Bill > SB97

This bill mandates that all health benefit plans, including short-term limited-duration coverage and student health insurance, must provide coverage for prostheses and orthoses, which are artificial limbs and braces, respectively. The coverage must be at least as good as that provided for Medicare beneficiaries and must include devices prescribed by a healthcare provider and deemed appropriate by a licensed prosthetist or orthotist to meet medical needs for daily living, work, physical activities, and overall well-being. It also requires coverage for the necessary number of devices, replacements due to changes in the patient's condition or irreparable damage, and all associated materials and instructions. Utilization review decisions by insurers or their private review agents must be non-discriminatory, and they must inform insured individuals of their rights and provide detailed written explanations for any denials based on medical necessity. Furthermore, insurers must maintain an adequate network of prosthetists and orthotists, offering at least two licensed professionals in the state, and have a process for referring patients to out-of-network providers if necessary, with cost-sharing calculated as if they were in-network. Insurers will also be required to report annually on their experience with this coverage to the Commissioner of Insurance, who will then report aggregated data to the legislature. The bill also amends existing laws to ensure that self-insured group health plans offered by state postsecondary education institutions and the state employee health plan comply with these new coverage requirements. These provisions will take effect for health benefit plans issued or renewed on or after January 1, 2027.

https://apps.legislature.ky.gov/record/26RS/sb97.html