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-CHAPTER 101
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-CHAPTER 101
-( HB 169 )
-AN ACT relating to coverage for feeding or eating disorders.
-Be it enacted by the General Assembly of the Commonwealth of Kentucky:
-SECTION 1.   A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 IS CREATED TO READ
-AS FOLLOWS:
-As used in Sections 1 to 3 of this Act:
-(1) "Feeding or eating disorder":
-(a) Has the same meaning as in the most recent version of the Diagnostic and Statistical Manual of
-Mental Disorders; and
-(b) Includes:
-1. Anorexia nervosa;
-2. Bulimia nervosa;
-3. Atypical anorexia nervosa;
-4. Binge-eating disorder; and
-5. Any other feeding or eating disorder specified in the most recent version of the Diagnostic and
-Statistical Manual of Mental Disorders; and
-(2) "Health plan":
-(a) Means any health insurance policy, certificate, contract, or plan that offers or provides behavioral or
-mental health coverage:
-1. By direct payment, reimbursement, or otherwise; and
-2. On a fully insured or self-insured basis or any combination thereof; and
-(b) Includes:
-1. A health benefit plan; and
-2. Student health insurance offered by a Kentucky -licensed insurer under written contract with a
-university or college whose students it proposes to insure.
-SECTION 2.   A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 IS CREATED TO READ
-AS FOLLOWS:
-A health plan shall provide coverage for the diagnosis and treatment of feeding or eating disorders.
-SECTION 3.   A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 IS CREATED TO READ
-AS FOLLOWS:
-An insurer that offers or provides coverage for the treatment of a diagnosed feeding or eating disorder under a
-health plan:
-(1) Shall not utilize any of the following standards as the sole reason for denying, limiting, or restricting the
-coverage:
-(a) Body mass index;
-(b) Ideal body weight; or
-(c) Any other standard requiring an achieved weight; and
-(2) May consider the following factors when determining the medical necessity of a treatment, or the
-appropriate level of care, for an individual with a diagnosed feeding or eating disorder:
-(a) Eating behaviors;
-ACTS OF THE GENERAL ASSEMBLY 2
-(b) The need for supervised meals and support interventions;
-(c) Laboratory results of heart rate, renal or cardiovascular activity, and blood pressure;
-(d) Recovery environment; and
-(e) Co-occurring disorders.
-Section 4.   KRS 304.17C-125 is amended to read as follows:
-The following shall apply to limited health service benefit plans, including any limited health service contract [, as]
-defined in KRS 304.38A-010:
-(1) KRS 304.17A-129;
-(2) KRS 304.17A-262;[ and]
-(3) KRS 304.17A-591 to 304.17A-599; and
-(4) Sections 1 to 3 of this Act.
-Section 5.   KRS 304.38A-115 is amended to read as follows:
-Limited health service organizations shall comply with:
-(1) KRS 304.17A-262;
-(2) KRS 304.17A-265;[ and]
-(3) KRS 304.17A-591 to 304.17A-599; and
-(4) Sections 1 to 3 of this Act.
-Section 6.   KRS 205.522 is amended to read as follows:
-(1) With respect to the administration and provision of Medicaid benefits pursuant to this chapter, the Dep artment
-for Medicaid Services, any managed care organization contracted to provide Medicaid benefits pursuant to this
-chapter, and the state's medical assistance program shall be subject to, and comply with, the following, as
-applicable:
-(a) KRS 304.17A-129;
-(b) KRS 304.17A-145;
-(c) KRS 304.17A-163;
-(d) KRS 304.17A-1631;
-(e) KRS 304.17A-167;
-(f) KRS 304.17A-235;
-(g) KRS 304.17A-257;
-(h) KRS 304.17A-259;
-(i) KRS 304.17A-263;
-(j) KRS 304.17A-264;
-(k) KRS 304.17A-515;
-(l) KRS 304.17A-580;
-(m) KRS 304.17A-600, 304.17A-603, and 304.17A-607;[ and]
-(n) KRS 304.17A-740 to 304.17A-743; and
-(o) Sections 1 to 3 of this Act.
-(2) A managed care organization contracted to provide Medicaid benefits pursuant to this chapter shall comply
-with the reporting requirements of KRS 304.17A-732.
-Section 7.   KRS 205.6485 is amended to read as follows:
-(1) As used in this section, "KCHIP" means the Kentucky Children's Health Insurance Program.
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-(2) The Cabinet for Health and Family Services shall:
-(a) Prepare a state child health pla n, known as KCHIP, meeting the requirements of Title XXI of the
-Federal Social Security Act, for submission to the Secretary of the United States Department of Health
-and Human Services within such time as will permit the state to receive the maximum amoun ts of
-federal matching funds available under Title XXI; and
-(b) By administrative regulation promulgated in accordance with KRS Chapter 13A, establish the
-following:
-1. The eligibility criteria for children covered by KCHIP, which shall include a provision that no
-person eligible for services under Title XIX of the Social Security Act, 42 U.S.C. secs. 1396 to
-1396v, as amended, shall be eligible for services under KCHIP, except to the extent that Title
-XIX coverage is expanded by KRS 205.6481 to 205.6495 and KRS 304.17A-340;
-2. The schedule of benefits to be covered by KCHIP, which shall:
-a. Be at least equivalent to one (1) of the following:
-i. The standard Blue Cross/Blue Shield preferred provider option under the Federal
-Employees Health Benefit Plan established by 5 U.S.C. sec. 8903(1);
-ii. A mid-range health benefit coverage plan that is offered and generally available to
-state employees; or
-iii. Health insurance coverage offered by a health maintenance organization that has
-the largest insured commercial, non -Medicaid enrollment of covered lives in the
-state; and
-b. Comply with subsection (6) of this section;
-3. The premium contribution per family for health insurance coverage available under KCHIP,
-which shall be based:
-a. On a six (6) month period; and
-b. Upon a sliding scale relating to family income not to exceed:
-i. Ten dollars ($10), to be paid by a family with income between one hundred percent
-(100%) to one hundred thirty-three percent (133%) of the federal poverty level;
-ii. Twenty dolla rs ($20), to be paid by a family with income between one hundred
-thirty-four percent (134%) to one hundred forty -nine percent (149%) of the federal
-poverty level; and
-iii. One hundred twenty dollars ($120), to be paid by a family with income between
-one hu ndred fifty percent (150%) to two hundred percent (200%) of the federal
-poverty level, and which may be made on a partial payment plan of twenty dollars
-($20) per month or sixty dollars ($60) per quarter;
-4. There shall be no copayments for services provided under KCHIP; and
-5. a. The criteria for health services providers and insurers wishing to contract with the
-Commonwealth to provide coverage under KCHIP.
-b. The cabinet shall provide, in any contracting process for coverage of preventive services,
-the o pportunity for a public health department to bid on preventive health services to
-eligible children within the public health department's service area. A public health
-department shall not be disqualified from bidding because the department does not
-currently offer all the services required by this section. The criteria shall be set forth in
-administrative regulations under KRS Chapter 13A and shall maximize competition
-among the providers and insurers. The Finance and Administration Cabinet shall provide
-oversight over contracting policies and procedures to assure that the number of applicants
-for contracts is maximized.
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-(3) Within twelve (12) months of federal approval of the state's Title XXI child health plan, the Cabinet for Health
-and Family Services shall assure that a KCHIP program is available to all eligible children in all regions of the
-state. If necessary, in order to meet this assurance, the cabinet shall institute its own program.
