SB 143/HM (BR 326) - R. Alvarado

     AN ACT relating to prior authorization.
    Create a new section of subtitle 17A of KRS Chapter 304 to require an insurer develop processes for electronic prior authorizations; to establish an extended length of authorization under certain circumstances; create a new section of KRS Chapter 205 to require that the Department of Medicaid Services comply with the provisions of this Act; amend KRS 205.522 to require a Medicaid managed care organization to comply with Sections 1, 8, 9, 10, 11, and 12 of this Act; amend KRS 217.211 to require governmental units of the Commonwealth to promulgate administrative regulations for electronic prescribing that include electronic prior authorization standards meeting certain requirements; amend KRS 218A.171 to require governmental units of the Commonwealth to promulgate administrative regulations for electronic prescribing that include electronic prior authorization standards meeting certain requirements; amend KRS 304.17A-005 to define "cost sharing," "covered services," "emergency health care services," "emergency medical condition," "health care services," "health facility" or "facility," "insured" or "covered person," "medically necessary health care services," "nonparticipating provider," and "participating provider"; amend KRS 304.17A-500 to remove duplicate definitions; amend KRS 304.17A-580 to include prehospital transportation in required coverage; to prohibit a requirement of a utilization review for prehospital transportation or for the provision of emergency health care services; to establish a presumption of medical necessity if a provider certifies in writing that services were emergency health care services; to allow rebuttal of presumption of medical necessity by clear and convincing evidence; to prohibit greater restrictions of emergency health care services coverage for nonparticipating providers than for participating providers; to establish time frame for notification of an insurer following provision of emergency health care services to a covered person; amend KRS 304.17A-600 to amend the definition of "prospective review" to include prior authorization, step therapy, preadmission review, pretreatment review, and utilization and case management; establish standard of review for "urgent health care services"; amend KRS 304.17A-603 to require certain written procedures of insurers be accessible on its Web site; amend KRS 304.17A-607 to require that only physicians licensed in Kentucky decisions relating to utilization reviews; to establish a time frame for providing utilization decisions; to allow for electronic format of certain required notices; to establish that an insurer's failure to respond within set time frames shall be deemed a preauthorization; amend KRS 304.17A-641 to establish preauthorization time frame requirement for emergency medical conditions or other health care services that require immediate post-evaluation or post-stabilization services; to establish that an insurer's failure to respond within set time frames shall be deemed a preauthorization; amend KRS 304.17A-096, 304.17A-430, 304.17A-623, 304.17A-600 304.17B-001, 304.17B-015, 304.17B-033, 304.17C-010, 304.18-114, 304.38A-010 and 304.29-241 to conform; repeal KRS 304.17A-640