The Kentucky (KY) Department of Insurance published Insurance Bulletin Number 2017-03. The bulletin summarizes the changes made by the KY legislature during 2017. Outlined below are the legislative changes described in the bulletin relating to health insurance coverage — including those previously covered in Compliance Corner. The effective date of the legislation discussed below is June 29, 2017.
The first legislative change relates to experimental treatment for terminal illnesses and was contained in SB 21, which was signed into law by KY Gov. Matt Bevin on March 21, 2017. Specifically, this law allows manufacturers of investigational drugs, biological products and devices, as defined in the bill, to make them available upon request to eligible patients. Patient eligibility depends on a number of factors, including whether they have:
- A terminal illness that’s attested to by the patient’s treating health care provider
- Considered all other treatment options currently approved by the U.S. FDA
- Received a recommendation from the patient’s treating health care provider for an investigational drug, biological product or device
- Given written informed consent for the use of the investigational drug, biological product or device
- Documentation from the treating health care provider that the patient meets these requirements
As part of the informed consent process, the patient agrees that their health plan, third-party administrator or provider will not be liable for the cost of such treatment or any care consequent to the use of such treatment (unless otherwise required). The bill does not expand or mandate coverage for such treatments by an insurer, but it authorizes health plans, administrators and governmental agencies to provide coverage for these types of services.
The second relates to garnishment and health savings accounts. On March 27, 2017, KY Gov. Matt Bevin signed SB 62 into law, amending KRS 427.010 by including an exemption from wage attachment and garnishment for funds deposited in a health savings account under IRC Section 223.
The third legislative change relates to smoking cessation. On March 21, 2017, Gov. Bevin signed SB 89 into law, which requires insured group health benefit plans to provide coverage for certain smoking cessation medications and services. Specifically, plans must provide coverage for all tobacco cessation, including:
- Medications approved by the U.S. FDA
- Services recommended by the U.S. Preventive Services Task Force, including, but not limited to, individual, group and telephone counseling or any combination of these services
Additionally, coverage for tobacco cessation services can't be subject to any of the following:
- Counseling requirements for medication
- Limits on duration of services, including but not limited to annual or lifetime limits on number of attempts to quit
- Copayments or other out-of-pocket cost sharing, including deductibles
Utilization management requirements cannot be imposed on any tobacco cessation services, including prior authorization and step therapy, except in the following circumstances where plans can require prior authorization:
- For a treatment that exceeds the duration recommended by the most recent U.S. Public Health Service clinical practice guidelines on treating tobacco use and dependence; or
- For services associated with more than two attempts to quit smoking within a 12-month period
The fourth change was contained in HB 78, which was signed into law by Gov. Bevin on April 11, 2017. This law requires insurers that provide individual, expense-incurred policies (under KRS Chapter 304.17), health benefit plans (under KRS 304.17A) and group plans (under KRS 304.18) to include coverage for digital mammography. The benefit is limited to $50 per mammogram, and any deductible and coinsurance are required to be “no less favorable than for coverage for physical illness.”
Physicians are now statutorily encouraged to utilize digital mammography (i.e., breast tomosynthesis) when ordering mammograms. The definition of “mammogram” pursuant to KRS 304.17-316 now incorporates digital mammograms.
The bulletin and new laws do not contain any new employer compliance obligations. But KY employers will want to be aware of the changes to the insurance laws in KY should employees have questions regarding health insurance coverage.
Insurance Bulletin Number 2017-03 »
SB 21 »
SB 62 »
SB 89 »
HB 78 »