-(4) KCHIP recipients shall have direct access without a referral  from any gatekeeper primary care provider to
-dentists for covered primary dental services and to optometrists and ophthalmologists for covered primary eye
-and vision services.
-(5) KCHIP shall comply with:
-(a) KRS 304.17A-163 and 304.17A-1631; and
-(b) Sections 1 to 3 of this Act.
-(6) The schedule of benefits required under subsection (2)(b)2. of this section shall include:
-(a) Preventive services;
-(b) Vision services, including glasses;
-(c) Dental services, including sealants, extractions, and fillings; and
-(d) The coverage required under:
-1. KRS 304.17A-129;[ and]
-2. KRS 304.17A-145; and
-3. Sections 1 to 3 of this Act.
-Section 8.   KRS 164.2871 is amended to read as follows:
-(1) The governing board of each state postsecondary educational institution is authorized to purchase liability
-insurance for the protection of the individual members of the governing board, faculty, and staff of such
-institutions from liability for acts and omissions committed in the course and scope of th e individual's
-employment or service. Each institution may purchase the type and amount of liability coverage deemed to
-best serve the interest of such institution.
-(2) All retirement annuity allowances accrued or accruing to any employee of a state postse condary educational
-institution through a retirement program sponsored by the state postsecondary educational institution are
-hereby exempt from any state, county, or municipal tax, and shall not be subject to execution, attachment,
-garnishment, or any oth er process whatsoever, nor shall any assignment thereof be enforceable in any court.
-Except retirement benefits accrued or accruing to any employee of a state postsecondary educational
-institution through a retirement program sponsored by the state postsec ondary educational institution on or
-after January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent provided in KRS
-141.010 and 141.0215.
-(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for members of  governing boards,
-faculty and staff of institutions of higher education in this state shall not be construed to be a waiver of
-sovereign immunity or any other immunity or privilege.
-(4) The governing board of each state postsecondary education institution  is authorized to provide a self -insured
-employer group health plan to its employees, which plan shall:
-(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and
-(b) Except as provided in subsection (5) of this section, be exempt from conformi ty with Subtitle 17A of
-KRS Chapter 304.
-(5) A self-insured employer group health plan provided by the governing board of a state postsecondary education
-institution to its employees shall comply with:
-(a) KRS 304.17A-129;
-(b) KRS 304.17A-133;
-(c) KRS 304.17A-145;
-(d) KRS 304.17A-163 and 304.17A-1631;
-(e) KRS 304.17A-261;
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-(f) KRS 304.17A-262;
-(g) KRS 304.17A-264;[ and]
-(h) KRS 304.17A-265; and
-(i) Sections 1 to 3 of this Act.
-(6) (a) A self -insured employer group health plan provided by the governing board of a state postsecondary
-education institution to its employees shall provide a special enrollment period to pregnant women who
-are eligible for coverage in accordance with the requirements set forth in KRS 304.17 -182.
-(b) The governing board of a state postsecondary education institution shall, at or before the time an
-employee is initially offered the opportunity to enroll in the plan or coverage, provide the employee a
-notice of the special enrollment rights under this subsection.
-Section 9.   KRS 18A.225 is amended to read as follows:
-(1) (a) The term "employee" for purposes of this section means:
-1. Any person, including an elected public official, who is regularly employed by any department,
-office, board, agency, or branch of state government ; or by a public postsecondary educational
-institution; or by any city, urban -county, charter county, county, or consolidated local
-government, whose legislative body has opted to participate in the state -sponsored health
-insurance program pursuant to KRS 79.080; and who is either a contributing member to any one
-(1) of the retirement systems administered by the state, including but not limited to the Kentucky
-Retirement Systems, County Employees Retirement System, Kentucky Teachers' Retirement
-System, the Legislators' Retirement Plan, or the Judicial Retirement Plan; or is receiving a
-contractual contribution from the state toward a retirement plan; or, in the case of a public
-postsecondary education institution, is an individual participating in an optiona l retirement plan
-authorized by KRS 161.567; or is eligible to participate in a retirement plan established by an
-employer who ceases participating in the Kentucky Employees Retirement System pursuant to
-KRS 61.522 whose employees participated in the healt h insurance plans administered by the
-Personnel Cabinet prior to the employer's effective cessation date in the Kentucky Employees
-Retirement System;
-2. Any certified or classified employee of a local board of education or a public charter school as
-defined in KRS 160.1590;
-3. Any elected member of a local board of education;
-4. Any person who is a present or future recipient of a retirement allowance from the Kentucky
-Retirement Systems, County Employees Retirement System, Kentucky Teachers' Retirement
-System, the Legislators' Retirement Plan, the Judicial Retirement Plan, or the Kentucky
-Community and Technical College System's optional retirement plan authorized by KRS
-161.567, except that a person who is receiving a retirement allowance and who is age si xty-five
-(65) or older shall not be included, with the exception of persons covered under KRS
-61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively employed pursuant to
-subparagraph 1. of this paragraph; and
-5. Any eligible dependents and benefi ciaries of participating employees and retirees who are
-entitled to participate in the state-sponsored health insurance program;
-(b) The term "health benefit plan" for the purposes of this section means a health benefit plan as defined in
-KRS 304.17A-005;
-(c) The term "insurer" for the purposes of this section means an insurer as defined in KRS 304.17A -005;
-and
-(d) The term "managed care plan" for the purposes of this section means a managed care plan as defined in
-KRS 304.17A-500.
-(2) (a) The secretary of the Finance and Administration Cabinet, upon the recommendation of the secretary of
-the Personnel Cabinet, shall procure, in compliance with the provisions of KRS 45A.080, 45A.085, and
-45A.090, from one (1) or more insurers authorized to do business in thi s state, a group health benefit
-plan that may include but not be limited to health maintenance organization (HMO), preferred provider
-ACTS OF THE GENERAL ASSEMBLY 6
-organization (PPO), point of service (POS), and exclusive provider organization (EPO) benefit plans
-encompassing all or an y class or classes of employees. With the exception of employers governed by
-the provisions of KRS Chapters 16, 18A, and 151B, all employers of any class of employees or former
-employees shall enter into a contract with the Personnel Cabinet prior to inclu ding that group in the
-state health insurance group. The contracts shall include but not be limited to designating the entity
-responsible for filing any federal forms, adoption of policies required for proper plan administration,
-acceptance of the contractual provisions with health insurance carriers or third -party administrators, and
-adoption of the payment and reimbursement methods necessary for efficient administration of the health
-insurance program. Health insurance coverage provided to state employees  under this section shall, at a
-minimum, contain the same benefits as provided under Kentucky Kare Standard as of January 1, 1994,
-and shall include a mail -order drug option as provided in subsection (13) of this section. All employees
-and other persons fo r whom the health care coverage is provided or made available shall annually be
-given an option to elect health care coverage through a self -funded plan offered by the Commonwealth
-or, if a self -funded plan is not available, from a list of coverage options  determined by the competitive
-bid process under the provisions of KRS 45A.080, 45A.085, and 45A.090 and made available during
-annual open enrollment.
-(b) The policy or policies shall be approved by the commissioner of insurance and may contain the
-provisions the commissioner of insurance approves, whether or not otherwise permitted by the
-insurance laws.
