{"data":{"id":"us-ky/krs-304.17a-661","jurisdiction":"us-ky","citation":"KRS 304.17A-661","heading":"Treatment of mental health conditions to be covered under terms or","body":"conditions that are no more restrictive than terms or conditions for treatment\nof physical health conditions -- Parity coverage for nonquantitative treatment\nlimitations and medical necessity criteria.\n(1) Notwithstanding any other provision of law:\n(a) 1. A health benefit plan issued or renewed on or after January 1, 2022, that\nprovides coverage for treatment of a mental health condition shall\nprovide coverage of any treat ment of a mental health condition under\nterms or conditions that are no more restrictive than the terms or\nconditions provided for treatment of a physical health condition.\n2. Expenses for mental health and physical health conditions shall be\ncombined for purposes of meeting deductible and out -of-pocket limits\nrequired under a health benefit plan.\n3. A health benefit plan that does not otherwise provide for management of\ncare under the plan or that does not provide for the same degree of\nmanagement of care for all health or mental health conditions may\nprovide coverage for treatment of mental health conditions through a\nmanaged care organization;\n(b) With respect to mental health condition benefits in any classification of\nbenefits, a health benefit plan req uired to comply with paragraph (a) of this\nsubsection shall not impose:\n1. A nonquantitative treatment limitation that does not apply to medical\nand surgical benefits in the same classification; and\n2. Medical necessity criteria or a nonquantitative treatm ent limitation\nunless, under the terms of the plan, as written and in operation, any\nprocesses, strategies, evidentiary standards, or other factors used in\napplying the criteria or limitation to mental health condition benefits in\nthe classification are comparable to, and are applied no more stringently\nthan, the processes, strategies, evidentiary standards, or other factors\nused in applying the criteria or limitation to medical and surgical\nbenefits in the same classification; and\n(c) Paragraph (b) of this  subsection shall be construed to require, at a minimum,\ncompliance with the requirements for nonquantitative treatment limitations set\nforth in the Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C.\nsec. 300gg-26, as amended, and any related  federal regulations, as amended,\nincluding but not limited to 45 C.F.R. secs. 146.136, 147.160, and\n156.115(a)(3).\n(2) (a) An insurer that issues or renews a health benefit plan that is subject to the\nprovisions of this section shall submit an annual repo rt to the commissioner\non or before April 1 of each year following January 1, 2022, that contains the\nfollowing:\n1. A description of the process used to develop or select the medical\nnecessity criteria for both mental health condition benefits and medical\nand surgical benefits;\n2. Identification of all nonquantitative treatment limitations applicable to\nbenefits and services covered under the plan that are applied to both\nmental health condition benefits and medical and surgical benefits\nwithin each classification of benefits;\n3. The results of an analysis that demonstrates compliance with subsection\n(1)(b) and (c) of this section for the medical necessity criteria described\nin subparagraph 1. of this paragraph and for each nonquantitative\ntreatment limitation identified in subparagraph 2. of  this paragraph, as\nwritten and in operation. At a minimum, the results of the analysis shall:\na. Identify the factors used to determine that a nonquantitative\ntreatment limitation will apply to a benefit, including factors that\nwere considered but rejected;\nb. Identify and define the specific evidentiary standards used to\ndefine the factors and any other evidence relied upon in designing\neach nonquantitative treatment limitation;\nc. Provide the comparative analyses, including the results of the\nanalyses, performed to determine that the processes and strategies:\ni. Used to design each nonquantitative treatment limitation, as\nwritten, and the as -written processes and strategies used to\napply the nonquantitative treatment limitation to mental\nhealth condition benefits are comparable to, and are applied\nno more stringently than, the processes and strategies used to\ndesign each nonquantitative treatment limitation, as written,\nand the as -written processes and strategies used to apply the\nnonquantitative treatment limitation to medical and surgical\nbenefits; and\nii. Used to apply each nonquantitative treatment limitation, in\noperation, for mental health condition benefits are\ncomparable to, and are applied no more stringently than, the\nprocesses and strategies used  to apply each nonquantitative\ntreatment limitation, in operation, for medical and surgical\nbenefits; and\nd. Disclose the specific findings and conclusions reached by the\ninsurer that the results of the analyses performed under this\nsubparagraph indicate t hat the insurer is in compliance with\nsubsection (1)(b) and (c) of this section; and\n4. Any additional information that may be prescribed by the commissioner\nfor use in determining compliance with the requirements of this section.\n(b) The annual report shall be submitted in a manner and format prescribed by the\ncommissioner through administrative regulation.\n(3) A willful violation of this section shall constitute an act of discrimination and shall\nbe an unfair trade practice under this chapter. The remedie s provided under Subtitle\n12 of this chapter shall apply to conduct in violation of this section.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=51770","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:48Z","sha256":"5ed09c73e50824bbfcbfba2bd132c30eb15baac17dd827ac4b8a15bb8ca0ca51","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-660","next":"us-ky/krs-304.17a-662"},"notice":"GroundRules: Original legal text. Not legal advice."}