Kentucky 2022 Regular Session Status: Enacted 2 R cosponsors

SB 140 — AN ACT relating to step therapy protocols.

Last action — signed by Governor (Acts Ch. 19)

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed Senate
  4. ✓
    Passed House
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced February 03, 2022. Enacted.

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Likely to advance 74% · moderate confidence

Where this bill stands today.

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High

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  • Enacted

    Current position in the legislative process.

  • 2 sponsors

    2 primary, 0 co-sponsors signed on.

  • Single-party support

    Sponsorship is currently within one party (2 R).

  • Cleared a recorded vote

    Passed 2 recorded votes so far.

Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.

Summary

Amend KRS 304.17A-163 to define terms; establish requirements for clinical review criteria and clinical practice guidelines used to establish step therapy protocols; require certain notices and disclosures relating to step therapy protocols; establish requirements for exception requests, internal appeals, and external reviews of step therapy protocols; create a new section of Subtitle 17A of KRS Chapter 304 to require the commissioner of insurance to promulgate administrative regulations; require insurers, health plans, pharmacy benefit managers, or private review agents to submit an annual report relating to step therapy exception requests; amend KRS 304.17A-168, 304.17A-535, 304.17A-600, 304.17A-607, 304.17A-617, and 304.17A-623 to conform; amend KRS 205.522, 205.6485, 164.2871, and 18A.225 to require Medicaid, the Kentucky Children's Health Insurance Program, self-insured employer group health plans provided by the governing board of a state postsecondary education institution, and the state employee health plan to comply with the step therapy protocol requirements; apply to health plans delivered, issued for delivery, or renewed on or after the effective date of Sections 1 to 12 of the Act; require the Cabinet for Health and Family Services to seek a federal waiver of authorization if necessary; EFFECTIVE, in part, January 1, 2023.

Bill Text

What changed in the latest version

879 added · 1184 removed

879 line(s) added, 1184 removed.

