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This page lists some of the action toward parity compliance undertaken by Kentucky regulatory agencies since 2008.

Are we missing any actions taken by state regulatory agencies? Let us know at info@paritytrack.org.

Action in the Regulatory Arena

2/2016

Primary Focus:  Medicaid; SUD
Agency: The Cabinet for Health and Family Services / Department for Medicaid Services
Title/Description:  Outpatient hospital service coverage provisions and requirements.
Citation: 907 Ky. Admin. Regs. 10:014 (5).
Summary:  Enumerates behavioral health and substance abuse disorder services that are covered under Medicaid.
Effective Date: Original effective date October 14, 1990; last amendment February 9, 2016
Notes:  Recodified from 904 KAR 1:014, 5-6-1986; Am. 17 Ky.R. 557; eff. 10-14-1990; 33 Ky.R. 578; 1550; eff. 1-5-2007; 37 Ky.R. 984; eff. 11-05-2010; Recodified from 907 KAR 1:014, eff. 5-3-2011; TAm eff. 7-16-2013; 40 Ky.R. 2009; 2554; 2771; eff. 7-7-2014; 41 Ky.R. 2428; 42 Ky.R. 406; 741; eff. 10-2-2015; TAm eff. 2-9-2016.

7/2015

Primary Focus:   Medicaid; SUD
Agency: The Cabinet for Health and Family Services/ Department for Medicaid Services
Title/Description:  Coverage provisions and requirements regarding community mental health center behavioral health services.
Citation: 907 Ky Admin. Regs. 1:044
Summary:  Enumerates behavioral health and substance abuse disorder services that are covered under Medicaid for community mental health centers.
Effective Date:  Original effective date August 5, 1989; last amendment July 6, 2015
Notes: Recodified from 904 KAR 1:044, 5-2-1986; 15 Ky.R. 2461; eff. 8-5-1989; 18 Ky.R. 915; eff. 10-16-1991; 20 Ky.R. 663; eff. 10-21-1993; 32 Ky.R. 1801; 2039; 2276; eff. 7-7-2006; 34 Ky.R. 1825; 2313; 2404; eff. 6-6-2008; 40 Ky.R. 1955; 2487; 2718; eff. 7-7-2014; 41 Ky.R. 1910; 2261; 2553; eff. 7-6-2015.

7/2014

Primary Focus:  Medicaid; SUD
Agency: The Cabinet for Health and Family Services / Department for Medicaid Services
Title/Description:  Coverage provisions and requirements regarding rural health clinic services
Citation: 907 Ky. Admin. Regs. 1:082 (3).
Summary:  Enumerates behavioral health and substance abuse disorder services that are covered under Medicaid for rural health clinics
Effective Date: Original effective date December 13, 1988
Notes:   Recodified from 904 KAR 1:082, 5-2-1986; Am. 15 Ky.R. 1329; eff. 12-13-1988; 34 Ky.R. 1831; 2116; eff. 4-4-2008; 1977; 2510; 2736; eff. 7-7-2014.

5/2012

The Kentucky Department of Insurance issued an emphatic bulletin that notified plans that they must cover autism services provided by “supervisees” of Board Certified Behavior Analysts. Insurance plans previously had not been covering services provided by supervisees. The plans’ justification was that the section of the state insurance law about autism coverage states “No reimbursement is required under this section … for services provided by persons who are not licensed as required by law.” Plans’ interpretation of this language was that this means that they do not have to cover services by anyone who is not a licensed professional.

The Department strongly disagreed, stating “To assign this meaning to that subsection is contrary to its plain language and frustrates the statutory purpose…” The Department explained that the subsection in question was designed to prevent reimbursement for professionals who are supposed to have a license but do not; not the prevent reimbursement for professionals who are not required to have a license, such as supervisees.

4/2011

The Kentucky Department of Insurance updated its regulation regarding the sections of the state insurance law about autism coverage. This regulation reaffirms several provisions in the state law about certain definitions, financial requirements, and outpatient visit limits. It also specifies that when plans perform utilization review for autism services, they must comply with the sections of the state insurance law about utilization review.

6/2010

The Kentucky Department of Insurance released this two-page document that explains the sections of the state law that requires insurance plans to cover autism services (these sections of the law are summarized at the bottom of this page under “Kentucky Parity Law”).

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

Term Name


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