05RS HB278

HB278

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HB 278 (BR 1157) - T. Thompson, B. Smith, A. Arnold, J. Bowen, J. Carr, M. Cherry, T. Couch, R. Crimm, J. DeCesare, M. Denham, J. Draud, T. Edmonds, C. Embry Jr, T. Feeley, J. Fischer, D. Floyd, D. Ford, M. Harmon, J. Higdon, S. Lee, G. Lynn, P. Marcotte, R. Mobley, B. Montell, S. Nunn, R. Palumbo, T. Pullin, M. Rader, J. Reinhardt, S. Westrom, A. Wuchner, B. Yonts

     AN ACT relating to small business health insurance relief.
     Create new sections of Subtitle 17A of KRS Chapter 304 to create the Small Business Access Program to make health insurance more affordable for small employer groups with 2 to 10 employees; require all insurers, stop-loss carriers, and self-insured employer-controlled or bona fide associations to participate in the program as a supporting insurer or a participating insurer; require participating insurers to provide health benefit plans to small employer groups with 2 to 10 employees and require supporting insurers to only be subject to assessments and payments through the program risk assessment process; define terms; deem as a participating insurer each insurer issuing health benefit plans in Kentucky in the small employer group market; exempt an insurer that provides coverage solely to Medicaid recipients, Medicare beneficiaries, or CHAMPUS insureds, and exempt self-insured health benefit plans covering employees of institutions of higher education and self-insured plans covering elected and salaried employees of cities, counties, urban-counties, charter counties, consolidated local governments, or special districts; establish critieria for a program plan as a health benefit plan purchased by a qualified group that provides primary coverage for a member with a high-cost condition who is identified at the time of underwriting; prohibit the insurer from considering the high-cost condition or the claims experience of the individual with the high-cost condition in establishing rates for a qualified group; require insurers to report certain information to the Department of Insurance annually; require the department to establish an assessment process to fund program losses; establish the assessment rate as one-half of one percent of the total amount of all assessable health benefit plan premiums earned during the prior assessment period; require supporting insurers to report total stop-loss premiums and health benefit plan premiums and other information required by the department; require the department to establish and maintain a program fund; require the department to complete a risk adjustment process to determine actual program losses for each calendar year; direct the department to reimburse each participating insurer the amount of its reimbursable losses not to exceed the assessment available in the program account; require the commissioner to report on the operations of the program to the Legislative Research Commission prior to each regular session of the General Assembly; direct the Auditor of Public Accounts to be responsible for an audit of the program; require an insurer that issues group health benefit plans to an employer-organized association health benefit plan to provide information relating to the association's health benefit plan for the previous 3 years on aggregate claims experience, total premiums paid, total number of insureds, and detailed claims information; authorize insurers to offer one or more basic health benefit plans in the small group and employer-organized association markets which covers physician, pharmacy, home health, preventive, emergency, and inpatient and outpatient hospital services; permit the insurer that offers a basic benefit plan to, upon request, exclude mandated benefits except for state-mandated coverage of diabetes and hospice, federally mandated benefits, and mandated payment, indemnity, or reimbursement of specified health care providers for specific health care services; require insurers offering basic benefit plans to disclose to the small employer groups and employer-organized associations prior to issuance of the policy that the plan provides limited benefits, includes federal mandated benefits, and excludes state mandated benefits except for diabetes and hospice coverage; create a new section of KRS Chapter 367 to prohibit a health care provider from billing, charging, collecting a deposit, seeking compensation, remuneration, or reimbursement from an enrollee or subscriber for services, treatment, or supplies provided if the provider has entered into an agreement as a participating provider under a health benefit plan, or if there exists any appliable state or federal law which requires a hold harmless provision; provide for penalties enforceable by the Attorney General; amend KRS 205.560 to direct the Medical Assistance Program to use the form and guidelines established for assessing credentials of those applying to participate in the Medical Assistance Program; amend KRS 216.2923 to direct the cabinet to convene a permanent cabinet advisory committee to advise the secretary on the collection, analysis, and distribution of consumer-oriented information related to the health care system, the cost of treatment and procedures, outcomes and quality indicators, and policies and regulations to implement electronic collection and transmission of patient information and other cost-saving patient record systems; amend KRS 216B.155 to direct certain health care facilities to use the application form and guidelines for assessing credentials of those applying for privileges; amend KRS 304.17A-005 to define "basic health benefit plan" and "preventive services"; amend KRS 304.17A-545 to direct the commissioner of insurance to promulgate administrative regulations to establish uniform application form and guidelines for the evaluation and reevaluation of health care providers who will be on the plan's list of participating providers; amend KRS 304.17A-430, 304.17B-001, 304.17A-005, 304.18-114, and 304.38A-010 to conform.

HB 278 - AMENDMENTS


     HCS - Retain original provisions of the Act, except delete Section 12 pertaining to billing by health care providers who have entered into provider agreements; amend KRS 205.560 and KRS 216B.155 to make technical changes; amend KRS 216.2923(2)(e) to include nonphysician health care providers on the committee; amend KRS 304.17A-545(5) to include psychologists as a health care provider subject to to uniform application form and guidelines for evaluation and reevaluation.

     HFA (1, R. Damron) - Amend KRS 141.010 to include Title XII of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 in the definition of Internal Revenue Code.

     HFA (2/Title, R. Damron) - Make title amendment.

     HFA (3, L. Clark) - Prohibit supporting insurers from being assessed to generate moneys in the fund in excess of $15,000,000; prohibit a participating insurer from including in any rate filing the amount of any assessment that generates moneys in the fund in excess of $15,000,000.