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UNOFFICIAL COPY 22 RS SB 140/GA AN ACT relating to step therapy protocols.
CHAPTER 19 1 CHAPTER 19 ( SB 140 ) AN ACT relating to step therapy protocols.
and (g) "Step therapy protocol" means a protocol, policy, or program that establishes the specific sequence in which prescription drugs that are for a specified medical condition and medically appropriate for a particular Page 1 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA insured are covered by an insurer or health plan[protocol that establishes the specific sequence in which prescription drugs for a specified medical condition and medically appropriate for a particular patient are to be prescribed;
and (g) "Step therapy protocol" means a protocol, policy, or program that establishes the specific sequence in which prescription drugs that are for a specified medical condition and medically appropriate for a particular insured are covered by an insurer or health plan[protocol that establishes the specific sequence in which prescription drugs for a specified medical condition and medically appropriate for a particular patient are to be prescribed;
b.
Legislative Research Commission PDF Version ACTS OF THE GENERAL ASSEMBLY b.
and Page 2 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA c.
and c.
On the insurer's, health plan's, pharmacy benefit manager's, or Page 3 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA private review agent's Web site;
On the insurer's, health plan's, pharmacy benefit manager's, or private review agent's Web site;
Page 4 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA 1.
1.
and[, under the following documented circumstances:] 2.
and[, under the following documented circumstances:] CHAPTER 19 3 2.
One of the following apply:
One (1) of the following apply:
Page 5 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA (b) If a request for a step therapy exception, or an internal appeal under Section 7 of this Act of a step therapy exception request denial, is incomplete or additional clinically relevant information is required, the insurer, health plan, pharmacy benefit manager, or private review agent shall notify the prescribing provider within forty-eight (48) hours of submission of the request or appeal:
(b) If a request for a step therapy exception, or an internal appeal under Section 7 of this Act of a step therapy exception request denial, is incomplete or additional clinically relevant information is required, the insurer, health plan, pharmacy benefit manager, or private review agent shall notify the prescribing provider within forty-eight (48) hours of submission of the request or appeal:
The prescribing practitioner can demonstrate that the preferred treatment required under the step therapy or fail-first protocol will cause or will likely cause an adverse reaction or other physical harm to the insured.] (5) If a step therapy exception request determination, notification under subsection (4)(b) of this section, or internal appeal determination under Section 7 of this Act of a step therapy exception request denial by an insurer, health plan, pharmacy benefit manager, or private review agent is not received by the prescribing provider within the time period specified in subsection (4) of this section, the step Page 6 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA therapy exception request or internal appeal shall be deemed granted.
The prescribing practitioner can demonstrate that the preferred treatment required under the step therapy or fail-first protocol will cause or will likely cause an adverse reaction or other physical harm to the insured.] (5) If a step therapy exception request determination, notification under subsection (4)(b) of this section, or internal appeal determination under Section 7 of this Act of a step therapy exception request denial by an insurer, health plan, pharmacy benefit manager, or private review agent is not received by the prescribing provider within the time period specified in subsection (4) of this section, the step therapy exception request or internal appeal shall be deemed granted.
and (b) Request an external review under Section 8 of this Act upon the denial of an internal appeal under paragraph (a) of this subsection.
and Legislative Research Commission PDF Version ACTS OF THE GENERAL ASSEMBLY (b) Request an external review under Section 8 of this Act upon the denial of an internal appeal under paragraph (a) of this subsection.
(8) (a)[(3)] Except as provided in paragraph (b) of this subsection, the duration of any step therapy [or fail-first ]protocol shall not be longer than a period of thirty (30) days if the treatment is deemed and documented as clinically ineffective by the prescribing provider[practitioner].
(8) (a)[(3)] Except as provided in paragraph (b) of this subsection, the duration of any step therapy [or fail- first ]protocol shall not be longer than a period of thirty (30) days if the treatment is deemed and documented as clinically ineffective by the prescribing provider[practitioner].
An insured to try an AB-rated generic equivalent or interchangeable Page 7 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA biological product, as defined in 42 U.S.C.
An insured to try an AB-rated generic equivalent or interchangeable biological product, as defined in 42 U.S.C.
Initially denied and then subsequently reversed by internal appeals or Page 8 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA external reviews;
Initially denied and then subsequently reversed by internal appeals or external reviews;
(1) Notwithstanding any provision of law to the contrary, a health benefit plan shall, at a minimum, provide coverage for all United States Food and Drug Administration- approved tobacco cessation medications, all forms of tobacco cessation services recommended by the United States Preventive Services Task Force, including but not limited to individual, group, and telephone counseling, and any combination thereof.
