This article examines required insurance benefits in Kansas law, the “test track” requirements for the Legislature’s consideration of proposed mandates, and any anticipated reporting from the State Employee Health Plan (SEHP).
What is a mandate? Statutes added in Kansas insurance law require certain health care providers be paid for services rendered (provider mandates) or be paid for certain types of prescribed coverage or benefits (benefit mandates). For example, Kansas has a benefit mandate for osteoporosis:
a) Any individual or group health insurance policy. . . which [is] delivered, issued for delivery, amended or renewed on or after July 1, 2001, shall include coverage for services related to diagnosis, treatment and management of osteoporosis when such services are provided by a person licensed to practice medicine and surgery in this state, for individuals with a condition or medical history for which bone mass measurement is medically necessary for such individual.
Such policy, provision, contract, plan or agreement may apply to such services the same deductibles, coinsurance, and other limitations as apply to other covered services (KSA 40-2,166a).
Which health insurance plans are affected when a new mandate becomes law? Generally, the new law would apply to individual health insurance policies and group health insurance policies issued. The legislation would likely also specify policies issued by Health Maintenance Organizations (HMOs), municipal-group funded pools, and the SEHP.
Which health plans and policies would not be required to incorporate new mandate requirements in their policies?
- Self-insured health plans, including Association Health Plans (Employee Retirement Income Security Act of 1974 [ERISA] plans). Self-insured plans are governed by federal laws and are enforced by the U.S. Department of Labor (states cannot regulate these self-insured plans);
- Supplemental benefit policies (e.g., dental care and vision plans); and
- Short-term limited duration plans.
How do proposed new mandates become law? The following chart illustrates the statutory process and associated timing for the Legislature’s consideration of a proposal during the 2023 Session.
*Prior law has excepted one or more of the prescribed steps (e.g., 2010 S Sub. for HB 2160 required the Kansas State Employees Health Care Commission to provide coverage for certain autism spectrum disorder services and required all individual and group insurance policies that provide coverage for prescription drugs to cover orally administered anticancer medications).
**The SEHP is a health care benefits plan administered by the Health Care Commission. Final Plan Year 2021 enrollment included 45,516 contracts (80,324 total covered lives).
Are any proposed mandates currently subject to the “test track”? During the 2021-2022 biennium, legislation requiring coverage of certain benefits or specified conditions was introduced: breast cancer examinations (SB 48 and HB 2241, specifically exempted from test track requirements); contraceptives (HB 2343); and mental illness and substance use disorders (SB 82 and HB 2073 – expansion of an existing mandate). Two bills proposed coverage only in the SEHP: HB 2110 (treatment of PANS/PANDAS — autoimmune conditions that affect children) and HB 2129 (tobacco cessation benefits).
The 2022 Legislature passed HB 2110. Coverage for PANS/ PANDAS will commence in Plan Year 2023, and the report to the Legislature’s Presiding Officers must be provided on or before March 1, 2024.
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