Co-pay accumulators: SB 45, sponsored by Sen. Ralph Alvarado, R-Winchester, would limit the use of health plans' copay-accumulator programs, which prevent cost-sharing paid on behalf of enrollees from counting toward their out-of-pocket limits.
In short, SB 45 would require health insurers to count all payments made by patients directly or on their behalf toward their overall deductibles and maximum out-of-pocket costs, unless a generic drug is available. It would not apply to the Kentucky Employees Health Plan.
Insurance payments: SB 44, by Alvarado, ensures that any insurance payments made on behalf of an individual by a nonprofit are counted just as if the patient made it themselves.The Senate agreed to House changes in SB 44 that updates a sunset clause in another bill that requires health-care providers to tell women whose mammograms show dense breast tissue that such tissue is not abnormal, but slightly increases the risk for developing breast cancer until 2025. That same legislation asks providers to encourage "digital mammography" that provides a three-dimensional image of the breast. Another change ensures that the insured is responsible for payment, even if made by someone else; and bans providers from paying premiums for their patients.
Medicaid co-pays: SB 55, sponsored by Sen. Stephen Meredith, R-Leitchfield, would get rid of all co-pays required by Medicaid.
Telehealth: HB 140, sponsored by Rep. Deanna Frazier, R-Richmond, would permit telehealth services that were allowed to expand due to the pandemic to remain in place. The bill requires reimbursement for telehealth to be equivalent to reimbursement for the same service provided in person.
The bill would ensure that Medicaid and its managed-care organizations don't deny telehealth reimbursement "based on quality-of-care protocols established by health care facilities," and that reimbursements paid to rural health clinics and other facilities include a supplemental reimbursement.
The House agreed to Senate changes that say certain regulations for telehealth be no more restrictive than for in-person services and allows Medicaid, its managed-care organizations and other insurers to negotiate lower reimbursement rates for telehealth services with providers.
Pharmacy reimbursements: HB 48, by Bentley, a retired pharmacist, would allow commercial insurance to reimburse pharmacists for providing medical care that other health-care providers typically bill for, such as a rapid flu test, smoking-cessation counseling or immunizations. Beshear signed the bill March 18.
Mental health: HB 50, sponsored by Moser, would make health plans comply with a 2008 federal law that requires them to treat mental-health conditions and substance-use disorders the same as physical conditions, and file annual reports to show how they are complying. Beshear signed this bill March 12.
“Mental health and substance use disorders are often treated differently than other health conditions by insurers, but there is no health care without mental health care,” Alvarado said in presenting HB 50 to the Senate. “When there is a disparity in treatment, it causes harm. Many people go without treatment for years with disparities worsening by the day. There is an average delay of 11 years between the onset of mental illness symptoms and the time most people access treatment.”