(1) Notwithstanding any provision of law to the contrary, a health benefit plan shall, at a minimum, provide coverage for all United States Food and Drug Administration-approved tobacco cessation medications, all CHAPTER 19 5 forms of tobacco cessation services recommended by the United States Preventive Services Task Force, including but not limited to individual, group, and telephone counseling, and any combination thereof.
(4) Nothing in this section shall be construed to prohibit a plan or issuer from providing Page 9 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA coverage for tobacco cessation services in addition to those recommended or to deny coverage for services that are not recommended by the United States Preventive Services Task Force.
(4) Nothing in this section shall be construed to prohibit a plan or issuer from providing coverage for tobacco cessation services in addition to those recommended or to deny coverage for services that are not recommended by the United States Preventive Services Task Force.
2.[(b)] Education of health care providers and enrollees regarding the appropriate use of prescription drugs;
2.[(b)]Education of health care providers and enrollees regarding the appropriate use of prescription drugs;
(3) When, in the professional opinion of a provider with prescriptive authority, the provider determines that generic substitution of a pharmaceutical product is medically inappropriate, the provider shall prescribe the pharmaceutical product the provider determines medically appropriate with the indication "Do Not Substitute," Page 10 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA and no substitution shall be made without the provider's approval.
(3) When, in the professional opinion of a provider with prescriptive authority, the provider determines that generic substitution of a pharmaceutical product is medically inappropriate, the provider shall prescribe the pharmaceutical product the provider determines medically appropriate with the indication "Do Not Substitute," and no substitution shall be made without the provider's approval.
(1) (a) "Adverse determination" means a determination by an insurer or its designee that the health care services furnished or proposed to be furnished to a covered person are:
Legislative Research Commission PDF Version ACTS OF THE GENERAL ASSEMBLY (1) (a) "Adverse determination" means a determination by an insurer or its designee that the health care services furnished or proposed to be furnished to a covered person are:
(6) "Health benefit plan" has the same meaning as in KRS 304.17A-005, except that for purposes of KRS 304.17A-600 to 304.17A-633, the term includes short-term Page 11 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA coverage policies;
(6) "Health benefit plan" has the same meaning as in KRS 304.17A-005, except that for purposes of KRS 304.17A-600 to 304.17A-633, the term includes short-term coverage policies;
(9) "Internal appeals process" means a formal process, as set forth in KRS 304.17A- 617, established and maintained by the insurer, its designee, or agent whereby the covered person, an authorized person, or a provider may contest an adverse determination rendered by the insurer, its designee, or private review agent;
(9) "Internal appeals process" means a formal process, as set forth in KRS 304.17A-617, established and maintained by the insurer, its designee, or agent whereby the covered person, an authorized person, or a provider may contest an adverse determination rendered by the insurer, its designee, or private review agent;
(a) Means a person or entity performing utilization review that is either affiliated Page 12 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA with, under contract with, or acting on behalf of any insurer or other person providing or administering health benefits to citizens of this Commonwealth;
(a) Means a person or entity performing utilization review that is either affiliated with, under contract with, or acting on behalf of any insurer or other person providing or administering health benefits to citizens of this Commonwealth;
(14) "Registration" means an authorization issued by the department to an insurer or a private review agent to conduct utilization review;
CHAPTER 19 7 (14) "Registration" means an authorization issued by the department to an insurer or a private review agent to conduct utilization review;
In the opinion of a physician with knowledge of the covered person's Page 13 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA medical condition, would subject the covered person to severe pain that cannot be adequately managed without the care or treatment that is the subject of the utilization review.
In the opinion of a physician with knowledge of the covered person's medical condition, would subject the covered person to severe pain that cannot be adequately managed without the care or treatment that is the subject of the utilization review.
Make a utilization review decision to deny, reduce, limit, or terminate a health care benefit or to deny, or reduce payment for a health care service because that service is not medically necessary, experimental, or investigational except in the case of a health care service rendered by a Page 14 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA chiropractor or optometrist where the denial shall be made respectively by a chiropractor or optometrist duly licensed in Kentucky;
Make a utilization review decision to deny, reduce, limit, or terminate a health care benefit or to deny, or reduce payment for a health care service because that service is not medically necessary, experimental, or investigational except in the case of a health care service rendered by a chiropractor or optometrist where the denial shall be made respectively by a chiropractor or optometrist duly licensed in Kentucky;
