Summary of Original Version

Create a new section of Subtitle 17A of KRS Chapter 304 to require health benefit plans to provide coverage for prostheses and orthoses; establish minimum requirements for the required coverage; require utilizations review decisions to be made in a nondiscriminatory manner; require an insurer or its private review agent to provide notice of certain rights of the insured; establish notice requirements for denials; establish network adequacy requirements for the provision of a prosthesis or orthosis that is required to be covered; establish reporting requirements for insurers and the commissioner of the Department of Insurance relating to the required coverage; amend KRS 164.2871 and 18A.225 to require self-insured group health plans offering by the governing board of state postsecondary education institutions and the state employee health plan to comply with the requirements relating to coverage for prostheses and orthoses; provide that the Act applies to health benefit plans issued or renewed on or after January 1, 2027; EFFECTIVE January 1, 2027.

Summary of Amendment: Senate Committee Substitute 1

Summary Retain original provisions, except delete short-term limited duration coverage from the definition of "health benefit plan"; modify minimum coverage and network adequacy requirements; suspend the coverage requirement's application to qualified health plans if the state would be required to make cost defrayal payments; make technical corrections; amend KRS 304.17A-099 to conform; require the Department of Insurance to make a determination as to whether any requirement in Section 1 is in addition to essential health benefits, make submissions to the federal Department of Health and Human Services, and consider the determination accepted if a response is not received within 365 days; EFFECTIVE, January 1, 2028.

Summary of Amendment: House Committee Substitute 1

Summary Retain original provisions, except delete provisions modifying requirements of KRS 304.17A-099.

Statutes affected:
Introduced: 164.2871, 18A.225
Senate Committee Substitute 1: 164.2871, 18A.225
House Committee Substitute 1: 164.2871, 18A.225
Current: 164.2871, 18A.225