-(c) Any carrier bidding to offer health care coverage to employees shall agree to provide coverage to all
-members of the state group, including active emp loyees and retirees and their eligible covered
-dependents and beneficiaries, within the county or counties specified in its bid. Except as provided in
-subsection (20) of this section, any carrier bidding to offer health care coverage to employees shall als o
-agree to rate all employees as a single entity, except for those retirees whose former employers insure
-their active employees outside the state -sponsored health insurance program and as otherwise provided
-in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b.
-(d) Any carrier bidding to offer health care coverage to employees shall agree to provide enrollment,
-claims, and utilization data to the Commonwealth in a format specified by the Personnel Cabinet with
-the understanding that the data shall be owned by the C ommonwealth; to provide data in an electronic
-form and within a time frame specified by the Personnel Cabinet; and to be subject to penalties for
-noncompliance with data reporting requirements as specified by the Personnel Cabinet. The Personnel
-Cabinet shall take strict precautions to protect the confidentiality of each individual employee; however,
-confidentiality assertions shall not relieve a carrier from the requirement of providing stipulated data to
-the Commonwealth.
-(e) The Personnel Cabinet shall d evelop the necessary techniques and capabilities for timely analysis of
-data received from carriers and, to the extent possible, provide in the request -for-proposal specifics
-relating to data requirements, electronic reporting, and penalties for noncomplia nce. The
-Commonwealth shall own the enrollment, claims, and utilization data provided by each carrier and shall
-develop methods to protect the confidentiality of the individual. The Personnel Cabinet shall include in
-the October annual report submitted pur suant to the provisions of KRS 18A.226 to the Governor, the
-General Assembly, and the Chief Justice of the Supreme Court, an analysis of the financial stability of
-the program, which shall include but not be limited to loss ratios, methods of risk adjustme nt,
-measurements of carrier quality of service, prescription coverage and cost management, and statutorily
-required mandates. If state self -insurance was available as a carrier option, the report also shall provide
-a detailed financial analysis of the self -insurance fund including but not limited to loss ratios, reserves,
-and reinsurance agreements.
-(f) If any agency participating in the state -sponsored employee health insurance program for its active
-employees terminates participation and there is a state appropriation for the employer's contribution for
-active employees' health insurance coverage, then neither the agency nor the employees shall receive
-the state -funded contribution after termination from the state -sponsored employee health insurance
-program.
-(g) Any funds in flexible spending accounts that remain after all reimbursements have been processed shall
-be transferred to the credit of the state-sponsored health insurance plan's appropriation account.
-(h) Each entity participating in the state -sponsored health insurance program shall provide an amount at
-least equal to the state contribution rate for the employer portion of the health insurance premium. For
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-any participating entity that used the state payroll system, the employer contribution amount  shall be
-equal to but not greater than the state contribution rate.
-(3) The premiums may be paid by the policyholder:
-(a) Wholly from funds contributed by the employee, by payroll deduction or otherwise;
-(b) Wholly from funds contributed by any department , board, agency, public postsecondary education
-institution, or branch of state, city, urban -county, charter county, county, or consolidated local
-government; or
-(c) Partly from each, except that any premium due for health care coverage or dental coverage,  if any, in
-excess of the premium amount contributed by any department, board, agency, postsecondary education
-institution, or branch of state, city, urban -county, charter county, county, or consolidated local
-government for any other health care coverage shall be paid by the employee.
-(4) If an employee moves his or her place of residence or employment out of the service area of an insurer
-offering a managed health care plan, under which he or she has elected coverage, into either the service area of
-another managed health care plan or into an area of the Commonwealth not within a managed health care plan
-service area, the employee shall be given an option, at the time of the move or transfer, to change his or her
-coverage to another health benefit plan.
-(5) No payment of premium by any department, board, agency, public postsecondary educational institution, or
-branch of state, city, urban -county, charter county, county, or consolidated local government shall constitute
-compensation to an insured employee for the purposes of any statute fixing or limiting the compensation of
-such an employee. Any premium or other expense incurred by any department, board, agency, public
-postsecondary educational institution, or branch of state, city, urban -county, charter c ounty, county, or
-consolidated local government shall be considered a proper cost of administration.
-(6) The policy or policies may contain the provisions with respect to the class or classes of employees covered,
-amounts of insurance or coverage for desig nated classes or groups of employees, policy options, terms of
-eligibility, and continuation of insurance or coverage after retirement.
-(7) Group rates under this section shall be made available to the disabled child of an employee regardless of the
-child's age if the entire premium for the disabled child's coverage is paid by the state employee. A child shall
-be considered disabled if he or she has been determined to be eligible for federal Social Security disability
-benefits.
-(8) The health care contract or contracts for employees shall be entered into for a period of not less than one (1)
-year.
-(9) The secretary shall appoint thirty -two (32) persons to an Advisory Committee of State Health Insurance
-Subscribers to advise the secretary or the secretary's d esignee regarding the state -sponsored health insurance
-program for employees. The secretary shall appoint, from a list of names submitted by appointing authorities,
-members representing school districts from each of the seven (7) Supreme Court districts, m embers
-representing state government from each of the seven (7) Supreme Court districts, two (2) members
-representing retirees under age sixty -five (65), one (1) member representing local health departments, two (2)
-members representing the Kentucky Teache rs' Retirement System, and three (3) members at large. The
-secretary shall also appoint two (2) members from a list of five (5) names submitted by the Kentucky
-Education Association, two (2) members from a list of five (5) names submitted by the largest st ate employee
-organization of nonschool state employees, two (2) members from a list of five (5) names submitted by the
-Kentucky Association of Counties, two (2) members from a list of five (5) names submitted by the Kentucky
-League of Cities, and two (2) m embers from a list of names consisting of five (5) names submitted by each
-state employee organization that has two thousand (2,000) or more members on state payroll deduction. The
-advisory committee shall be appointed in January of each year and shall mee t quarterly.
-(10) Notwithstanding any other provision of law to the contrary, the policy or policies provided to employees
-pursuant to this section shall not provide coverage for obtaining or performing an abortion, nor shall any state
-funds be used for th e purpose of obtaining or performing an abortion on behalf of employees or their
-dependents.
-(11) Interruption of an established treatment regime with maintenance drugs shall be grounds for an insured to
-appeal a formulary change through the established ap peal procedures approved by the Department of
-ACTS OF THE GENERAL ASSEMBLY 8
-Insurance, if the physician supervising the treatment certifies that the change is not in the best interests of the
-patient.
-(12) Any employee who is eligible for and elects to participate in the state health i nsurance program as a retiree, or
-the spouse or beneficiary of a retiree, under any one (1) of the state -sponsored retirement systems shall not be
-eligible to receive the state health insurance contribution toward health care coverage as a result of any ot her
-employment for which there is a public employer contribution. This does not preclude a retiree and an active
-employee spouse from using both contributions to the extent needed for purchase of one (1) state sponsored
-health insurance policy for that plan year.
-(13) (a) The policies of health insurance coverage procured under subsection (2) of this section shall include a
-mail-order drug option for maintenance drugs for state employees. Maintenance drugs may be
-dispensed by mail order in accordance with Kentucky law.
-(b) A health insurer shall not discriminate against any retail pharmacy located within the geographic
-coverage area of the health benefit plan and that meets the terms and conditions for participation
-established by the insurer, including pric e, dispensing fee, and copay requirements of a mail -order
-option. The retail pharmacy shall not be required to dispense by mail.
-(c) The mail-order option shall not permit the dispensing of a controlled substance classified in Schedule II.