(g) Provide decisions to covered persons, authorized persons, and all providers on appeals of adverse determinations and coverage denials of the insurer or private review agent, in accordance with this section and administrative regulations promulgated in accordance with KRS 304.17A-609;
Legislative Research Commission PDF Version ACTS OF THE GENERAL ASSEMBLY (g) Provide decisions to covered persons, authorized persons, and all providers on appeals of adverse determinations and coverage denials of the insurer or private review agent, in accordance with this section and administrative regulations promulgated in accordance with KRS 304.17A-609;
(h) Except for retrospective review of an emergency admission where the covered person remains hospitalized at the time the review request is made, which shall be considered a concurrent review, or as otherwise provided in this subtitle, provide a utilization review decision in accordance with the Page 15 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA timeframes in paragraph (i) of this subsection and 29 C.F.R.
(h) Except for retrospective review of an emergency admission where the covered person remains hospitalized at the time the review request is made, which shall be considered a concurrent review, or as otherwise provided in this subtitle, provide a utilization review decision in accordance with the timeframes in paragraph (i) of this subsection and 29 C.F.R.
An insurer or agent that denies a step therapy exception, as defined in KRS 304.17A-163,[ overrides] or denies coverage or reduces payment for a treatment, procedure, drug that requires prior approval, or device shall include in the written notice:
An insurer or agent that denies a step therapy exception, as defined in KRS 304.17A- 163,[ overrides] or denies coverage or reduces payment for a treatment, procedure, drug that requires prior approval, or device shall include in the written notice:
Page 16 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA 2.
2.
No change to policies Page 17 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA and procedures shall be effective or used until after it has been filed with and approved by the commissioner.
No change to policies and procedures shall be effective or used until after it has been filed with and approved by the commissioner.
(4) A private review agent shall provide to the department the names of the entities for which the private review agent is performing utilization review in this state.
CHAPTER 19 9 (4) A private review agent shall provide to the department the names of the entities for which the private review agent is performing utilization review in this state.
(1) (a) Every insurer shall have an internal appeal process to be utilized by the insurer or its designee, consistent with this section and KRS 304.17A-619 and which shall be disclosed to covered persons in accordance with KRS 304.17A- 505(1)(g).
(1) (a) Every insurer shall have an internal appeal process to be utilized by the insurer or its designee, consistent with this section and KRS 304.17A-619 and which shall be disclosed to covered persons in accordance with KRS 304.17A-505(1)(g).
(b) An insurer shall disclose the availability of the internal process to the covered person in the insured's timely notice of an adverse determination or notice of a coverage denial which meets the requirements set forth in KRS 304.17A- 607(1)(j).
(b) An insurer shall disclose the availability of the internal process to the covered person in the insured's timely notice of an adverse determination or notice of a coverage denial which meets the requirements set forth in KRS 304.17A-607(1)(j).
Page 18 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA (a) Except as provided in Section 1 of this Act:
(a) Except as provided in Section 1 of this Act:
and 2.[(b)] Insurers or their designees shall render a decision not later than three (3) business days after receipt of the request for an expedited appeal of either an adverse determination or a coverage denial.
and 2.[(b)]Insurers or their designees shall render a decision not later than three (3) business days after receipt of the request for an expedited appeal of either an adverse determination or a coverage denial.
a.[1.]Placing the health of the covered person or, with respect to a pregnant woman, the health of the covered person or the unborn child in serious jeopardy;
a.[1.] Placing the health of the covered person or, with respect to a pregnant woman, the health of the covered person or the unborn child in serious jeopardy;
b.[2.]Serious impairment to bodily functions;
b.[2.] Serious impairment to bodily functions;
or c.[3.]Serious dysfunction of a bodily organ or part;
or c.[3.] Serious dysfunction of a bodily organ or part;
and Page 19 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA (d)[(e)] In addition to any previous notice required under KRS 304.17A- 607(1)(j), and to facilitate expeditious handling of a request for external review of an adverse determination or a coverage denial, an insurer or agent that denies, limits, reduces, or terminates coverage for a treatment, procedure, drug, or device for a covered person shall provide the covered person, authorized person, or provider acting on behalf of the covered person with an internal appeal determination letter that shall include:
and (d)[(e)] In addition to any previous notice required under KRS 304.17A-607(1)(j), and to facilitate expeditious handling of a request for external review of an adverse determination or a coverage denial, an insurer or agent that denies, limits, reduces, or terminates coverage for a treatment, procedure, drug, or device for a covered person shall provide the covered person, authorized person, or provider acting on behalf of the covered person with an internal appeal determination letter that shall include:
1.
Legislative Research Commission PDF Version ACTS OF THE GENERAL ASSEMBLY 1.
