{"data":{"id":"us-ky/krs-304.17a-099","jurisdiction":"us-ky","citation":"KRS 304.17A-099","heading":"Qualified health plans -- Effect of requirement that state make","body":"payments under federal law to defray the cost of application of provision of\nchapter -- Administrative regulations.\n(1) As used in this section, \"qualified health plan\" has the s ame meaning as in 42\nU.S.C. sec. 18021(a)(1), as amended.\n(2) Notwithstanding any other provision of this chapter:\n(a) Except as provided in paragraph (b) of this subsection, if the application of a\nprovision of this chapter results, or would result, in a determination that the\nstate must make payments to defray the cost of the provision under 42 U.S.C.\nsec. 18031(d)(3) and 45 C.F.R. sec. 155.170, as amended, then the provision\nshall not apply to a qualified health plan or any other health insurance policy,\ncertificate, plan, or contract until the requirement to make cost defrayal\npayments is no longer applicable; and\n(b) This subsection shall not apply to a provision of this chapter that became\neffective on or before January 1, 2024.\n(3) To the extent permi tted by federal law, if the state is required under 42 U.S.C. sec.\n18031(d)(3) and 45 C.F.R. sec. 155.170, as amended, to make payments to defray\nthe cost of a provision of this chapter:\n(a) 1. Each qualified health plan issuer shall determine, and provide  to the\ncommissioner, the cost attributable to the provision for the qualified\nhealth plan.\n2. The cost attributable to a provision for a qualified health plan under\nsubparagraph 1. of this paragraph shall be:\na. Calculated in accordance with generally accepted actuarial\nprinciples and methodologies;\nb. Conducted by a member of the American Academy of Actuaries;\nand\nc. Reported by the qualified health plan issuer to:\ni. The commissioner; and\nii. The Division of Hea lth Benefit Exchange within the Office\nof Data Analytics;\n(b) The commissioner shall use the information obtained under paragraph (a) of\nthis subsection to determine the statewide average of the cost attributable to\nthe provision for all qualified health p lan issuers to which the provision is\napplicable; and\n(c) The required payments shall be:\n1. Calculated based on the statewide average of the cost attributable to the\nprovision as determined by the commissioner under paragraph (b) of this\nsubsection; and\n2. Submitted directly to qualified health plan issuers by the department\nthrough a process established by the commissioner.\n(4) A qualified health plan issuer that receives a payment under subsection (3)(c)2. of\nthis section shall:\n(a) Reduce the premium ch arged to an individual on whose behalf the issuer\nreceived the payment in an amount equal to the amount of the payment; or\n(b) Notwithstanding KRS 304.12-090, provide a premium rebate to an individual\non whose behalf the issuer received the payment in an a mount equal to the\namount of the payment.\n(5) Any fines collected for violations of this section shall be:\n(a) Placed in a trust and agency account within the department, which shall not\nlapse; and\n(b) Used solely by the department to make payments in acco rdance with\nsubsection (3)(c)2. of this section.\n(6) The commissioner shall promulgate any administrative regulations necessary to\nenforce and effectuate this section.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=54575","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:46Z","sha256":"a9d1d044d3be42977c331ea69461db15efdb6e94ea8e68b6da041c7b1090ad03","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-098","next":"us-ky/krs-304.17a-100"},"notice":"GroundRules: Original legal text. Not legal advice."}