-(14) The policy or policies provided to state employees or their dependents pursuant to this section shall provide
-coverage for obtaining a hearing aid and acquiring hearing aid -related services for insured individuals under
-eighteen (18) years of age, subject to a cap of  one thousand four hundred dollars ($1,400) every thirty -six (36)
-months pursuant to KRS 304.17A-132.
-(15) Any policy provided to state employees or their dependents pursuant to this section shall provide coverage for
-the diagnosis and treatment of autism spectrum disorders consistent with KRS 304.17A-142.
-(16) Any policy provided to state employees or their dependents pursuant to this section shall provide coverage for
-obtaining amino acid-based elemental formula pursuant to KRS 304.17A-258.
-(17) If a stat e employee's residence and place of employment are in the same county, and if the hospital located
-within that county does not offer surgical services, intensive care services, obstetrical services, level II
-neonatal services, diagnostic cardiac catheteriz ation services, and magnetic resonance imaging services, the
-employee may select a plan available in a contiguous county that does provide those services, and the state
-contribution for the plan shall be the amount available in the county where the plan se lected is located.
-(18) If a state employee's residence and place of employment are each located in counties in which the hospitals do
-not offer surgical services, intensive care services, obstetrical services, level II neonatal services, diagnostic
-cardiac catheterization services, and magnetic resonance imaging services, the employee may select a plan
-available in a county contiguous to the county of residence that does provide those services, and the state
-contribution for the plan shall be the amount available in the county where the plan selected is located.
-(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and in the best interests of the
-state group to allow any carrier bidding to offer health care coverage under this  section to submit bids that may
-vary county by county or by larger geographic areas.
-(20) Notwithstanding any other provision of this section, the bid for proposals for health insurance coverage for
-calendar year 2004 shall include a bid scenario that ref lects the statewide rating structure provided in calendar
-year 2003 and a bid scenario that allows for a regional rating structure that allows carriers to submit bids that
-may vary by region for a given product offering as described in this subsection:
-(a) The regional rating bid scenario shall not include a request for bid on a statewide option;
-(b) The Personnel Cabinet shall divide the state into geographical regions which shall be the same as the
-partnership regions designated by the Department for Medi caid Services for purposes of the Kentucky
-Health Care Partnership Program established pursuant to 907 KAR 1:705;
-(c) The request for proposal shall require a carrier's bid to include every county within the region or regions
-for which the bid is submitted  and include but not be restricted to a preferred provider organization
-(PPO) option;
-(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the carrier all of the counties
-included in its bid within the region. If the Personnel Cabi net deems the bids submitted in accordance
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-with this subsection to be in the best interests of state employees in a region, the cabinet may award the
-contract for that region to no more than two (2) carriers; and
-(e) Nothing in this subsection shall prohib it the Personnel Cabinet from including other requirements or
-criteria in the request for proposal.
-(21) Any fully insured health benefit plan or self -insured plan issued or renewed on or after July 12, 2006, to public
-employees pursuant to this section wh ich provides coverage for services rendered by a physician or osteopath
-duly licensed under KRS Chapter 311 that are within the scope of practice of an optometrist duly licensed
-under the provisions of KRS Chapter 320 shall provide the same payment of cove rage to optometrists as
-allowed for those services rendered by physicians or osteopaths.
-(22) Any fully insured health benefit plan or self -insured plan issued or renewed to public employees pursuant to
-this section shall comply with:
-(a) KRS 304.12-237;
-(b) KRS 304.17A-270 and 304.17A-525;
-(c) KRS 304.17A-600 to 304.17A-633;
-(d) KRS 205.593;
-(e) KRS 304.17A-700 to 304.17A-730;
-(f) KRS 304.14-135;
-(g) KRS 304.17A-580 and 304.17A-641;
-(h) KRS 304.99-123;
-(i) KRS 304.17A-138;
-(j) KRS 304.17A-148;
-(k) KRS 304.17A-163 and 304.17A-1631;
-(l) KRS 304.17A-265;
-(m) KRS 304.17A-261;
-(n) KRS 304.17A-262;
-(o) KRS 304.17A-145;
-(p) KRS 304.17A-129;
-(q) KRS 304.17A-133;
-(r) KRS 304.17A-264;[ and]
-(s) Sections 1 to 3 of this Act; and
-(t) Administrative regulations promulgated pursuant to statutes listed in this subsection.
-(23) (a) Any fully insured health benefit plan or self -insured plan issued or renewed to public employees
-pursuant to this section shall provide a special enrollment period to pregnant women who are eligi ble
-for coverage in accordance with the requirements set forth in KRS 304.17 -182.
-(b) The Department of Employee Insurance shall, at or before the time a public employee is initially
-offered the opportunity to enroll in the plan or coverage, provide the em ployee a notice of the special
-enrollment rights under this subsection.
-Section 10.   Sections 1, 2, 3, 4, 5, 8, and 9 of this Act apply to health plans issued or renewed on or after
-January 1, 2027.
-Section 11.   If the Cabinet for Health and Family Ser vices or the Department for Medicaid Services
-determines that a state plan amendment, waiver, or any other form of authorization or approval from any federal
-agency to implement Section 6 or 7 of this Act is necessary to prevent the loss of federal funds o r to comply with
-federal law, the cabinet or department:
-ACTS OF THE GENERAL ASSEMBLY 10
-(1) Shall, within 90 days after the effective date of this section, request the necessary federal authorization
-or approval to implement Sections 6 and 7 of this Act; and
-(2) May only delay implement ation of the provisions of Sections 6 and 7 of this Act for which federal
-authorization or approval was deemed necessary until the federal authorization or approval is granted.
-Section 12.   Sections 6, 7, and 11 of this Act shall constitute the specific authorization required under KRS
-205.5372(1).
-Section 13.   The Department for Medicaid Services or the Cabinet for Health and Family Services shall, in
-accordance with KRS 205.525, provide a copy of any state plan amendment, waiver application, or other request for
-authorization or approval submitted pursuant to Section 11 of this Act to the Legislative Research Commission for
-referral to the Interim Joint Committees on Health Services and Appropriations and Revenue and shall provide  an
-update on the status of any application or request submitted pursuant to Section 11 of this Act at the request of the
-Legislative Research Commission or any committee thereof.
-Section 14.   Sections 1 to 10 of this Act take effect January 1, 2027.
-Signed by Governor April 13, 2026.