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(c)[(a)] On receipt of a written request for review of a coverage denial from a covered person, authorized person, or provider, the department shall notify the insurer which issued the denial of the request for review and shall call for the insurer to respond to the department regarding the request for review within Page 20 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA ten (10) business days of receipt of notice to the insurer.
(c)[(a)] On receipt of a written request for review of a coverage denial from a covered person, authorized person, or provider, the department shall notify the insurer which issued the denial of the request for review and shall call for the insurer to respond to the department regarding the request for review within ten (10) business days of receipt of notice to the insurer.
If the department determines that the treatment, service, drug, or device is not specifically limited or excluded, it shall so notify the insurer, and the insurer shall either cover the service, or afford the covered person an Page 21 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA opportunity for external review under KRS 304.17A-621, 304.17A-623, and 304.17A-625, where the conditions precedent to the review are present.
If the department determines that the treatment, service, drug, or device is not specifically limited or excluded, it shall so notify the insurer, and the insurer shall either cover the service, or afford the covered person an opportunity for external review under KRS 304.17A-621, 304.17A-623, and 304.17A-625, where the conditions precedent to the review are present.
(b) An insurer, its designee, or agent shall disclose the availability of the external review process to the covered person in the insured's timely notice of an adverse determination or notice of a coverage denial as set forth in KRS 304.17A-607(1)(j) and in the denial letter required in KRS 304.17A-617(1) and (3)(d)[(2)(e)].
CHAPTER 19 11 (b) An insurer, its designee, or agent shall disclose the availability of the external review process to the covered person in the insured's timely notice of an adverse determination or notice of a coverage denial as set forth in KRS 304.17A-607(1)(j) and in the denial letter required in KRS 304.17A-617(1) and (3)(d)[(2)(e)].
Page 22 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA (2) A covered person, an authorized person, or a provider acting on behalf of and with the consent of the covered person, may request an external review of an adverse determination rendered by an insurer, its designee, or agent.
(2) A covered person, an authorized person, or a provider acting on behalf of and with the consent of the covered person, may request an external review of an adverse determination rendered by an insurer, its designee, or agent.
(5) The covered person shall be assessed a one (1) time filing fee of twenty-five dollars ($25) to be paid to the independent review entity and which may be waived if the independent review entity determines that the fee creates a financial hardship on the Page 23 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA covered person.
(5) The covered person shall be assessed a one (1) time filing fee of twenty-five dollars ($25) to be paid to the independent review entity and which may be waived if the independent review entity determines that the fee creates a financial hardship on the covered person.
(b) The complaint process established in this section shall be separate and distinct from, and shall in no way limit other grievance or complaint processes available to consumers under other provisions of the KRS or duly Page 24 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA promulgated administrative regulations.
Legislative Research Commission PDF Version ACTS OF THE GENERAL ASSEMBLY (b) The complaint process established in this section shall be separate and distinct from, and shall in no way limit other grievance or complaint processes available to consumers under other provisions of the KRS or duly promulgated administrative regulations.
(12) For expedited external review, a determination shall be made by the independent review entity within twenty-four (24) hours from the receipt of all information required from the insurer.
(12) For expedited external review, a determination shall be made by the independent review entity within twenty- four (24) hours from the receipt of all information required from the insurer.
Page 25 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA Section 9.
Section 9.
(1) The Department for Medicaid Services and any managed care organization contracted to provide Medicaid benefits pursuant to this chapter shall comply with the provisions of Sections 1 and 2 of this Act and KRS 304.17A-167, 304.17A- 235, 304.17A-257, 304.17A-259, 304.17A-515, 304.17A-580, 304.17A-600, 304.17A-603, 304.17A-607, and 304.17A-740 to 304.17A-743, as applicable.
(1) The Department for Medicaid Services and any managed care organization contracted to provide Medicaid benefits pursuant to this chapter shall comply with the provisions of Sections 1 and 2 of this Act and KRS 304.17A-167, 304.17A-235, 304.17A-257, 304.17A-259, 304.17A-515, 304.17A-580, 304.17A-600, 304.17A- 603, 304.17A-607, and 304.17A-740 to 304.17A-743, as applicable.
The standard Blue Cross/Blue Shield preferred provider option under the Page 26 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA Federal Employees Health Benefit Plan established by U.S.C.
The standard Blue Cross/Blue Shield preferred provider option under the Federal Employees Health Benefit Plan established by U.S.C.
or 3.
or CHAPTER 19 13 3.
Page 27 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA However, the cabinet shall provide, in any contracting process for the preventive health insurance program, the opportunity for a public health department to bid on preventive health services to eligible children within the public health department's service area.
