Kentucky

SUMMARY

In the most recent legislative term, Kentucky actively sought to regulate healthcare price transparency—in the very narrow area of air ambulance pricing. HB171, which was introduced but did not pass, would have required air ambulance providers to disclose certain price information to the Kentucky Board of Emergency Medical Services and would have required health benefit plans to “prominently provide notice in each contract” whether air ambulance is covered, and if so, the amount of coverage.

 

LEGISLATION/REGULATION

Legislative Calendar

Kentucky’s regular legislative session runs has ended for 2017.

 

Recent Legislative Developments

Healthcare Transparency

2015-2016 HB171

 

AIR AMBULANCE CLAIMS DIRECTORY: would require the Kentucky Board of Emergency Medical Services to annually obtain charges billed by all air ambulance providers licensed and operating in the state and deem the information as proprietary and not subject to the Open Records Act; to determine the average cost of air ambulance services in the state which shall be subject to the provisions of the Open Records Act; require the board to submit the average cost to the commissioner of the Department of Insurance; authorize the board to promulgate administrative regulations to establish a form to be completed by all air ambulance service providers to determine average cost of services; and require any air ambulance service providers licensed and operating in the state to comply with the submission of charges requirement.

HB171 would also require health benefit plans to prominently provide a notice in each contract for coverage whether the contract covers air ambulance service and, if provided, the dollar amount of coverage; and require the commissioner of the Department of Insurance to review all health benefit plans for compliance with the notice requirement and to provide the average cost of all ambulance services to all health benefit plans every three years.

Inactive— Died.

 

Healthcare Cost

  • None identified.

 

Healthcare Markets

  • None identified.

 

Key Statutes

We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.

 

Transparency in Healthcare

  • Stat. Ann. § 216.261 creates the Kentucky Health Care Infrastructure Authority, to be operated jointly by the University of Kentucky and the University of Louisville. The Authority is charged with providing leadership and expertise in the redesign of Kentucky’s healthcare delivery system vis-à-vis improved information technology infrastructure, and to conduct research to determine the impact of said improvements on healthcare quality and costs.

 

  • Stat. Ann. § 216.267 creates the Kentucky e-Health Network Board to oversee the creation of a Kentucky e-health network (“Ke-HN”) under the auspices of the Kentucky Health Care Infrastructure Authority. The Ke-HN is envisioned to support electronic transactions and activities such as electronic access to lab results, disease tracking, links to drug formularies and cost information, medical records transferal, and links to patient educational materials.

 

 

  • Stat. Ann. § 216.2929 directs the Cabinet for Health and Family Services to annually publish information on charges for healthcare services on its website in order to permit consumers to make comparisons between healthcare facilities.

 

Healthcare Contracting

  • Stat. Ann. § 304.17A-560 prohibits most favored nation provision in an agreement between an insurance carrier and a participating provider except in cases “where the commissioner determines the market share of the insurer is nominal.” A most favored nations clause is an agreement between a payer (such as an insurance company) and a provider that typically requires a provider to give the payer the lowest rate that it gave to any other comparable payer, which can be anticompetitive by encouraging oligopolistic pricing by large payers and increasing barriers for new entrants.

 

Healthcare Markets

  • Stat. Ann. ch. 216B et seq. prohibits health care providers from acquiring, replacing, or adding to their facilities and equipment, except in specified circumstances, without the prior approval of the Cabinet for Health and Family Services through the state’s Certificate of Need process. A Certificate of Need regime aims to reduce healthcare overheard by reducing unnecessary or duplicative services, but can be anticompetitive by increasing regulatory barriers for new entrants.

 

  • Stat. Ann. § 304.17A-270 prohibits a health insurer from discriminating against any provider who is located within the geographic coverage area of the health benefit plan and is also willing to meet the established terms and conditions for participation in the plan.

 

2016-2018 BUDGET

Annual appropriations are made in the biennial budget bills. The state’s fiscal year begins July 1 and extends to the following June 30. Kentucky enacted the 2016-2018 biennium budget in the regular 2016 legislative session. To view Kentucky’s spending on health and family services, visit pages here.

 

LITIGATION/ENFORCEMENT

  • None identified.

 

KEY RESOURCES

Kentucky State Legislature

Kentucky Office of the Attorney General

Hospital Discharge Database