HB 445 (BR 1497) - T. Thompson, B. Smith, R. Adams, R. Adkins, J. Arnold Jr, E. Ballard, J. Barrows, S. Baugh, J. Bowen, T. Burch, J. Carr, M. Cherry, L. Clark, H. Collins, J. Crenshaw, R. Damron, J. DeCesare, M. Denham, T. Edmonds, C. Embry Jr, D. Graham, J. Gray, W. Hall, J. Higdon, C. Hoffman, J. Hoover, D. Horlander, D. Keene, T. Kerr, Ji. Lee, G. Lynn, T. McKee, C. Meade, R. Meeks, C. Miller, H. Moberly Jr, R. Nelson, F. Nesler, S. Nunn, D. Osborne, D. Owens, R. Palumbo, D. Pasley, T. Pullin, R. Rand, J. Richards, S. Riggs, T. Riner, A. Simpson, A. Smith, J. Stacy, K. Stein, J. Stewart III, M. Weaver, R. Webb, S. Westrom, R. Wilkey, B. Yonts
AN ACT relating to the Insurance Coverage, Affordability and Relief to Small Employers (ICARE) Program.
Create new sections of Subtitle 17A of KRS Chapter 304 to create the Insurance Coverage, Affordability and Relief to Small Employers (ICARE) Program to make health insurance more affordable for small employer groups; designate the program as a four-year pilot project for employer groups with 2 to 25 employees; authorize the Office of Insurance to establish two health care incentive programs; provide that one incentive program applies to an eligible employer with low-income employees if the eligible employer pays 50% or more of the premium cost of that health benefit plan and the employer has not provided employer-sponsored coverage to employees within the past 12 months; provide that the other incentive program applies to an eligible employer if the eligible employer pays 50% or more of the premium cost of that health benefit plan and the employer group has at least one employee with a high-cost condition; provide that an eligible employer is one whose employer group has an annual salary that does not exceed 200% of the federal poverty level; provide that the ICARE Program does not apply to an insurer that provides coverage solely to Medicaid recipients, Medicare beneficiaries, CHAMPUS insureds, or self-insured groups; require participating insurers to offer at least three plans, which must be a consumer-driven plan, basic benefit plan, and enriched plan; require each participating insurer to conduct a health risk assessment and offer a wellness program, case management services, and disease management services; require a healthy lifestyle discount for participating employers; permit a separate class of business to be established for rate filings for plans offered under the ICARE Program; permit incentive payments of $40 per employee per month and $60 per employee per month under the two incentive programs; direct the allocated surplus remaining in the ICARE Program to be carried forward to the next fiscal year through the end of the pilot period; authorize the Office of Insurance to limit enrollment for the ICARE Program; authorize the Office of Insurance to select a licensed third-party administrator; establish the duties of the third-party administrator; direct the office to establish an ICARE Program fund; require the office to work with the Cabinet for Health and Family Services to review the availability of federal funds for the ICARE Program; permit the Office of Insurance to implement the program through arrangements with other agencies of the Commonwealth; require insurers to disclose the availability of the health insurance purchasing program as defined in 42 U.S.C. sec. 1396e to eligible employer groups and make a disclosure about the availability of the ICARE Program; create a new section of Subtitle 17A of KRS Chapter 304 to require insurers to provide upon request to the Cabinet for Health and Family Services by electronic means coverage information and claims paid data on Medicaid-eligible policyholders and dependents; create a new section of Subtitle 17A of KRS Chapter 304 to explore, initiate, and establish the Interstate Reciprocal Health Benefit Plan Compact with contiguous states to allow Kentucky residents and residents of contiguous states to purchase health benefit plan coverage among the states participating with the compact; create a new section of Subtitle 17A of KRS Chapter 304 to prohibit a health care provider from billing, charging, or collecting from an enrollee under a health benefit plan for professional services, treatment or supplies provided or rendered if the provider has entered into a provider agreement and is a participating provider under a health care plan, or if there exists a federal or state law which requires a hold harmless provision; require certain statements pertaining to an enrollee's responsibility for a bill to be included in a provider's bill; require a health care provider who bills, collects or charges in violation of this section to refund the amount paid within 25 days of receipt of written request; prohibit a health care provider from obtaining a waiver from an enrollee which requires the enrollee to be responsible for payments that are the responsibility of the insurer or provider; create new sections of Subtitle 99 of KRS Chapter 304 to require a fine of not less than $5000 for violation of the section on provider billing of enrollees and a fine of not less than $100 for any insurer in violation; amend KRS 216.2921 to direct the Cabinet for Health and Family Services to educate consumers on the cost and quality of health care; amend KRS 216.2923 to require the secretary to make publicly available on the Internet in understandable language information that allows consumers to draw meaningful comparisons between every hospital and ambulatory facility in the Commonwealth; require the cabinet advisory committee to utilize the Health Services Data Advisory Committee to review administrative regulations on quality outcome measurements; amend KRS 216.2925 to require hospitals to report certain data on a quarterly, rather than periodic, basis; permit electronic submission formats; permit the cabinet to collect data using the Professional 837 or Institutional 837 format; amend KRS 216.2927 to make technical change; amend KRS 216.2929 to direct the cabinet to publish on the Internet reports on health care charges and quality and outcomes on an annual basis on or before July 1; amend KRS 216B.250 to require a hospital and ambulatory surgical center to furnish each requesting paying patient prior to nonemergency treatment with a written good-faith estimate of the reasonably anticipated charges; prohibit a hospital or ambulatory surgical center from requiring a paying patient to sign any form that requires or binds the patient to make an unspecified or unlimited financial commitment or to waive the patient's right to appeal charges billed; require each health facility to post in a publicly visible place notice that the paying patient has a right to appeal charges incurred and notice of whether interest is charged on any amounts not covered by a third-party payor and the interest rate; amend KRS 304.17A-0952 to permit an insurer to establish a separate class of business because the insurer offers a qualified health benefit plan under the ICARE Program; amend KRS 304.17A-700 to define "clean claim" as a completed electronic billing instrument rather than an electronic or paper billing instrument; amend KRS 304.17A-704 to delete the requirement that within 20 days of receipt of an original or corrected claim an insurer must acknowledge the date of receipt of the claim to the provider; provide that, within 10 days of acknowledgment of receipt of an electronic claim, an insurer must notify the provider of all information that is missing from the billing instrument, any errors in the billing instrument, or any other circumstances which prevent it from being a clean claim; amend KRS 304.17A-730 to establish a single interest rate of 12% for claims paid one or more days from the date payment was due; amend KRS 304.17C-090 to conform; Sections 1 to 8 and Section 20 EFFECTIVE JANUARY 1, 2007.
