HB 390/FN/HM (BR 1489) - S. Johns, J. Adams, Ro. Adams, R. Adkins, S. Alexander, H. Anderson, J. Arnold Jr., A. Arnold, E. Ballard, J. Barrows, P. Bather, C. Belcher, L. Belcher, J. Bowling, I. Branham, J. Bruce, B. Buckingham, T. Burch, De. Butler, Dw. Butler, J. Callahan, M. Cherry, P. Childers, L. Clark, P. Clark, J. Coleman, H. Collins, B. Colter, J. Crenshaw, R. Damron, C. Geveden, J. Gooch, G. Graham, J. Gray, J. Haydon, B. Heleringer, C. Hoffman, D. Horlander, J. Jenkins, E. Jordan, T. Kerr, J. Lee, M. Marzian, T. McKee, C. Miller, H. Moberly, F. Nesler, S. Nunn, R. Palmer, R. Palumbo, B. Polston, J. Richards, S. Riggs, T. Riner, W. Scott, C. Siler, A. Simpson, D. Sims, J. Stacy, K. Stein, J. Stewart, G. Stumbo, R. Thomas, J. Thompson, J. Turner, J. Vincent, J. Wayne, M. Weaver, R. Webb, S. Westrom, R. Wilkey, P. Worthington, B. Yonts
AN ACT relating to health insurance.
Amend KRS 304.17A-500 to include definitions for "adverse determination", "life threatening", "medical necessity", and other terms, and to define "complainant" as an enrollee, physician, provider, or other person designated to act on behalf of an enrollee; create a new section of KRS 304.17A to require an insurer that offers a managed care plan to disclose, in writing, certain information regarding emergency care services and other services and those circumstances in which an OB/GYN may serve as a primary care provider to an enrollee, both at the time of enrollment and upon request; amend KRS 304.17A-520 to require each plan application form to include a space for an enrollee to select a primary care provider, and specify that a managed care plan may limit an enrollee's request to change providers to no more then four (4) changes in any twelve (12) month period; create a new section of KRS 304.17A to require an insurer that offers a managed care plan to notify a group contract holder, within thirty (30) calendar days, of substantive changes to a payment arrangement between the managed care plan and providers, to require insurers that offer managed care plans to establish procedures providing access to a member handbook, to the internal system for complaints, and to the independent external review process to certain disabled enrollees; create a new section of KRS 304.17A to require insurers that offer managed care plans to establish and maintain an internal system for the resolution of complaints, either oral or written, to require that the managed care plan investigate and resolve each complaint within thirty (30) days, to require that complaints concerning emergencies or denial of continued stays for hospitalization be resolved within one (1) day from receipt of complaint, to require the managed care plan to issue a response letter to complainant with certain specific information, to allow an enrollee immediate appeal to an independent external review organization in a circumstance involving a life-threatening condition, to require the managed care plan to maintain a record of complaints, proceedings, and actions for three (3) years, to allow a free copy of the record on the complaint to the complainant; create a new section of KRS 304.17A to prohibit an insurer that offers a managed care plan from engaging in any retaliatory action against a group contract holder, enrollee, physician, or provider who filed a complaint against the managed care plan or appealed a decision of the managed care plan; amend KRS 304.17A-525 to require notice sixty (60) days prior to termination of participation of an enrollee's primary care provider; create a new section of KRS 304.17A to define "special circumstance", to create an opportunity for the treating provider to continue treatment of the enrollee, to clarify that the obligation of the managed care plan to reimburse the provider for ongoing treatment of an enrollee does not extend beyond certain specified limits, to establish a payment plan of capitation amount to the enrollee's provider; to create a new section of KRS 304.17A to establish the Independent Health Care Appeals Program in the Department of Insurance, to require an enrollee to apply for review within sixty (60) days of the date of the final decision issued by the managed care plan, and to require enrollees to include certain information with the application for review; create a new section of KRS 304.17A to require the commissioner to contract with one (1) or more independent external review organizations to conduct the independent external review, to promulgate administrative regulations regarding certification, selection, and operation of independent external review organizations, to establish procedures and standards regarding the independent external review; create a new section of KRS 304.17A to require the independent external review organization to state its findings in writing, to require the managed care plan to comply with the determination, and to pay for the external review according to a schedule of fees established by the commissioner; create a new section of KRS 304.17A to establish the certification requirements of an independent external review organization; create a new section of KRS 304.17A to allow the commissioner to promulgate administrative regulations, to require the commissioner to appoint an advisory committee to advise him in the development of the Independent Health Care Appeals Program; create a new section of KRS 304.17A to require the commissioner to report every six (6) months to the Interim Joint Committee on Banking and Insurance and to the Governor on the status of the Independent Health Care Appeals Program; amend KRS 304.17A-505, 211.464, 304.17-412, 304.18-045, 304.32-147 and 304.38-225 to conform; cite this bill as the Health Care Protection Act.