However, the cabinet shall provide, in any contracting process for the preventive health insurance program, the opportunity for a public health department to bid on preventive health services to eligible children within the public health department's service area.
Page 28 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA (2) All retirement annuity allowances accrued or accruing to any employee of a state postsecondary 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 other process whatsoever, nor shall any assignment thereof be enforceable in any court.
(2) All retirement annuity allowances accrued or accruing to any employee of a state postsecondary 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 other process whatsoever, nor shall any assignment thereof be enforceable in any court.
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304;
Legislative Research Commission PDF Version ACTS OF THE GENERAL ASSEMBLY (a) Conform to the requirements of Subtitle 32 of KRS Chapter 304;
Any person, including an elected public official, who is regularly employed by any department, office, board, agency, or branch of state Page 29 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA government;
Any person, including an elected public official, who is regularly employed by any department, office, board, agency, or branch of state government;
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;
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;
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 sixty-five (65) or older shall not be included, with the exception of persons covered under KRS Page 30 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA 61.702(4)(c), unless he or she is actively employed pursuant to subparagraph 1.
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 sixty-five (65) or older shall not be included, with the exception of persons covered under KRS 61.702(4)(c), unless he or she is actively employed pursuant to subparagraph 1.
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 Page 31 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA administration of the health insurance program.
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 CHAPTER 19 15 insurance program.
and to be subject Page 32 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA to penalties for noncompliance with data reporting requirements as specified by the Personnel Cabinet.
and to be subject to penalties for noncompliance with data reporting requirements as specified by the Personnel Cabinet.
(g) Any funds in flexible spending accounts that remain after all reimbursements Page 33 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA have been processed shall be transferred to the credit of the state-sponsored health insurance plan's appropriation account.
(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.
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.
or Legislative Research Commission PDF Version ACTS OF THE GENERAL ASSEMBLY (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.
(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 Page 34 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA insured employee for the purposes of any statute fixing or limiting the compensation of such an employee.
(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.
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 state employee organization of nonschool Page 35 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA 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) members 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 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 state 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) members 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.
(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.
CHAPTER 19 17 (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 Page 36 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA accordance with Kentucky law.
Maintenance drugs may be dispensed by mail order in accordance with Kentucky law.
(18) If a state employee's residence and place of employment are each located in counties Page 37 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA 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.
(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.
If the Personnel Cabinet deems the bids submitted in accordance with this subsection to be in Page 38 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA 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;
If the Personnel Cabinet deems the bids submitted in accordance 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;
(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 which 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 coverage to optometrists as allowed for those services rendered by physicians or osteopaths.
(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 which 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 Legislative Research Commission PDF Version ACTS OF THE GENERAL ASSEMBLY under the provisions of KRS Chapter 320 shall provide the same payment of coverage to optometrists as allowed for those services rendered by physicians or osteopaths.
[(23) Any fully insured health benefit plan or self-insured plan issued or renewed on or Page 39 of 40 SB014010.100 - 1471 - XXXX GA UNOFFICIAL COPY 22 RS SB 140/GA after January 1, 2022, to public employees pursuant to this section shall comply with KRS 304.17A-148.] Section 13.
[(23) Any fully insured health benefit plan or self-insured plan issued or renewed on or after January 1, 2022, to public employees pursuant to this section shall comply with KRS 304.17A-148.] Section 13.
Page 40 of 40 SB014010.100 - 1471 - XXXX GA
Signed by Governor March 17, 2022.
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Action History