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 1 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+AN ACT relating to coverage for feeding or eating disorders. 1
+Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
+SECTION 1.   A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 3
+IS CREATED TO READ AS FOLLOWS: 4
+As used in Sections 1 to 3 of this Act: 5
+(1) "Feeding or eating disorder": 6
+(a) Has the same meaning as in the most recent version of the Diagnostic and 7
+Statistical Manual of Mental Disorders; and 8
+(b) Includes: 9
+1. Anorexia nervosa; 10
+2. Bulimia nervosa; 11
+3. Atypical anorexia nervosa; 12
+4. Binge-eating disorder; and 13
+5. Any other feeding or eating disorder specified in the most recent 14
+version of the Diagnostic and Statistical Manual of Mental Disorders; 15
+and 16
+(2) "Health plan": 17
+(a) Means any health insurance policy, certificate, contract, or pl an that offers 18
+or provides behavioral or mental health coverage: 19
+1. By direct payment, reimbursement, or otherwise; and 20
+2. On a fully insured or self -insured basis or any combination thereof; 21
+and 22
+(b) Includes: 23
+1. A health benefit plan; and 24
+2. Student healt h insurance offered by a Kentucky -licensed insurer 25
+under written contract with a university or college whose students it 26
+proposes to insure. 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 2 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+SECTION 2.   A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 1
+IS CREATED TO READ AS FOLLOWS: 2
+A health plan shall provide coverage for the diagnosis and treatment of feeding or 3
+eating disorders. 4
+SECTION 3.   A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 5
+IS CREATED TO READ AS FOLLOWS: 6
+An insurer that offers or provides coverage for the treatment of a diagnosed feeding or 7
+eating disorder under a health plan: 8
+(1) Shall not utilize any of the following standards as the sole reason for denying, 9
+limiting, or restricting the coverage: 10
+(a) Body mass index; 11
+(b) Ideal body weight; or 12
+(c) Any other standard requiring an achieved weight; and 13
+(2) May consider the following factors when determining the medical necessity of a 14
+treatment, or the appropriate level of care, for an individual with a diagnosed 15
+feeding or eating disorder: 16
+(a) Eating behaviors; 17
+(b) The need for supervised meals and support interventions; 18
+(c) Laboratory results of heart rate, renal or cardiovascular activity, and blood 19
+pressure; 20
+(d) Recovery environment; and 21
+(e) Co-occurring disorders. 22
+Section 4.   KRS 304.17C-125 is amended to read as follows: 23
+The following shall apply to limited health service benefit plans, including any limited 24
+health service contract[, as] defined in KRS 304.38A-010: 25
+(1) KRS 304.17A-129; 26
+(2) KRS 304.17A-262;[ and] 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 3 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+(3) KRS 304.17A-591 to 304.17A-599; and 1
+(4) Sections 1 to 3 of this Act. 2
+Section 5.   KRS 304.38A-115 is amended to read as follows: 3
+Limited health service organizations shall comply with: 4
+(1) KRS 304.17A-262; 5
+(2) KRS 304.17A-265;[ and] 6
+(3) KRS 304.17A-591 to 304.17A-599; and 7
+(4) Sections 1 to 3 of this Act. 8
+Section 6.   KRS 205.522 is amended to read as follows: 9
+(1) With respect to t he administration and provision of Medicaid benefits pursuant to 10
+this chapter, the Department for Medicaid Services, any managed care organization 11
+contracted to provide Medicaid benefits pursuant to this chapter, and the state's 12
+medical assistance program shall be subject to, and comply with, the following, as 13
+applicable: 14
+(a) KRS 304.17A-129; 15
+(b) KRS 304.17A-145; 16
+(c) KRS 304.17A-163; 17
+(d) KRS 304.17A-1631; 18
+(e) KRS 304.17A-167; 19
+(f) KRS 304.17A-235; 20
+(g) KRS 304.17A-257; 21
+(h) KRS 304.17A-259; 22
+(i) KRS 304.17A-263; 23
+(j) KRS 304.17A-264; 24
+(k) KRS 304.17A-515; 25
+(l) KRS 304.17A-580; 26
+(m) KRS 304.17A-600, 304.17A-603, and 304.17A-607;[ and] 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 4 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+(n) KRS 304.17A-740 to 304.17A-743; and 1
+(o) Sections 1 to 3 of this Act. 2
+(2) A managed care organization contracted to provide Medicaid benefits pursuant to 3
+this chapter shall comply with the reporting requirements of KRS 304.17A-732. 4
+Section 7.   KRS 205.6485 is amended to read as follows: 5
+(1) As used in this section, "KCHIP" means the Kentucky Children's Health Insurance 6
+Program. 7
+(2) The Cabinet for Health and Family Services shall: 8
+(a) Prepare a state child health plan, known as KCHIP, meeting the requirements 9
+of Title XXI of the Federal Social S ecurity Act, for submission to the 10
+Secretary of the United States Department of Health and Human Services 11
+within such time as will permit the state to receive the maximum amounts of 12
+federal matching funds available under Title XXI; and 13
+(b) By administrativ e regulation promulgated in accordance with KRS Chapter 14
+13A, establish the following: 15
+1. The eligibility criteria for children covered by KCHIP, which shall 16
+include a provision that no person eligible for services under Title XIX 17
+of the Social Security Act , 42 U.S.C. secs. 1396 to 1396v, as amended, 18
+shall be eligible for services under KCHIP, except to the extent that 19
+Title XIX coverage is expanded by KRS 205.6481 to 205.6495 and KRS 20
+304.17A-340; 21
+2. The schedule of benefits to be covered by KCHIP, which shall: 22
+a. Be at least equivalent to one (1) of the following: 23
+i. The standard Blue Cross/Blue Shield preferred provider 24
+option under the Federal Employees Health Benefit Plan 25
+established by 5 U.S.C. sec. 8903(1); 26
+ii. A mid-range health benefit coverage plan t hat is offered and 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 5 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+generally available to state employees; or 1
+iii. Health insurance coverage offered by a health maintenance 2
+organization that has the largest insured commercial, non -3
+Medicaid enrollment of covered lives in the state; and 4
+b. Comply with subsection (6) of this section; 5
+3. The premium contribution per family for health insurance coverage 6
+available under KCHIP, which shall be based: 7
+a. On a six (6) month period; and 8
+b. Upon a sliding scale relating to family income not to exceed: 9
+i. Ten dollars  ($10), to be paid by a family with income 10
+between one hundred percent (100%) to one hundred thirty -11
+three percent (133%) of the federal poverty level; 12
+ii. Twenty dollars ($20), to be paid by a family with income 13
+between one hundred thirty -four percent (134 %) to one 14
+hundred forty -nine percent (149%) of the federal poverty 15
+level; and 16
+iii. One hundred twenty dollars ($120), to be paid by a family 17
+with income between one hundred fifty percent (150%) to 18
+two hundred percent (200%) of the federal poverty level, and 19
+which may be made on a partial payment plan of twenty 20
+dollars ($20) per month or sixty dollars ($60) per quarter; 21
+4. There shall be no copayments for services provided under KCHIP; and 22
+5. a. The criteria for health services providers and insurers wishing  to 23
+contract with the Commonwealth to provide coverage under 24
+KCHIP. 25
+b. The cabinet shall provide, in any contracting process for coverage 26
+of preventive services, the opportunity for a public health 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 6 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+department to bid on preventive health services to eligible children 1
+within the public health department's service area. A public  health 2
+department shall not be disqualified from bidding because the 3
+department does not currently offer all the services required by 4
+this section. The criteria shall be set forth in administrative 5
+regulations under KRS Chapter 13A and shall maximize 6
+competition among the providers and insurers. The Finance and 7
+Administration Cabinet shall provide oversight over contracting 8
+policies and procedures to assure that the number of applicants for 9
+contracts is maximized. 10
+(3) Within twelve (12) months of federal a pproval of the state's Title XXI child health 11
+plan, the Cabinet for Health and Family Services shall assure that a KCHIP 12
+program is available to all eligible children in all regions of the state. If necessary, 13
+in order to meet this assurance, the cabinet shall institute its own program. 14
+(4) KCHIP recipients shall have direct access without a referral from any gatekeeper 15
+primary care provider to dentists for covered primary dental services and to 16
+optometrists and ophthalmologists for covered primary eye and vision services. 17
+(5) KCHIP shall comply with: 18
+(a) KRS 304.17A-163 and 304.17A-1631; and 19
+(b) Sections 1 to 3 of this Act. 20
+(6) The schedule of benefits required under subsection (2)(b)2. of this section shall 21
+include: 22