     HFA (4, T. Thompson) - Provide that an insurer shall consider the high-cost condition or a portion thereof or the claims experience of the individual with the high-cost condition or a portion thereof is establishing rates for a qualified group pursuant to administrative regulations.

     SCS - Delete Sections 1 through 8 that create the Small Business Access Program; retain remaining sections except add the individual market to those eligible for basic health benefit plans, provide that an insurer in the individual, small group or employer-organized association market may offer a basic health benefit plan, rather than offer a basic health benefit plan upon request; provide that chiropractic benefits shall be required in the basic health benefit plan; add and amend KRS 91A.080 to provide that the license fees and taxes under this section shall not apply to premiums received on high deductible health plans as defined in 26 U.S.C. sec. 220(C)(2); declare an emergency for Section 2 of the Act, relating to basic health benefit plans, to take effect upon final passage and signature by the governor or as otherwise provided by law.

     SCA (1/Title, T. Buford) - Make title amendment.

     SFA (1, J. Carroll) - Delete Section 7 containing the assessment plan; provide that the individual market is eligible for basic health benefit plans as defined in the Act; provide that chiropractic benefits shall be required in the basic health benefit plan.

     SFA (2/Title, J. Carroll) - Make title amendment.

     SFA (3, J. Denton) - Retain original provisions and add noncodified language to establish a short term small business health insurance task force; specify membership; require reports at Interim Joint Committee on Banking and Insurance during the 2005 interim; require recommendations on legislation and funding; cease to exist on December 31, 2005 unless otherwise authorized by the General Assembly.

     SFA (4, J. Denton) - Make technical correction.

     SFA (5, J. Carroll) - Create new sections of Subtitle 17A of KRS Chapter 304 to create the Small Business Access Program to make health insurance more affordable for small employer groups with two (2) to ten (10) employees; require all insurers, stop-loss carriers, and self-insured employer-controlled or bona fide associations to participate in the program as a supporting insurer or a participating insurer; require participating insurers to provide health benefit plans to small employer groups with two (2) to ten (10) employees and require supporting insurers to only be subject to assessments and payments through the program risk assessment process; define terms; deem as a participating insurer each insurer issuing health benefit plans in Kentucky in the small employer group market; exempt from this Act an insurer that provides coverage solely to Medicaid recipients, Medicare beneficiaries, or CHAMPUS insureds and exempt self-insured health benefit plans covering employees of institutions of higher education and self-insured plans covering elected and salaried employees of cities, counties, urban-counties, charter counties, or special districts; establish criteria for a program plan as a health benefit plan purchased by a qualified group that provides primary coverage for a member with a high-cost condition who is identified at the time of underwriting; allow the insurer to consider the high cost condition or a portion thereof or the claims experience of the individual with the high-cost condition in establishing rates for a qualified group; require insurers to report certain information to the Department of Insurance annually; require the commissioner to report on the operations of the program to the Legislative Research Commission prior to each regular session of the General Assembly; direct the Auditor of Public Accounts to be responsible for an audit of the program; make technical corrections.

     SFA (6, T. Buford) - Amend Section 5, which establishes the membership of the advisory committee for health data collection, to add one (1) representative of employers with less than fifty (50) employees and one (1) representative of employers with more than fifty (50) employees, from a list of employers submitted by the Chamber of Commerce.

     Feb 3-introduced in House
     Feb 4-to Banking and Insurance (H); posted in committee
     Feb 9-reported favorably, 1st reading, to Calendar with Committee Substitute
     Feb 10-2nd reading, to Rules; posted for passage in the Regular Orders of the Day for Friday, February 11, 2005; floor amendment (1) filed to Committee Substitute, floor amendment (2-title) filed
     Feb 14-floor amendments (3) and (4) filed to Committee Substitute
     Feb 16-3rd reading, passed 96-0 with Committee Substitute, floor amendment (4)
     Feb 17-received in Senate
     Feb 18-to Banking and Insurance (S)
     Feb 25-reported favorably, 1st reading, to Calendar with Committee Substitute, committee amendment (1-title)
     Feb 28-2nd reading, to Rules; posted for passage in the Regular Orders of the Day for Tuesday, March 1, 2005; floor amendments (3) (4) and (5) filed to Committee Substitute, floor amendments (1) and (2-title) filed
     Mar 1-passed over and retained in the Orders of the Day; floor amendment (6) filed to Committee Substitute
     Mar 2-passed over and retained in the Orders of the Day
     Mar 3-taken from the Regular Orders of the Day; recommitted to Banking and Insurance (S)
     Mar 4-taken from committee; laid on clerk's desk; taken from clerk's desk; posted for passage in the Regular Orders of the Day for Friday, March 4, 2005; 3rd reading; floor amendments (1) (2-title) and (5) withdrawn; passed 33-1 with Committee Substitute, committee amendment (1-title), floor amendments (3) (4) and (6)
     Mar 8-received in House; to Rules (H); posted for passage for concurrence in Senate Committee Substitute, committee amendment (1-title), floor amendments (3) (4) and (6) on Tuesday, March 8, 2005; House concurred in Senate Committee Substitute, committee amendment (1-title), floor amendment (4); House refused to concur in Senate floor amendments (3) and (6); received in Senate; posted for passage for receding from Senate floor amendments (3) and (6); Senate receded from floor amendments (3) and (6); passed 36-1; received in House; passed 86-0; enrolled, signed by each presiding officer; delivered to Governor
     Mar 18-signed by Governor (Acts ch. 144)


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