HB 433/HM (BR 1622) - S. Westrom, T. Thompson, D. Horlander, M. Marzian
AN ACT relating to health insurance coverage for dialysis patients
Create new sections of Subtitle 17A of KRS Chapter 304 to require a health benefit plan with a provider network to provide coverage for the dialysis provider of the insured's choice; establish a method of determining the payment rate for out-of-network dialysis services; prevent restriction of the insured's choice; prevent restriction of the dialysis benefit during open enrollment; define "unreasonable distance" and prohibit travel of such distance for in-network dialysis service; provide coverage for out-of-network dialysis if the distance for in-network dialysis is unreasonable; require written notice of any change to a health plan with a provider network that would affect a dialysis patient's coverage or benefit level concerning out-of-network coverage; require payment directly to the dialysis provider and not to the patient; require the executive director of the Office of Insurance to conduct a review of all findings to determine compliance within 120 days of the effective date of this Act; require insurers to notify the office of any violations; authorize the office to promulgate necessary regulations to implement the provisions of the Act; provide that the new sections may be cited as the "Dialysis Patients' Bill of Rights"; create a new section of Subtitle 99 of KRS Chapter 304 to establish fines for violations; amend KRS 304.17A-550 to conform.
HB 433 - AMENDMENTS
HCS/HM - Delete original provisions; create a new section of Subtitle 17A of KRS Chapter 304 to prohibit discrimination against an insured based on the insured's need for dialysis, except as defined by contract; prohibit balance billing by dialysis providers; provide that out-of-network reimbursement for dialysis services be based on historical payment amounts, and the payment shall be no lower than the predominant payment to that dialysis provider for services rendered prior to January 1, 2007 in the Commonwealth; prohibit consideration of Medicare and Medicaid reimbursement levels when determining reimbursement amounts; allow a decrease in the reimbursement amount up to 3% in any year; require reimbursement for dialysis to be made directly to the provider; create a new section of Subtitle 99 of KRS Chapter 304 to establish fines of $1000 to $10,000 for violations of this Act; and, amend KRS 304.17A-550 and 304.18-040 to conform.
HFA (1, S. Westrom) - Amend by deleting subsection (1) and providing in lieu thereof that insurance plan benefits for dialysis services shall be similar to other major medical coverage in the plan; amend subsection (3)(a) to provide that reimbursement for dialysis services shall be the average payment rate agreed to between the insurer and the dialysis provider for out-of-network services rendered in the Commonwealth during calendar year 2006; define "dialysis provider."
Jan 31-introduced in House
Feb 1-to Banking & Insurance (H)
Feb 14-posted in committee
Mar 5-reported favorably, 1st reading, to Calendar with Committee Substitute
Mar 6-2nd reading, to Rules
Mar 12-posted for passage in the Regular Orders of the Day for Thursday, March 13, 2008
Mar 17-floor amendment (1) filed to Committee Substitute
Mar 19-3rd reading, passed 83-12 with Committee Substitute, floor amendment (1)
Mar 20-received in Senate
Mar 26-to Appropriations & Revenue (S)