+(a) Preventive services; 23
+(b) Vision services, including glasses; 24
+(c) Dental services, including sealants, extractions, and fillings; and 25
+(d) The coverage required under: 26
+1. KRS 304.17A-129;[ and] 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 7 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+2. KRS 304.17A-145; and 1
+3. Sections 1 to 3 of this Act. 2
+Section 8.   KRS 164.2871 is amended to read as follows: 3
+(1) The governing board of each state postsecondary educational institution is 4
+authorized to purchase liability insurance for the protection of the individual 5
+members of the governing board, faculty, and staff of such institutions from liability 6
+for acts and omissions committed in the course and scope of the individual's 7
+employment or service. Each institution may purchase the type and amount of 8
+liability coverage deemed to best serve the interest of such institution. 9
+(2) All retirement annuity allowances accrued or accruing to any employee of a state 10
+postsecondary educational institution through a retirement program sponsored by 11
+the state postsecondary educational institution are hereby exempt  from any state, 12
+county, or municipal tax, and shall not be subject to execution, attachment, 13
+garnishment, or any other process whatsoever, nor shall any assignment thereof be 14
+enforceable in any court. Except retirement benefits accrued or accruing to any 15
+employee of a state postsecondary educational institution through a retirement 16
+program sponsored by the state postsecondary educational institution on or after 17
+January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 18
+provided in KRS 141.010 and 141.0215. 19
+(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 20
+members of governing boards, faculty and staff of institutions of higher education 21
+in this state shall not be construed to be a waiver of sovereign i mmunity or any 22
+other immunity or privilege. 23
+(4) The governing board of each state postsecondary education institution is authorized 24
+to provide a self -insured employer group health plan to its employees, which plan 25
+shall: 26
+(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 8 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+(b) Except as provided in subsection (5) of this section, be exempt from 1
+conformity with Subtitle 17A of KRS Chapter 304. 2
+(5) A self-insured employer group health plan provided by the governing board of a 3
+state postsecondary education institution to its employees shall comply with: 4
+(a) KRS 304.17A-129; 5
+(b) KRS 304.17A-133; 6
+(c) KRS 304.17A-145; 7
+(d) KRS 304.17A-163 and 304.17A-1631; 8
+(e) KRS 304.17A-261; 9
+(f) KRS 304.17A-262; 10
+(g) KRS 304.17A-264;[ and] 11
+(h) KRS 304.17A-265; and 12
+(i) Sections 1 to 3 of this Act. 13
+(6) (a) A self-insured employer group health plan provided by the governing board of 14
+a state postsecondary education institution to its employees shall provide a 15
+special enrollment period to pregnant wo men who are eligible for coverage in 16
+accordance with the requirements set forth in KRS 304.17-182. 17
+(b) The governing board of a state postsecondary education institution shall, at or 18
+before the time an employee is initially offered the opportunity to enroll in the 19
+plan or coverage, provide the employee a notice of the special enrollment 20
+rights under this subsection. 21
+Section 9.   KRS 18A.225 is amended to read as follows: 22
+(1) (a) The term "employee" for purposes of this section means: 23
+1. Any person, including an elected public official, who is regularly 24
+employed by any department, office, board, agency, or branch of state 25
+government; or by a public postsecondary educational institution; or by 26
+any city, urban -county, charter c ounty, county, or consolidated local 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 9 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+government, whose legislative body has opted to participate in the state -1
+sponsored health insurance program pursuant to KRS 79.080; and who 2
+is either a contributing member to any one (1) of the retirement systems 3
+administered by the state, including but not limited to the Kentucky 4
+Retirement Systems, County Employees Retirement System, Kentucky 5
+Teachers' Retirement System, the Legislators' Retirement Plan, or the 6
+Judicial Retirement Plan; or is receiving a contractual co ntribution from 7
+the state toward a retirement plan; or, in the case of a public 8
+postsecondary education institution, is an individual participating in an 9
+optional retirement plan authorized by KRS 161.567; or is eligible to 10
+participate in a retirement plan  established by an employer who ceases 11
+participating in the Kentucky Employees Retirement System pursuant to 12
+KRS 61.522 whose employees participated in the health insurance plans 13
+administered by the Personnel Cabinet prior to the employer's effective 14
+cessation date in the Kentucky Employees Retirement System; 15
+2. Any certified or classified employee of a local board of education or a 16
+public charter school as defined in KRS 160.1590; 17
+3. Any elected member of a local board of education; 18
+4. Any person who is a present or future recipient of a retirement 19
+allowance from the Kentucky Retirement Systems, County Employees 20
+Retirement System, Kentucky Teachers' Retirement System, the 21
+Legislators' Retirement Plan, the Judicial Retirement Plan, or the 22
+Kentucky Community and Technical College System's optional 23
+retirement plan authorized by KRS 161.567, except that a person who is 24
+receiving a retirement allowance and who is age sixty -five (65) or older 25
+shall not be included, with the exception of persons covered under KRS 26
+61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 10 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+employed pursuant to subparagraph 1. of this paragraph; and 1
+5. Any eligible dependents and beneficiaries of participating employees 2
+and retirees who are entitled to participate in the state -sponsored health 3
+insurance program; 4
+(b) The term "health benefit plan" for the purposes of this section means a health 5
+benefit plan as defined in KRS 304.17A-005; 6
+(c) The term "insurer" for the purposes of this section means an insurer as defined 7
+in KRS 304.17A-005; and 8
+(d) The term "managed care plan" for the purposes of this section means a 9
+managed care plan as defined in KRS 304.17A-500. 10
+(2) (a) The secretary of the Finance and Administration Cabinet, upon the 11
+recommendation of the secretary of the Personn el Cabinet, shall procure, in 12
+compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 13
+from one (1) or more insurers authorized to do business in this state, a group 14
+health benefit plan that may include but not be limited to health maintenance 15
+organization (HMO), preferred provider organization (PPO), point of service 16
+(POS), and exclusive provider organization (EPO) benefit plans 17
+encompassing all or any class or classes of employees. With the exception of 18
+employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 19
+all employers of any class of employees or former employees shall enter into 20
+a contract with the Personnel Cabinet prior to including that group in the state 21
+health insurance group. The contracts shall include but not be lim ited to 22
+designating the entity responsible for filing any federal forms, adoption of 23
+policies required for proper plan administration, acceptance of the contractual 24
+provisions with health insurance carriers or third -party administrators, and 25
+adoption of th e payment and reimbursement methods necessary for efficient 26
+administration of the health insurance program. Health insurance coverage 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 11 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+provided to state employees under this section shall, at a minimum, contain 1
+the same benefits as provided under Kentucky K are Standard as of January 1, 2
+1994, and shall include a mail -order drug option as provided in subsection 3
+(13) of this section. All employees and other persons for whom the health care 4
+coverage is provided or made available shall annually be given an option  to 5
+elect health care coverage through a self -funded plan offered by the 6
+Commonwealth or, if a self -funded plan is not available, from a list of 7
+coverage options determined by the competitive bid process under the 8
+provisions of KRS 45A.080, 45A.085, and 45 A.090 and made available 9
+during annual open enrollment. 10
+(b) The policy or policies shall be approved by the commissioner of insurance 11
+and may contain the provisions the commissioner of insurance approves, 12
+whether or not otherwise permitted by the insurance laws. 13
+(c) Any carrier bidding to offer health care coverage to employees shall agree to 14
+provide coverage to all members of the state group, including active 15
+employees and retirees and their eligible covered dependents and 16
