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Legislation Signed into Law

2015

Primary Focus: Mandated Benefit; SUD; Medicaid
Title/Description: Substance use disorder treatment benefit
Citation: Ky. Rev. Stat. Ann. § 205.6311
Summary: The Department for Medicaid Services shall provide a substance use disorder benefit consistent with federal laws and regulations which shall include a broad array of treatment options for those with heroin and other substance use disorders.
Effective Date: March 25, 2015
Notes: Enacted by Ky SB 192.

2010

HB 159
Introduced: 1/2010
Sponsor: Rep. Greer and Rep. Brinkman
Status: Signed into law 4/2010
Summary: Among other things, this bill changed the sections of the insurance law about autism coverage to what they are currently (these sections are summarized at the bottom of this page under “Kentucky Parity Law,” “Autism Coverage”).

2000

Primary Focus: Parity General
Title/Description: Treatment of mental health conditions to be covered under same terms and conditions as treatment of physical health conditions.
Citation: Ky. Rev. Stat. Ann. § 304.17A-661
Summary: Any health benefit plan issued or renewed after July 14, 2000, that provides coverage for treatment of a mental health condition shall provide coverage of any treatment for a mental health condition under the same terms or conditions as provided for treatment of a physical health condition.
Effective Date: July 14, 2000
Notes: Enacted by Ky. HB 268.

Kentucky Parity Law

There are multiple sections in the state law about parity and two sections about autism coverage. They will be summarized as follows:

  • Behavioral health coverage
  • Mental health coverage
  • Alcohol use disorder coverage
  • Autism coverage

Behavioral Health Coverage

This section and this section require large employer fully-insured plans to offer optional behavioral health coverage. If the employer chooses the optional coverage, the coverage must be on the “same terms and conditions” as coverage for other medical services. Terms or conditions is defined as including:

  • Inpatient day limits
  • Outpatient visit limits
  • Annual maximums and lifetime maximums
  • Deductibles
  • Copayments and coinsurance
  • Prescription coverage
  • Out-of-pocket limits, and any other cost-sharing requirements

Treatment of behavioral health conditions is defined as including inpatient care, outpatient care, partial hospitalization, residential treatment, crisis stabilization, and emergency care.

Deductibles for behavioral health services should be part of one, overall deductible for all medical services.

Plans are allowed to use managed care for behavioral health coverage to a greater extent than they do for other medical coverage.

Any violations of these sections of the law are considered “an act of discrimination and shall be
an unfair trade practice under this chapter.”

Mental Health Coverage

This section and this section require individual plans and small employer fully-insured plans to offer optional coverage for mental health conditions. This coverage should include inpatient care and outpatient care and must be “to the same extent and degree” as coverage for other medical care.

Alcohol Use Disorder Coverage

This section requires small employer fully-insured plans to offer optional coverage for treatment of alcoholism. This coverage includes emergency detoxification, residential treatment, and outpatient care. However, plans do not have to pay for any services if the patient does not complete the treatment program. The following are required for these services:Detoxification:

  • 3 days and $40 per day
  • Residential treatment: 10 days and $50 per day
  • Outpatient care: 10 visits and $10 per visit

Autism

This section requires large employer fully-insured plans to cover autism services for individuals through age 21. State employee plans also have to comply with this section (although that is not listed in this section). For children at birth through age 6 plans must cover an annual maximum of $50,000. For children age 7 through 21, the annual maximum is $12,000.

Copayments, coinsurance, and deductibles must be “no less favorable” than those in place for other medical services.

Insurance plans can review a child’s treatment plan once every 12 months.

Treatment for autism is defined as pharmacy care, psychiatric care, psychological care, therapeutic care, applied behavior analysis, habilitative care, and rehabilitative care.

This section requires individual plans and small employer fully-insured plans to cover pharmacy care, psychiatric care, psychological care, therapeutic care, applied behavior analysis, habilitative care, and rehabilitative care.

Plans are required to cover an annual maximum of $12,000.

This section provides definitions for many of the terms above (pharmacy care, psychiatric care, etc) and defines autism as any pervasive developmental disorders in the DSM, and specifically lists autistic disorder, asperger’s syndrome, and pervasive developmental disorder not otherwise specified.

Get Support

Kentucky Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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