  1. signed by Governor (Acts Ch. 19)

  2. delivered to Governor

  3. enrolled, signed by Speaker of the House

  4. enrolled, signed by President of the Senate

  5. received in Senate

  6. 3rd reading, passed 95-0

  7. posted for passage in the Regular Orders of the Day for Thursday, March 10, 2022

  8. 2nd reading, to Rules

  9. reported favorably, 1st reading, to Calendar

  10. to Banking & Insurance (H)

  11. to Committee on Committees (H)

  12. received in House

  13. 3rd reading, passed 35-0 with Committee Substitute (1)

  14. posted for passage in the Regular Orders of the Day for Thursday, February 17, 2022

  15. 2nd reading, to Rules

  16. reported favorably, 1st reading, to Calendar with Committee Substitute (1)

  17. to Banking & Insurance (S)

  18. to Committee on Committees (S)

  19. introduced in Senate

Sponsors

Sponsorship breakdown

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2 sponsors · 0 co-sponsors · 136 not signed on

Sponsors (2)

Co-sponsors (0)

None.

Not signed on (136)

136 members have not signed on to this bill.

Show all 136 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Final Passage

Passed 95 Yea · 0 Nay · 5 Other
Party YeaNayPresentNot Voting
Republican 51002
Unaffiliated 36002
Democrat 8001
Total 95005
% of votes cast 95%0%0%5%
How each member voted (100)
Member Party Vote
Meredith — Yea
Fischer — Yea
Santoro — Yea
Bechler — Yea
Jenkins — Yea
Scott — Yea
Bentley — Yea
Minter — Yea
Sheldon — Yea
Flood — Yea
Smith — Yea
Nemes — Yea
Koenig — Yea
Palumbo — Yea
Thomas — Yea
Graham — Yea
Pratt — Yea
Timoney — Yea
Burch — Yea
Prunty — Yea
Hatton — Yea
Massey — Yea
Raymond — Yea
Webber — Yea
Dixon — Yea
Heath — Yea
McCoy — Yea
Westrom — Yea
Wheatley — Yea
DuPlessis — Yea
Rowland — Yea
Cantrell — Not Voting
Donohue — Not Voting
Huff R — Yea
Kirk McCormick — Yea
Miller C — Yea
Miller J — Yea
Stevenson C — Yea
Al Gentry Democrat Yea
Ashley Tackett Laferty Democrat Yea
George Brown Jr. Democrat Yea
Keturah J. Herron Democrat Yea
Lisa Willner Democrat Yea
Mary Lou Marzian Democrat Not Voting
Nima Kulkarni Democrat Yea
Pamela Stevenson Democrat Yea
Tina Bojanowski Democrat Yea
Aaron Reed Republican Yea
Adam Bowling Republican Yea
Bill Wesley Republican Yea
Bobby McCool Republican Yea
Chris Freeland Republican Yea
Chris Fugate Republican Yea
DJ Johnson Republican Yea
Daniel Elliott Republican Yea
Daniel Fister Republican Yea
David Hale Republican Yea
David Meade Republican Yea
David W. Osborne Republican Yea
Deanna Gordon Republican Yea
Derek Lewis Republican Yea
Felicia Rabourn Republican Yea
James Tipton Republican Yea
Jason Petrie Republican Yea
Jennifer Decker Republican Yea
Jim Gooch Jr. Republican Yea
John Blanton Republican Yea
Josh Branscum Republican Yea
Josh Bray Republican Yea
Josh Calloway Republican Yea
Ken Fleming Republican Yea
Ken Upchurch Republican Yea
Kim Banta Republican Yea
Kim King Republican Yea
Kimberly Poore Moser Republican Yea
Mark Hart Republican Yea
Mary Beth Imes Republican Yea
Matt Lockett Republican Yea
Matthew Koch Republican Yea
Michael Sarge Pollock Republican Yea
Myron Dossett Republican Yea
Nancy Tate Republican Yea
Patrick Flannery Republican Yea
Randy Bridges Republican Yea
Richard White Republican Not Voting
Ryan Dotson Republican Yea
Samara Heavrin Republican Yea
Savannah Maddox Republican Yea
Scott Lewis Republican Yea
Scott Sharp Republican Yea
Shane Baker Republican Yea
Shawn McPherson Republican Yea
Steve Bratcher Republican Yea
Steve Riley Republican Yea
Steven Rudy Republican Yea
Suzanne Miles Republican Yea
T.J. Roberts Republican Yea
Thomas Huff Republican Yea
Timmy Truett Republican Not Voting
William Lawrence Republican Yea