HB 390 - AMENDMENTS
HCS (1/FN/HM) - Create new sections of Subtitle 17A of KRS Chapter 304 to define terms; to establish a system of utilization review; to establish requirements for internal appeal; to establish the Independent External Review Program in the Department of Insurance; to establish the criteria for an external review program; to establish the standards for determinations of an independent review entity; to establish the requirements for certification of an independent review entity; to require the commissioner to promulgate administrative regulations and to report to the Interim Joint Committee on Banking and Insurance and to the Governor regarding the program every six (6) months; to define "emergency medical condition"; to define "special circumstances"; to permit certain persons with chronic, disabling, or life-threatening illnesses to utilize a nonprimary care specialist as a primary care provider for a 12 month period or during the contract period without additional referral from a primary care provider; to permit certain persons with chronic gynecological problems or pregnant covered persons to utilize an obstetrician or gynecologist as a primary care provider for a 12 month period, or during the contract period without additional referral from a primary care provider; amend KRS 304.17A to establish that when a covered person seeks a second opinion, no more than the covered person's normal copay will be required; amend KRS 304.12-230 to establish that failing to comply with the decision of an independent review entity is an unfair practice; amend KRS 304.17-412, 304.17A-505, 304.18-045, 304.32-147, 304.32-330, 304.38-225, 304.47-050, 211.990 to conform; and to repeal KRS 211.461, 211.462, 211.463, 211.464, 211.465, and 211.466.
HCS (2/FN/HM) - Retain provisions of HCS; require department to establish fees for applications and renewals; make technical corrections.
HFA (1, H. Collins) - Amend to include covered persons with congenital conditions in the "special circumstances" category and to allow those same covered persons, after referral by their primary care physician, to see a specialist without further referral by their primary care physician for the contract period or for twelve (12) months.
HFA (2, S. Johns) - Amend to require the commissioner of the department of insurance to establish fees for applications and renewals regarding utilization review agents; make technical corrections; and repeal KRS 311.131, 311.132, 311.133, 311.134, 311.135, 311.136, 311.137, 311.138, 311.139.
HFA (3, S. Johns) - Amend to require health care professionals acting as reviewers for an independent review entity to be certified by a recognized health care professional board.
HFA (4, H. Collins) - Amend to include covered person with congenital conditions in the "special circumstances" category and to allow those same covered persons, after referral by their primary care physician, to see a specialist without further referral by their primary care physician for the contract period or for twelve (12) months.
SFA (1, J. Rose) - Attach provisions of SB 343 to HB 390/GA.
SFA (2, J. Rose) - Attach provisions of HB 371 to HB 390/GA.
SFA (3, J. Rose) - Attach the provisions of SB 98/GA.
SFA (4, J. Rose) - Retain original provisions and add a new section to amend KRS 205.5632 to require drugs that are comparable in pharmacological category, clinical application, and cost to other FDA-approved prescription drugs that are currently on the Medicaid nonprior-authorized shall also be placed on the nonprior authorized file, require administrative regulations to address drug comparability and define pharmacological category.
SFA (5/Title, J. Rose) - Make title amendment.
Jan 18-introduced in House
Jan 19-to Banking and Insurance (H)
Jan 27-posted in committee
Feb 17-reported favorably, 1st reading, to Calendar with Committee Substitute
Feb 18-2nd reading, to Rules
Feb 25-recommitted to Appropriations and Revenue (H); floor amendment (1) filed to Committee Substitute
Feb 28-posted in committee; floor amendment (2) filed to Committee Substitute
Mar 9-reported favorably, to Rules with Committee Substitutes (1) and (2)
Mar 10-posted for passage in the Regular Orders of the Day for Monday, March 13, 2000; floor amendment (3) filed to Committee Substitute (2)
Mar 13-floor amendment (4) filed to Committee Substitute (2)
Mar 14-3rd reading, passed 91-0 with Committee Substitute (2), floor amendments (2) (3) and (4)
Mar 15-received in Senate
Mar 17-to Health and Welfare (S)
Mar 22-reported favorably, 1st reading, to Consent Calendar
Mar 23-2nd reading, to Rules; posted for passage in the Consent Orders of the Day for Friday, March 24, 2000
Mar 24-floor amendments (1) (2) (3) (4) and (5-title) filed ; 3rd reading, passed 38-0; received in House; enrolled, signed by each presiding officer, delivered to Governor
Mar 31-signed by Governor (Acts ch. 262)