House Bill 414

Actions | Amendments
Last Action signed by Governor (Act ch. 76)
Title AN ACT relating to pharmacy audits.
Bill Documents Bill
Bill Request Number 1375
Sponsors T. Thompson, R. Adams, D. Butler, B. Damron, J. Glenn, K. Hall, T. Kerr, R. Rand, S. Rudy, J. Stacy, F. Steele
Summary of Original Version Create a new section of Subtitle 17A of KRS Chapter 304 to define "auditing entity" and to require that a provider agreement or provider contract between a pharmacy and an insurer, an agency of the Commonwealth, a health maintenance organization, a pharmacy benefits administrator or a pharmacy benefits manager that requires an audit of the pharmacy's records shall comply with this Act; create a new section of Subtitle 17A of KRS Chapter 304 to specify the requirements for an audit of the records of a pharmacy when conducted by an auditing entity pursuant to a provider agreement or provider contract; create a new section of Subtitle 17A of KRS Chapter 304 to require an auditing entity conducting an audit of a pharmacy to establish an appeals process, provide that if audit report or any portion of is unsubstantiated, the audit report or any portion thereof shall be dismissed, and provide that disputed funds shall not be collected until the appeals process is complete.
Index Headings of Original Version Insurance - Pharmacy, provider agreement, audits
Insurance, Health - Pharmacy, audit requirements
Insurance, Health - Pharmacy, recoupment of funds by insurer
Pharmacists - Audits performed pursuant to provider agreement or contract, requirements for
Insurance, Health - Pharmacy, audit appeals process
Proposed Amendments House Committee Substitute 1
House Floor Amendment 1
House Floor Amendment 2
House Floor Amendment 3
House Floor Amendment 4
Senate Committee Substitute 1
Votes Vote History

Actions

Top | Amendments
02/11/09
  • introduced in House
02/12/09
  • to Banking & Insurance (H)
02/23/09
  • posting waived
02/25/09
  • reported favorably, 1st reading, to Calendar with Committee Substitute
02/26/09
  • 2nd reading, to Rules
  • posted for passage in the Regular Orders of the Day for Friday, February 27, 2009
02/27/09
  • floor amendments (1) (2) (3) and (4) filed to Committee Substitute
03/03/09
  • 3rd reading
  • floor amendment (2) defeated
  • passed 100-0 with Committee Substitute, floor amendment (1)
03/04/09
  • received in Senate
03/06/09
  • to Judiciary (S)
03/09/09
  • taken from committee
  • 1st reading
  • returned to Judiciary (S)
03/10/09
  • taken from committee
  • 2nd reading
  • returned to Judiciary (S)
03/11/09
  • reported favorably, to Rules as a Consent bill with Committee Substitute
03/12/09
  • posted for passage in the Consent Orders of the Day for Thursday, March 12, 2009
  • 3rd reading, passed 38-0 with Committee Substitute
  • received in House
03/13/09
  • posted for passage for concurrence in Senate Committee Substitute
  • House concurred in Senate Committee Substitute
  • passed 93-0
  • enrolled, signed by each presiding officer
  • delivered to Governor
03/24/09
  • signed by Governor (Act ch. 76)

Proposed Amendments

Top | Actions
Amendment House Committee Substitute 1
Summary Retain original provisions; amend Section 1 to define "administrator", "auditing entity" and "insurer" and require compliance with the requirements of this Act if a provider agreement or contract "allows" rather than "requires" a pharmacy audit; amend the audit time limit requirement by excluding audits resulting from evidence of fraud from the time limit.
Index Headings Insurance - Pharmacy, provider agreement, audits
Insurance, Health - Pharmacy, audit requirements
Insurance, Health - Pharmacy, recoupment of funds by insurer
Pharmacists - Audits performed pursuant to provider agreement or contract, requirements for
Insurance, Health - Pharmacy, audit appeals process

Amendment House Floor Amendment 1
Sponsor T. Thompson
Summary Delete Kentucky licensure requirements for audit entity consulting pharmacist; allow an audit within the first 7 days of a month with consent of the pharmacy; authorize an appeal after the final audit report, rather than the preliminary audit report; and provide that the provisions of this Act do not apply to Medicaid investigative audits pursuant to KRS Chapter 205.
Index Headings Insurance - Pharmacy, provider agreement, audits
Insurance, Health - Pharmacy, audit requirements
Insurance, Health - Pharmacy, recoupment of funds by insurer
Pharmacists - Audits performed pursuant to provider agreement or contract, requirements for
Insurance, Health - Pharmacy, audit appeals process

Amendment House Floor Amendment 2
Sponsor S. Brinkman
Summary Delete 30-day audit notice requirement and substitute 7-day audit notice requirement; delete the provision that prohibits an auditing entity from receiving payment based on a percentage of the audit recovery amount.
Index Headings Insurance - Pharmacy, provider agreement, audits
Insurance, Health - Pharmacy, audit requirements
Insurance, Health - Pharmacy, recoupment of funds by insurer
Pharmacists - Audits performed pursuant to provider agreement or contract, requirements for
Insurance, Health - Pharmacy, audit appeals process

Amendment House Floor Amendment 3
Sponsor J. Gooch Jr.
Summary Delete the provision prohibiting recoupment of disputed funds by an auditing entity and in lieu thereof provide that recoupment shall be only by contractual agreement and shall not be made until the appeals process is complete; require that if an individual audit identifies a discrepancy in excess of $25,000, future payments to the pharmacy may be withheld pending finalization of the audit.
Index Headings Insurance - Pharmacy, provider agreement, audits
Insurance, Health - Pharmacy, audit requirements
Insurance, Health - Pharmacy, recoupment of funds by insurer
Pharmacists - Audits performed pursuant to provider agreement or contract, requirements for
Insurance, Health - Pharmacy, audit appeals process

Amendment House Floor Amendment 4
Sponsor J. Gooch Jr.
Summary Delete 30-day audit notice requirement and substitute a 7 day audit notice requirement.
Index Headings Insurance - Pharmacy, provider agreement, audits
Insurance, Health - Pharmacy, audit requirements
Insurance, Health - Pharmacy, recoupment of funds by insurer
Pharmacists - Audits performed pursuant to provider agreement or contract, requirements for
Insurance, Health - Pharmacy, audit appeals process

Amendment Senate Committee Substitute 1
Summary Amend to exempt audits where there are allegations of fraud, willful misrepresentation, or abuse and to exempt audits conducted for a Medicaid managed care organization.
Index Headings Insurance - Pharmacy, provider agreement, audits
Insurance, Health - Pharmacy, audit requirements
Insurance, Health - Pharmacy, recoupment of funds by insurer
Pharmacists - Audits performed pursuant to provider agreement or contract, requirements for
Insurance, Health - Pharmacy, audit appeals process

Last updated: 1/16/2019 4:30 PM (EST)