Senate Bill 54

Actions | Amendments
Last Action 03/26/19: signed by Governor (KY Acts ch. 190)
Title AN ACT relating to prior authorization.
Bill Documents Current/Final
Introduced
Impact Statements Health Mandate
Bill Request Number 104
Sponsors R. Alvarado, D. Carroll, S. Meredith
Summary of Original Version 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; amend KRS 205.522 to require the Department for Medicaid Services or a Medicaid managed care organization to comply with Sections 1, 6, 7, 8, and 9 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 "health care services," "health facility" or "facility," and "medically necessary health care services"; amend KRS 304.17A-580 to prohibit a requirement of a utilization review for the provision of emergency health care services; to establish a presumption of medical necessity; 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; 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 decisions relating to utilization reviews are conducted by physicians of the same specialty as the ordering provider; 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 prior authorization; amend 304.17A-430, to conform; EFFECTIVE January 1, 2020.
Index Headings of Original Version Health and Medical Services - Emergency health care services, insurance coverage, requiring
Insurance, Health - electronic prior authorization, standards, establishing
Insurance, Health - Emergency health care services, insurance coverage, requiring
Insurance, Health - Emergency services, medical necessity, presumption of
Insurance, Health - Insurers, written procedures, accessibility requirement for
Insurance, Health - Prior authorization, time frame, requirements of
Insurance, Health - Urgent health care services, prior authorization, time frame, establishment of
Local Government - Governmental units, regulation of electronic prescribing, standards, requiring
Pharmacists - Prior authorization, time span of authorization, establishing
Physicians and Practitioners - Emergency health care services, post stabilization treatment, prior authorization for
Physicians and Practitioners - Prior authorization, time span of authorization, establishing
Physicians and Practitioners - Urgent health care services, prior authorization, time frame, establishing
State Agencies - Governmental units, regulation of electronic prescribing, standards, requiring
Medicaid - Department of Medicaid Services, required compliance of
Unified Local Governments - Governmental units, regulation of electronic prescribing, standards, requiring
Administrative Regulations and Proceedings - Governmental units, regulation of electronic prescribing, standards, requiring
Cities - Governmental units, regulation of electronic prescribing, standards, requiring
Counties - Governmental units, regulation of electronic prescribing, standards, requiring
Boards and Commissions - Governmental units, regulation of electronic prescribing, standards, requiring
Health Benefit Mandate - Governmental units, regulation of electronic prescribing, standards, requiring
Jump to Proposed Amendments Senate Committee Substitute 1
Senate Floor Amendment 1
House Committee Substitute 1
House Floor Amendment 1
Votes Vote History

Actions

Top | Amendments
12/14/18
  • Prefiled by the sponsor(s).
01/08/19
  • introduced in Senate
01/09/19
  • to Banking & Insurance (S)
02/19/19
  • reported favorably, 1st reading, to Calendar with Committee Substitute (1)
  • floor amendment (1) filed to Committee Substitute
02/20/19
  • 2nd reading, to Rules
02/21/19
  • posted for passage in the Regular Orders of the Day for Thursday, February 21, 2019
  • 3rd reading, passed 33-1 with Committee Substitute (1) and floor amendment (1)
02/22/19
  • received in House
02/25/19
  • to Banking & Insurance (H)
  • posted in committee
02/27/19
  • reported favorably, 1st reading, to Calendar with Committee Substitute (1)
02/28/19
  • 2nd reading, to Rules
  • floor amendment (1) filed to Committee Substitute
03/06/19
  • posted for passage in the Regular Orders of the Day for Thursday, March 7, 2019
03/12/19
  • 3rd reading, passed 97-1 with Committee Substitute (1) and floor amendment (1)
03/13/19
  • received in Senate
  • posted for passage for concurrence in House Committee Substitute (1) and floor amendment (1) on Wednesday, March 13, 2019
  • Senate concurred in House Committee Substitute (1) and floor amendment (1)
  • Bill passed 37-0
03/14/19
  • enrolled, signed by President of the Senate
  • enrolled, signed by Speaker of the House
  • delivered to Governor
03/26/19
  • signed by Governor (KY Acts ch. 190)