Official roll call →

PASS SB 140 W/ scs1

Passed 35 Yea · 0 Nay · 3 Other
Party YeaNayPresentNot Voting
Unaffiliated 16003
Republican 17000
Democrat 2000
Total 35003
% of votes cast 92%0%0%8%
How each member voted (38)
Member Party Vote
Alvarado — Yea
Turner — Yea
Kerr — Yea
Schickel — Yea
Schroder — Yea
McGarvey — Yea
Smith — Yea
Westerfield — Yea
Meredith — Yea
Southworth — Yea
Nemes — Yea
Thayer — Yea
Yates — Yea
Parrett — Yea
Thomas — Yea
Castlen — Not Voting
Embry — Not Voting
Hornback — Not Voting
Harper Angel — Yea
Gerald A. Neal Democrat Yea
Karen Berg Democrat Yea
Brandon J. Storm Republican Yea
Christian McDaniel Republican Yea
Danny Carroll Republican Yea
David P. Givens Republican Yea
Donald Douglas Republican Yea
Jared Carpenter Republican Yea
Jason Howell Republican Yea
Jimmy Higdon Republican Yea
Julie Raque Adams Republican Yea
Max Wise Republican Yea
Mike Wilson Republican Yea
Phillip Wheeler Republican Yea
Rick Girdler Republican Yea
Robby Mills Republican Yea
Robert Stivers Republican Yea
Robin L. Webb Republican Yea
Stephen West Republican Yea

Official roll call →

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does SB 140 do?
Amend KRS 304.17A-163 to define terms; establish requirements for clinical review criteria and clinical practice guidelines used to establish step therapy protocols; require certain notices and disclosures relating to step therapy protocols; establish requirements for exception requests, internal appeals, and external reviews of step therapy protocols; create a new section of Subtitle 17A of KRS Chapter 304 to require the commissioner of insurance to promulgate administrative regulations; require insurers, health plans, pharmacy benefit managers, or private review agents to submit an annual report relating to step therapy exception requests; amend KRS 304.17A-168, 304.17A-535, 304.17A-600, 304.17A-607, 304.17A-617, and 304.17A-623 to conform; amend KRS 205.522, 205.6485, 164.2871, and 18A.225 to require Medicaid, the Kentucky Children's Health Insurance Program, self-insured employer group health plans provided by the governing board of a state postsecondary education institution, and the state employee health plan to comply with the step therapy protocol requirements; apply to health plans delivered, issued for delivery, or renewed on or after the effective date of Sections 1 to 12 of the Act; require the Cabinet for Health and Family Services to seek a federal waiver of authorization if necessary; EFFECTIVE, in part, January 1, 2023.
Who sponsors SB 140?
SB 140 is sponsored by Max Wise (Republican) and Danny Carroll (Republican).
What is the current status of SB 140?
This bill has been enacted into law. Introduced February 03, 2022. Enacted.
Where can I track SB 140?
Track SB 140 free on One Click Politics — get push/email alerts when it moves.

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