| Last Action | 02/21/25: 3rd reading, passed 91-0 with Committee Substitute (1) |
|---|---|
| Title | AN ACT relating to prior authorization. |
| Bill Documents |
Current
Introduced |
| Fiscal Impact Statements |
Actuarial Analysis
Health Mandate Local Mandate State Employee Health Plan Impact Additional Fiscal Impact Statements Exist |
| Bill Request Number | 278 |
| Sponsors | K. Moser, R. Duvall, C. Aull, B. Chester-Burton, D. Grossberg, M. Lockett, S. Stalker, N. Tate |
| Summary of Original Version | Create new sections of KRS 304.17A-600 to 304.17A-633 to define terms; prohibit insurers of health benefit plans from requiring prior authorization for a health care service for which the provider has an exemption; require insurers of health benefit plans to establish a program under which participating providers may qualify for exemptions from prior authorization; establish mandatory and permitted provisions of an insurer's prior authorization exemption program; establish requirements for sending forms and notices; require the commissioner of the Department of Insurance to submit an annual report relating to prior authorization, provide a detailed briefing upon request, and promulgate administrative regulations; amend KRS 304.17A-605 to conform; amend KRS 304.17A-611 to prohibit conducting a retrospective review that is based solely on a participating provider having a prior authorization exemption; provide that certain utilization review timeframes do not apply to retrospective reviews conducted for the purposes of determining eligibility for a prior authorization exemption; create a new section of KRS Chapter 205 to require the commissioner of the Department for Medicaid Services to submit an annual report relating to prior authorization, provide a detailed briefing upon request, and promulgate administrative regulations; apply the provisions to contracts delivered, entered, renewed, extended, or amended on or after January 1, 2027; EFFECTIVE, in part, January 1, 2026, and January 1, 2027. |
| Index Headings of Original Version |
Actuarial Analysis - Health plan, prior authorization, exemption program Health Benefit Plan Mandate - Health plan, prior authorization, exemption program Local Mandate - Health plan, prior authorization, exemption program Effective Dates, Delayed - Department for Medicaid Services, prior authorization report, January 1, 2026 Effective Dates, Delayed - Prior authorization, exemption program, January 1, 2027 Health and Medical Services - Prior authorization, exemption program Insurance, Health - Prior authorization, exemption program Physicians and Practitioners - Prior authorization, exemption program Public Medical Assistance - Medicaid, prior authorization, report State Agencies - Department for Medicaid Services, prior authorization, report State Agencies - Department of Insurance, commissioner, prior authorization exemption program State Employees - Health plan, prior authorization, exemption program Medicaid - Prior authorization, report Administrative Regulations and Proceedings - Department of Insurance, commissioner, prior authorization, report Reports Mandated - Department for Medicaid Services, commissioner, prior authorization Reports Mandated - Department of Insurance, commissioner, prior authorization exemption program |
| Jump to Proposed Amendments | House Committee Substitute 1 with Fiscal Impact Statements |
| Votes | Vote History |
| 02/11/25 |
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| 02/14/25 |
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| 02/19/25 |
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| 02/20/25 |
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| 02/21/25 |
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| Amendment | House Committee Substitute 1 |
|---|---|
| Fiscal Impact Statements |
Actuarial Analysis to House Committee Substitute 1
Health Mandate to House Committee Substitute 1 Local Mandate to House Committee Substitute 1 State Employee Health Plan Impact to House Committee Substitute 1 |
| Summary | Retain original provisions, except amend KRS 205.536 to conform. |
| Index Headings |
Health and Medical Services - Medicaid, prior authorization, exemption program Physicians and Practitioners - Medicaid, prior authorization, exemption program Public Medical Assistance - Medicaid, prior authorization, exemption program State Agencies - Department for Medicaid Services, Medicaid, prior authorization, exemption program Medicaid - Prior authorization, exemption program |
Last updated: 2/21/2025 4:29 PM (EST)