiled by the sponsor(s))

     Jan 4-introduced in House; to Health and Welfare (H)
     Jan 5-posted in committee
     Jan 18-reported favorably, 1st reading, to Calendar with Committee Substitute
     Jan 19-2nd reading, to Rules
     Jan 20-recommitted to Appropriations and Revenue (H)
     Feb 18-posted in committee
     Mar 14-reported favorably, to Rules with original Committee Substitute ; posted for passage in the Regular Orders of the Day for Wednesday, March 15, 2000
     Mar 15-floor amendment (1) filed to Committee Substitute
     Mar 17-3rd reading, passed 94-0 with Committee Substitute, floor amendment (1)
     Mar 20-received in Senate
     Mar 21-to Health and Welfare (S)
     Mar 24-reported favorably, 1st reading, to Calendar with Committee Substitute
     Mar 27-2nd reading, to Rules; posted for passage in the Regular Orders of the Day for Monday, March 27, 2000; placed in the Orders of the Day for Tuesday, March 28, 2000; floor amendments (1) (3) (4) and (5) filed to Committee Substitute, floor amendment (2-title) filed
     Mar 28-3rd reading; floor amendments (1) (2-title) (3) (4) and (5) withdrawn ; passed with 30-5 Committee Substitute ; received in House; posted for passage for concurrence in Senate Committee Substitute
     Mar 29-House concurred in Senate Committee Substitute ; passed 90-0; enrolled, signed by Speaker of the House
     Apr 11-enrolled, signed by President of the Senate; delivered to Governor
     Apr 21-signed by Governor (Acts ch. 457)

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