Proposed Amendments

Top | Actions
Amendment Senate Committee Substitute 1
Impact Statements Health Mandate
Summary Retain original provisions, except add requirement that prior authorization for a drug prescribed to a covered person with a condition that requires ongoing medication therapy shall cover changes in dosage prescribed by the health care provider during the period of authorization; amend KRS 304.17A-005 to add amyotrophic lateral sclerosis to definition of "high-cost condition" and incorporate most recent version of statute; amend KRS 304.17A-580 to remove utilization review requirements and presumption of medical necessity for emergency screening and stabilization services; amend KRS 304.17A-600 to include requests for life-supporting or life-sustaining devices as "urgent health care services"; amend KRS 304.17A-603 to add preauthorization review requirements for insurers; amend exception to timeframes provided in KRS 304.17A-607 to make technical correction.
Index Headings Insurance, Health - SB 54
Insurance, Health - Electronic prior authorization, standards, establishing
Insurance, Health - Insurers, written procedures, accessibility requirement for
Insurance, Health - Prior authorization, time frame, requirements of
Insurance, Health - Urgent health care services, prior authorization, time frame, establishment of
Local Government - Governmental units, regulation of electronic prescribing, standards, requiring
Pharmacists - Prior authorization, time span of authorization, establishing
Physicians and Practitioners - Prior authorization, time span of authorization, establishing
Physicians and Practitioners - Urgent health care services, prior authorization, time frame, establishing
State Agencies - Governmental units, regulation of electronic prescribing, standards, requiring
Medicaid - Department of Medicaid Services, required compliance of
Unified Local Governments - Governmental units, regulation of electronic prescribing, standards, requiring
Administrative Regulations and Proceedings - Governmental units, regulation of electronic prescribing, standards, requiring
Cities - Governmental units, regulation of electronic prescribing, standards, requiring
Counties - Governmental units, regulation of electronic prescribing, standards, requiring
Boards and Commissions - Governmental units, regulation of electronic prescribing, standards, requiring
Technical Corrections - SB 54
Health Benefit Mandate - Urgent health care services, prior authorization, time frame, establishment of

Amendment Senate Floor Amendment 1
Sponsor R. Alvarado
Summary Amend KRS 304.17A-600 to remove requests for life-supporting or life-sustaining devices as "urgent health care services."
Index Headings Insurance, Health - Prior authorization, time frame, requirements of
Insurance, Health - Urgent health care services, prior authorization, time frame, establishment of
Pharmacists - Prior authorization, time span of authorization, establishing
Physicians and Practitioners - Prior authorization, time span of authorization, establishing
Physicians and Practitioners - Urgent health care services, prior authorization, time frame, establishing
Medicaid - Department of Medicaid Services, required compliance of

Amendment House Committee Substitute 1
Impact Statements Health Mandate
Summary Retain original provisions, except add language allowing a health benefit plan to coordinate or adopt a process for electronic prior authorizations; amend language relating to when prior authorization requirements apply for ongoing medication therapy drugs; add exceptions to prior authorizations requirements for ongoing medication therapy drugs; amend KRS 205.522 to specify that compliance with specific provisions is as applicable; amend KRS 304.17A-005 to modify definition of "medically necessary health care services"; amend KRS 304.17A-603 to modify language relating to prior authorization and notification requirements; amend KRS 304.17A-607 to add licensed physicians who are of a similar specialty and subspecialty to utilization review requirements.
Index Headings Local Government - Governmental units, regulation of electronic prescribing, standards, requiring
Pharmacists - Prior authorization, time span of authorization, establishing
Physicians and Practitioners - Prior authorization, ongoing medication therapy, requirements of
Physicians and Practitioners - Prior authorization, time span of authorization, establishing
Physicians and Practitioners - Urgent health care services, prior authorization, time frame, establishing
State Agencies - Governmental units, regulation of electronic prescribing, standards, requiring
Technical Corrections - SB 54
Medicaid - Department of Medicaid Services, required compliance of
Unified Local Governments - Governmental units, regulation of electronic prescribing, standards, requiring
Administrative Regulations and Proceedings - Governmental units, regulation of electronic prescribing, standards, requiring
Cities - Governmental units, regulation of electronic prescribing, standards, requiring
Counties - Governmental units, regulation of electronic prescribing, standards, requiring
Boards and Commissions - Governmental units, regulation of electronic prescribing, standards, requiring
Health Benefit Mandate - Governmental units, regulation of electronic prescribing, standards, requiring

Amendment House Floor Amendment 1
Sponsor B. Rowland
Summary Amend utilization review timeframe for nonurgent health care services from 72 hours to five days.
Index Headings Health and Medical Services - Nonurgent health care services, utilization review decision, timeframes, establishing
Insurance, Health - Nonurgent health care services, utilization review decision, timeframes, establishing
Physicians and Practitioners - Nonurgent health care services, utilization review decision, timeframes, establishing

Last updated: 5/10/2019 10:34 AM (EDT)
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