+beneficiaries, within the county or counties specified in its bid. Except as 17
+provided in subsection (20) of this section, any carrier bidding to offer health 18
+care coverage to employees shall also agree to rate all employees as a single 19
+entity, except for those retirees whose former employ ers insure their active 20
+employees outside the state -sponsored health insurance program and as 21
+otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 22
+(d) Any carrier bidding to offer health care coverage to employees shall agree to 23
+provide enrollm ent, claims, and utilization data to the Commonwealth in a 24
+format specified by the Personnel Cabinet with the understanding that the data 25
+shall be owned by the Commonwealth; to provide data in an electronic form 26
+and within a time frame specified by the Per sonnel Cabinet; and to be subject 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 12 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+to penalties for noncompliance with data reporting requirements as specified 1
+by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 2
+to protect the confidentiality of each individual employee; however , 3
+confidentiality assertions shall not relieve a carrier from the requirement of 4
+providing stipulated data to the Commonwealth. 5
+(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 6
+for timely analysis of data received from carr iers and, to the extent possible, 7
+provide in the request -for-proposal specifics relating to data requirements, 8
+electronic reporting, and penalties for noncompliance. The Commonwealth 9
+shall own the enrollment, claims, and utilization data provided by each c arrier 10
+and shall develop methods to protect the confidentiality of the individual. The 11
+Personnel Cabinet shall include in the October annual report submitted 12
+pursuant to the provisions of KRS 18A.226 to the Governor, the General 13
+Assembly, and the Chief Jus tice of the Supreme Court, an analysis of the 14
+financial stability of the program, which shall include but not be limited to 15
+loss ratios, methods of risk adjustment, measurements of carrier quality of 16
+service, prescription coverage and cost management, and statutorily required 17
+mandates. If state self -insurance was available as a carrier option, the report 18
+also shall provide a detailed financial analysis of the self -insurance fund 19
+including but not limited to loss ratios, reserves, and reinsurance agreements. 20
+(f) If any agency participating in the state -sponsored employee health insurance 21
+program for its active employees terminates participation and there is a state 22
+appropriation for the employer's contribution for active employees' health 23
+insurance coverage, then neither the agency nor the employees shall receive 24
+the state -funded contribution after termination from the state -sponsored 25
+employee health insurance program. 26
+(g) Any funds in flexible spending accounts that remain after all reimbursements 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 13 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+have been p rocessed shall be transferred to the credit of the state -sponsored 1
+health insurance plan's appropriation account. 2
+(h) Each entity participating in the state-sponsored health insurance program shall 3
+provide an amount at least equal to the state contribution rate for the employer 4
+portion of the health insurance premium. For any participating entity that used 5
+the state payroll system, the employer contribution amount shall be equal to 6
+but not greater than the state contribution rate. 7
+(3) The premiums may be paid by the policyholder: 8
+(a) Wholly from funds contributed by the employee, by payroll deduction or 9
+otherwise; 10
+(b) Wholly from funds contributed by any department, board, agency, public 11
+postsecondary education institution, or branch of  state, city, urban -county, 12
+charter county, county, or consolidated local government; or 13
+(c) Partly from each, except that any premium due for health care coverage or 14
+dental coverage, if any, in excess of the premium amount contributed by any 15
+department, board, agency, postsecondary education institution, or branch of 16
+state, city, urban -county, charter county, county, or consolidated local 17
+government for any other health care coverage shall be paid by the employee. 18
+(4) If an employee moves his or her place of residence or employment out of the 19
+service area of an insurer offering a managed health care plan, under which he or 20
+she has elected coverage, into either the service area of another managed health care 21
+plan or into an area of the Commonwealth not withi n a managed health care plan 22
+service area, the employee shall be given an option, at the time of the move or 23
+transfer, to change his or her coverage to another health benefit plan. 24
+(5) No payment of premium by any department, board, agency, public postseco ndary 25
+educational institution, or branch of state, city, urban -county, charter county, 26
+county, or consolidated local government shall constitute compensation to an 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 14 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+insured employee for the purposes of any statute fixing or limiting the 1
+compensation of such an employee. Any premium or other expense incurred by any 2
+department, board, agency, public postsecondary educational institution, or branch 3
+of state, city, urban -county, charter county, county, or consolidated local 4
+government shall be considered a proper cost of administration. 5
+(6) The policy or policies may contain the provisions with respect to the class or classes 6
+of employees covered, amounts of insurance or coverage for designated classes or 7
+groups of employees, policy options, terms of eligibility,  and continuation of 8
+insurance or coverage after retirement. 9
+(7) Group rates under this section shall be made available to the disabled child of an 10
+employee regardless of the child's age if the entire premium for the disabled child's 11
+coverage is paid by the state employee. A child shall be considered disabled if he or 12
+she has been determined to be eligible for federal Social Security disability benefits. 13
+(8) The health care contract or contracts for employees shall be entered into for a 14
+period of not less than one (1) year. 15
+(9) The secretary shall appoint thirty -two (32) persons to an Advisory Committee of 16
+State Health Insurance Subscribers to advise the secretary or the secretary's 17
+designee regarding the state -sponsored health insurance program for employee s. 18
+The secretary shall appoint, from a list of names submitted by appointing 19
+authorities, members representing school districts from each of the seven (7) 20
+Supreme Court districts, members representing state government from each of the 21
+seven (7) Supreme Court districts, two (2) members representing retirees under age 22
+sixty-five (65), one (1) member representing local health departments, two (2) 23
+members representing the Kentucky Teachers' Retirement System, and three (3) 24
+members at large. The secretary shall also appoint two (2) members from a list of 25
+five (5) names submitted by the Kentucky Education Association, two (2) members 26
+from a list of five (5) names submitted by the largest state employee organization of 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 15 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+nonschool state employees, two (2) members from a list of five (5) names submitted 1
+by the Kentucky Association of Counties, two (2) members from a list of five (5) 2
+names submitted by the Kentucky League of Cities, and two (2) members from a 3
+list of names consisting of five (5) names submitted by each state employee 4
+organization that has two thousand (2,000) or more members on state payroll 5
+deduction. The advisory committee shall be appointed in January of each year and 6
+shall meet quarterly. 7
+(10) Notwithstanding any other provision of law to the contrar y, the policy or policies 8
+provided to employees pursuant to this section shall not provide coverage for 9
+obtaining or performing an abortion, nor shall any state funds be used for the 10
+purpose of obtaining or performing an abortion on behalf of employees or their 11
+dependents. 12
+(11) Interruption of an established treatment regime with maintenance drugs shall be 13
+grounds for an insured to appeal a formulary change through the established appeal 14
+procedures approved by the Department of Insurance, if the physician s upervising 15
+the treatment certifies that the change is not in the best interests of the patient. 16
+(12) Any employee who is eligible for and elects to participate in the state health 17
+insurance program as a retiree, or the spouse or beneficiary of a retiree, u nder any 18
+one (1) of the state-sponsored retirement systems shall not be eligible to receive the 19
+state health insurance contribution toward health care coverage as a result of any 20
