Kentucky

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

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.”

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.

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

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.