HB 445 - AMENDMENTS
HCS - Retain original provisions; delete Sections 9 to 19 and Sections 21 to 24; make technical changes.
HCA (1/Title, R. Damron) - Make title amendment.
SCS - Retain original provisions, except exclude the annual salary of anyone with an ownership interest in the employer group from the 300% of the poverty level threshold for eligibility, rather than any owner of the group; require the office to promulgate administrative regulations to establish guidelines for determination of preference for employer groups based on federal poverty level and other criteria; indicate that ICARE Program participating insurer plans are to be offered to "employers" rather than "enrollees"; declare that employer health care incentive programs offered by ICARE participating insurers are subject to KRS 304.17A-220; create a new section of KRS 304.17A to require insurers to disclose the availability of the health insurance purchasing program under current circumstances before the ICARE Program goes into effect; create a new section of KRS 304.17A to require insurers to provide the Cabinet for Health and Family Services with information in accordance with KRS 205.623 in the prescribed format, and label this information as confidential; create a new section of KRS 304.17A to seek to explore the feasibility of an Interstate Reciprocal Health Benefit Plan Compact (IRHBPC) with contiguous states for specified purposes; create a new section of KRS 304.17A to direct the office to conduct a study to determine the impact of inappropriate billing disparities on the insured, with the report on the study to be submitted to listed government entities; create a new section of KRS 304.99 to fine any insurer who fails to provide required information to the office $100 for each offense; amend KRS 216.2921 to mandate that the cabinet make every effort to make health data findings that can serve as a basis to educate consumers on the cost and quality of health care; amend KRS 216.2923 to require the secretary to make information on charges, quality, and outcomes of health care services provided publicly available; direct the Health Services Data Advisory Committee to make recommendations on data technical matters and methods for risk adjusting any data prepared and published by the cabinet; amend KRS 216.2925 to remove survey and data submission dates and requirements, but expand on acceptable formats for data submission and data-gathering activities, including that the cabinet may collect data in "Professional 837" or "Institutional 837" format as adopted by the Centers for Medicare and Medicaid Services; amend KRS 216.2927 to require the Health Services Data Advisory Committee to annually review and make recommendations regarding data release protocols, and indicate that these data are subject to HIPAA and the outlined public use data agreements; amend KRS 216.2929 to require the cabinet to make information on charges for health care services available on its Web site; require the information to allow the public to make meaningful comparisons between hospitals, ambulatory facilities, and provider groups, with risk adjusted charge information including median charge and other percentiles to describe typical charges; direct that data will include information on sources and limitations, and that providers will be given a maximum of 30 days to verify the accuracy of its data prior to public release; limit the cabinet to providing linkages to organizations that publicly report comparative charge data and related specified information; require the cabinet to make information on charges for health care services available on its Web site; direct the cabinet to describe quality and outcome measures to allow the public to make meaningful comparisons between hospitals and ambulatory facilities, utilizing and referring the public to only national quality indicators; specify required information in related reports by the cabinet; amend KRS 304.17A-700 to add durable medical equipment dealers to the definition of "health care provider"; amend KRS 304.17A-704 to limit an insurer, its agent, or designee to five calendar days after its acknowledgment of an electronically-submitted original or corrected claim to notify the submitting entity of any errors or omissions in the billing instrument or circumstances that preclude the claim from being a "clean claim"; amend KRS 304.17A-730 to accrue interest on paid claims against an insurer that fails to pay, deny, or settle a claim for more than 31 days at a rate of 14%; direct Sections 1 to 8 to take effect January 1, 2007.
SCA (1/Title, G. Tapp) - Make title amendment.
SFA (1, J. Denton) - Retain original provisions and specify that information regarding reimbursement amounts from insurers be included in data and information available to the public.
Jan 24-introduced in House
Jan 25-to Banking and Insurance (H)
Jan 30-posting waived
Feb 1-reported favorably, 1st reading, to Calendar with Committee Substitute, committee amendment (1-title)
Feb 2-2nd reading, to Rules; posted for passage in the Regular Orders of the Day for Friday, February 3, 2006
Feb 7-3rd reading, passed 95-1 with Committee Substitute, committee amendment (1-title)
Feb 8-received in Senate
Feb 10-to Licensing, Occupations & Administrative Regulations (S)
Mar 7-reported favorably, 1st reading, to Calendar with Committee Substitute, committee amendment (1-title)
Mar 8-2nd reading, to Rules
Mar 15-recommitted to Appropriations and Revenue (S)
Mar 16-floor amendment (1) filed to Committee Substitute