+other employment for which there is a public employer contribution. This does  not 21
+preclude a retiree and an active employee spouse from using both contributions to 22
+the extent needed for purchase of one (1) state sponsored health insurance policy 23
+for that plan year. 24
+(13) (a) The policies of health insurance coverage procured under s ubsection (2) of 25
+this section shall include a mail -order drug option for maintenance drugs for 26
+state employees. Maintenance drugs may be dispensed by mail order in 27
+UNOFFICIAL COPY  26 RS HB 169/HCS 1
+Page 16 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+accordance with Kentucky law. 1
+(b) A health insurer shall not discriminate against any retail  pharmacy located 2
+within the geographic coverage area of the health benefit plan and that meets 3
+the terms and conditions for participation established by the insurer, including 4
+price, dispensing fee, and copay requirements of a mail -order option. The 5
+retail pharmacy shall not be required to dispense by mail. 6
+(c) The mail -order option shall not permit the dispensing of a controlled 7
+substance classified in Schedule II. 8
+(14) The policy or policies provided to state employees or their dependents pursuant to 9
+this section shall provide coverage for obtaining a hearing aid and acquiring hearing 10
+aid-related services for insured individuals under eighteen (18) years of age, subject 11
+to a cap of one thousand four hundred dollars ($1,400) every thirty -six (36) months 12
+pursuant to KRS 304.17A-132. 13
+(15) Any policy provided to state employees or their dependents pursuant to this section 14
+shall provide coverage for the diagnosis and treatment of autism spectrum disorders 15
+consistent with KRS 304.17A-142. 16
+(16) Any policy provided to state employees or their dependents pursuant to this section 17
+shall provide coverage for obtaining amino acid -based elemental formula pursuant 18
+to KRS 304.17A-258. 19
+(17) If a state employee's residence and place of employment are in the same county, 20
+and if the hospital located within that county does not offer surgical services, 21
+intensive care services, obstetrical services, level II neonatal services, diagnostic 22
+cardiac catheterization services, and magnetic resonance imaging services, the 23
+employee may s elect a plan available in a contiguous county that does provide 24
+those services, and the state contribution for the plan shall be the amount available 25
+in the county where the plan selected is located. 26
+(18) If a state employee's residence and place of employ ment are each located in 27
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+Page 17 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+counties in which the hospitals do not offer surgical services, intensive care 1
+services, obstetrical services, level II neonatal services, diagnostic cardiac 2
+catheterization services, and magnetic resonance imaging services, the em ployee 3
+may select a plan available in a county contiguous to the county of residence that 4
+does provide those services, and the state contribution for the plan shall be the 5
+amount available in the county where the plan selected is located. 6
+(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 7
+in the best interests of the state group to allow any carrier bidding to offer health 8
+care coverage under this section to submit bids that may vary county by county or 9
+by larger geographic areas. 10
+(20) Notwithstanding any other provision of this section, the bid for proposals for health 11
+insurance coverage for calendar year 2004 shall include a bid scenario that reflects 12
+the statewide rating structure provided in calendar year 2003 and a b id scenario that 13
+allows for a regional rating structure that allows carriers to submit bids that may 14
+vary by region for a given product offering as described in this subsection: 15
+(a) The regional rating bid scenario shall not include a request for bid on a 16
+statewide option; 17
+(b) The Personnel Cabinet shall divide the state into geographical regions which 18
+shall be the same as the partnership regions designated by the Department for 19
+Medicaid Services for purposes of the Kentucky Health Care Partnership 20
+Program established pursuant to 907 KAR 1:705; 21
+(c) The request for proposal shall require a carrier's bid to include every county 22
+within the region or regions for which the bid is submitted and include but not 23
+be restricted to a preferred provider organization (PPO) option; 24
+(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 25
+carrier all of the counties included in its bid within the region. If the Personnel 26
+Cabinet deems the bids submitted in accordance with this subsection to be in 27
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+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+the best interests of state employees in a region, the cabinet may award the 1
+contract for that region to no more than two (2) carriers; and 2
+(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 3
+other requirements or criteria in the request for proposal. 4
+(21) Any fully insured health benefit plan or self -insured plan issued or renewed on or 5
+after July 12, 2006, to publi c employees pursuant to this section which provides 6
+coverage for services rendered by a physician or osteopath duly licensed under KRS 7
+Chapter 311 that are within the scope of practice of an optometrist duly licensed 8
+under the provisions of KRS Chapter 320  shall provide the same payment of 9
+coverage to optometrists as allowed for those services rendered by physicians or 10
+osteopaths. 11
+(22) Any fully insured health benefit plan or self -insured plan issued or renewed to 12
+public employees pursuant to this section shall comply with: 13
+(a) KRS 304.12-237; 14
+(b) KRS 304.17A-270 and 304.17A-525; 15
+(c) KRS 304.17A-600 to 304.17A-633; 16
+(d) KRS 205.593; 17
+(e) KRS 304.17A-700 to 304.17A-730; 18
+(f) KRS 304.14-135; 19
+(g) KRS 304.17A-580 and 304.17A-641; 20
+(h) KRS 304.99-123; 21
+(i) KRS 304.17A-138; 22
+(j) KRS 304.17A-148; 23
+(k) KRS 304.17A-163 and 304.17A-1631; 24
+(l) KRS 304.17A-265; 25
+(m) KRS 304.17A-261; 26
+(n) KRS 304.17A-262; 27
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+Page 19 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+(o) KRS 304.17A-145; 1
+(p) KRS 304.17A-129; 2
+(q) KRS 304.17A-133; 3
+(r) KRS 304.17A-264;[ and] 4
+(s) Sections 1 to 3 of this Act; and 5
+(t) Administrative regulations promulgated pursuant to statutes listed in this 6
+subsection. 7
+(23) (a) Any fully insured health benefit plan or self-insured plan issued or renewed to 8
+public employees pursuant to this section shall provide a special enrollment 9
+period to pregnant women who are eligible for coverage in accordance with 10
+the requirements set forth in KRS 304.17-182. 11
+(b) The Department of Employee Insurance shall, at or before the time a public 12
+employee is initially offered the opportunity to enroll i n the plan or coverage, 13
+provide the employee a notice of the special enrollment rights under this 14
+subsection. 15
+Section 10.   Sections 1, 2, 3, 4, 5, 8, and 9 of this Act apply to health plans 16
+issued or renewed on or after January 1, 2027. 17
+Section 11.   If the Cabinet for Health and Family Services or the D epartment for 18
+Medicaid Services determines that a state plan amendment, waiver, or any other form of 19
+authorization or approval from any federal agency to implement Section 6 or 7 of this Act 20
+is necessary to prevent the loss of federal funds or to comply with federal law, the cabinet 21
+or department: 22
+(1) Shall, within 90 days after the effective date of this section, request the 23
+necessary federal authorization or approval to implement Sections 6 and 7 of this Act; 24
+and 25
+(2) May only delay implementation of the p rovisions of Sections 6 and 7 of this 26
+Act for which federal authorization or approval was deemed necessary until the federal 27
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+Page 20 of 20
+HB016930.100 - 467 - XXXX   2/3/2026 2:19 PM  House Committee Substitute
+authorization or approval is granted. 1
+Section 12.   Sections 6, 7, and 11 of this Act shall const itute the specific 2
+authorization required under KRS 205.5372(1). 3
+Section 13.   The Department for Medicaid Services or the Cabinet for Health 4
+and Family Services shall, in accordance with KRS 205.525, provide a copy of any  state 5
+plan amendment, waiver application, or other request for authorization or approval 6
+submitted pursuant to Section 11 of this Act to the Legislative Research Commission for 7
+referral to the Interim Joint Committees on Health Services and Appropriations  and 8
+Revenue and shall provide an update on the status of any application or request submitted 9
+pursuant to Section 11 of this Act at the request of the Legislative Research Commission 10
+or any committee thereof. 11
+Section 14.   Sections 1 to 10 of this Act take effect January 1, 2027. 12