KRS 304.17A-099: Qualified health plans -- Effect of requirement that state make

payments under federal law to defray the cost of application of provision of

chapter -- Administrative regulations.

(1) As used in this section, "qualified health plan" has the s ame meaning as in 42

U.S.C. sec. 18021(a)(1), as amended.

(2) Notwithstanding any other provision of this chapter:

(a) Except as provided in paragraph (b) of this subsection, if the application of a

provision of this chapter results, or would result, in a determination that the

state must make payments to defray the cost of the provision under 42 U.S.C.

sec. 18031(d)(3) and 45 C.F.R. sec. 155.170, as amended, then the provision

shall not apply to a qualified health plan or any other health insurance policy,

certificate, plan, or contract until the requirement to make cost defrayal

payments is no longer applicable; and

(b) This subsection shall not apply to a provision of this chapter that became

effective on or before January 1, 2024.

(3) To the extent permi tted by federal law, if the state is required under 42 U.S.C. sec.

18031(d)(3) and 45 C.F.R. sec. 155.170, as amended, to make payments to defray

the cost of a provision of this chapter:

(a) 1. Each qualified health plan issuer shall determine, and provide to the

commissioner, the cost attributable to the provision for the qualified

health plan.

2. The cost attributable to a provision for a qualified health plan under

subparagraph 1. of this paragraph shall be:

a. Calculated in accordance with generally accepted actuarial

principles and methodologies;

b. Conducted by a member of the American Academy of Actuaries;

and

c. Reported by the qualified health plan issuer to:

i. The commissioner; and

ii. The Division of Hea lth Benefit Exchange within the Office

of Data Analytics;

(b) The commissioner shall use the information obtained under paragraph (a) of

this subsection to determine the statewide average of the cost attributable to

the provision for all qualified health p lan issuers to which the provision is

applicable; and

(c) The required payments shall be:

1. Calculated based on the statewide average of the cost attributable to the

provision as determined by the commissioner under paragraph (b) of this

subsection; and

2. Submitted directly to qualified health plan issuers by the department

through a process established by the commissioner.

(4) A qualified health plan issuer that receives a payment under subsection (3)(c)2. of

this section shall:

(a) Reduce the premium ch arged to an individual on whose behalf the issuer

received the payment in an amount equal to the amount of the payment; or

(b) Notwithstanding KRS 304.12-090, provide a premium rebate to an individual

on whose behalf the issuer received the payment in an a mount equal to the

amount of the payment.

(5) Any fines collected for violations of this section shall be:

(a) Placed in a trust and agency account within the department, which shall not

lapse; and

(b) Used solely by the department to make payments in acco rdance with

subsection (3)(c)2. of this section.

(6) The commissioner shall promulgate any administrative regulations necessary to

enforce and effectuate this section.