KRS 6.948: Definitions for section -- Health mandate impact statement and federal cost

defrayal impact statement requirement for bill or amendment with mandated

health benefit -- State employee health plan impact statement requirement for

bill or amendment wi th 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 publi c 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.

(2) (a) Any bill or amendment that contains a mandated health ben efit 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 Res earch

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.

(3) (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 bi ll or amendment that has not been introduced, filed, or

adopted, the sponsor of the bill or amendment.

(4) (a) Except as provided in paragraph (b) of this subsection, when a request is made

under this section, the department or Department of Employee Insur ance,

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 designate d 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 dec rease 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 insured s,

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 ma de to the department, unless the requestor and

commissioner of the department agree otherwise.

(6) (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 c ompleted 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. 155.1 70, 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 com missioner of the Department of Employee

Insurance agree otherwise.