6.948 Definitions for section -- Health mandate impact statement and federal cost
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/ky/6-948A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
defrayal impact statement requirement for bill or amendment with mandated
health benefit -- State employee health plan impact statement requirement for
bill or amendment with mandated health benefit applicable to state employee
health plan -- Preparation of statement -- Requirements -- Contents -- Time for
completion of statements.
(1)As used in this section:
(a)"Amendment" includes a committee substitute;
(b)"Department" means the Department of Insurance;
(c)"Federal cost defrayal impact statement" means a statement prepared and
transmitted in accordance with subsection
(6)of this section;
(d)"Health benefit plan" has the same meaning as in KRS 304.17A-005, except
that for purposes of this section the term does not include:
1. A state employee health plan; or
2. Any other self-insured policy, certificate, plan, or contract;
(e)"Health mandate impact statement" means a statement prepared and
transmitted in accordance with subsection
(5)of this section;
(f)"Mandated health benefit" means a requirement that any health benefit plan or
state employee health plan:
1. Provide a specified benefit, including but not limited to a specified
coverage;
2. Pay, indemnify, or reimburse for a specified medical service; or
3. Pay, indemnify, or reimburse specified health care providers for specific
health care services;
(g)"Sponsor" means a member of the General Assembly that has made a request
to the Legislative Research Commission for a bill or amendment;
(h)"State employee health plan" means any fully insured health benefit plan or
self-insured plan issued or renewed to public employees under KRS 18A.225
or 18A.2254; and
(i)"State employee health plan impact statement" means a statement prepared
and transmitted in accordance with subsection
(7)of this section.
(a)Any bill or amendment that contains a mandated health benefit shall be
identified by the staff of, and on a form specified by, the Legislative Research
Commission.
(b)If a bill or amendment is identified as having a mandated health benefit under
paragraph
(a)of this subsection, the staff of the Legislative Research
Commission shall:
1. Notify the sponsor of the bill or amendment that a health mandate
impact statement, federal cost defrayal impact statement, and state
employee health plan impact statement, as applicable, are required; and
2. Upon introduction, adoption, or filing of the legislation:
a. For a mandated health benefit that applies to any health benefit
plan, request the department to prepare and transmit a health
mandate impact statement and federal cost defrayal impact
statement in accordance with this section; and
b. For a mandated health benefit that applies to any state employee
health plan, request the Department of Employee Insurance to
prepare and transmit a state employee health plan impact statement
in accordance with this section.
(a)The individuals referenced in paragraph
(b)of this subsection may, in
accordance with that paragraph, request the department or the Department of
Employee Insurance, as applicable, to prepare any or all of the following:
1. A health mandate impact statement;
2. A federal cost defrayal impact statement; or
3. A state employee health plan impact statement.
(b)Any or all of the following may make a request under paragraph
(a)of this
subsection:
1. For any introduced bill or adopted or filed amendment:
a. The sponsor of the bill or amendment; or
b. Any of the following members from a chamber of the General
Assembly with possession of the legislation:
i. Any member of the majority or minority leadership; or
ii. A chair of a standing committee; and
2. For any bill or amendment that has not been introduced, filed, or
adopted, the sponsor of the bill or amendment.
(a)Except as provided in paragraph
(b)of this subsection, when a request is made
under this section, the department or Department of Employee Insurance,
including its staff and third-party contractors, shall:
1. Keep the bill or amendment confidential until the bill or amendment is
published for public distribution by the Legislative Research
Commission; and
2. Keep the impact statement, including the request for the statement and
any information relating thereto, confidential until the statement is
published for public distribution by the Legislative Research
Commission.
(b)Paragraph
(a)of this subsection shall not apply to any communications with
or transmittals to:
1. Staff or third-party contractors designated by the department or
Department of Employee Insurance to receive and prepare the impact
statements required under this section;
2. Staff designated by the Legislative Research Commission;
3. The requester; or
4. Any other person designated by the requester.
(c)Any health mandate impact statement, federal cost defrayal impact statement,
or state employee health plan impact statement requested under this section
shall be prepared and transmitted by the department or Department of
Employee Insurance as provided in this section.
(5)A health mandate impact statement shall:
(a)Be in writing;
(b)Be signed by the commissioner of the department or the commissioner's
designee;
(c)Determine the extent to which the mandated health benefit will:
1. Increase or decrease administrative expenses of insurers offering health
benefit plans;
2. Increase or decrease health benefit plan premiums in the market or
markets to which the mandate applies; and
3. Impact the total cost of health care for health benefit plan insureds,
including any potential cost savings that may be realized; and
(d)Be completed and transmitted to staff designated by the Legislative Research
Commission and the requester as soon as possible, but not later than thirty
(30)days after the request is made to the department, unless the requestor and
commissioner of the department agree otherwise.
(a)A federal cost defrayal impact statement shall:
1. Be in writing;
2. Be signed by the commissioner of the department or the commissioner's
designee;
3. a. Indicate:
i. Whether a bill or amendment that contains a mandated health
benefit may result in the state being required to make
payments to defray costs under 42 U.S.C. sec. 18031(d)(3)
and 45 C.F.R. sec. 155.170, as amended; and
ii. If applicable, which provision or provisions of the bill or
amendment may trigger the requirement to make payments
to defray costs under 42 U.S.C. sec. 18031(d)(3) and 45
C.F.R. sec. 155.170, as amended.
b. When making a determination under subdivision a. of this
subparagraph, the department shall consider whether the provision
or provisions would apply under KRS 304.17A-099(2);
4. If it is indicated under subparagraph 3. of this paragraph that the bill or
amendment may result in the state being required to make payments,
include a cost defrayal fiscal analysis prepared in accordance with
paragraph
(b)of this subsection; and
5. Be completed and transmitted to staff designated by the Legislative
Research Commission and the requestor as soon as possible, but not
later than the following, unless the requestor and the commissioner of
the department agree otherwise:
a. For an indication required under subparagraph 3. of this paragraph,
ten
(10)business days after the request is made to the department;
and
b. For a cost defrayal fiscal analysis required under subparagraph 4.
of this paragraph, thirty
(30)days after the request is made to the
department.
(b)A cost defrayal fiscal analysis shall:
1. Be conducted by:
a. The department; and
b. An actuary selected by the department;
2. Be based on an analysis performed in accordance with generally
accepted actuarial principles and methodologies;
3. Determine the extent to which benefits required under the bill or
amendment are already covered by health insurers; and
4. Include an estimate of the payments the state may be required to make
under 42 U.S.C. sec. 18031(d)(3) and 45 C.F.R. sec. 155.170, as
amended, if the bill or amendment is enacted into law.
(7)A state employee health plan impact statement shall:
(a)Be in writing;
(b)Be signed by the commissioner of the Department of Employee Insurance or
the commissioner's designee;
(c)Determine the extent to which:
1. The mandated health benefit will increase or decrease state employee
health plan premiums; and
2. The increased or decreased premiums identified in subparagraph 1. of
this paragraph may be passed on to public employees; and
(d)Be completed and transmitted to staff designated by the Legislative Research
Commission and the requester as soon as possible, but not later than thirty
(30)days after the request is made to the Department of Employee Insurance,
unless the requestor and commissioner of the Department of Employee
Insurance agree otherwise.