House Bill 343

Last Action 02/23/22: to Health & Family Services (H)
Title AN ACT relating to exemptions from prior authorization requirements.
Bill Documents Introduced
Bill Request Number 814
Sponsors K. Moser, J. Raymond, S. Santoro
Summary of Original Version Create new sections of KRS 304.17A-600 to KRS 304.17A-633 to establish eligibility criteria and requirements relating to prior authorization exemptions; establish requirements for rescinding prior authorization exemptions; set forth requirements relating to external reviews of prior authorization exemption determinations and denials; prohibit the retrospective denial, reduction in payment, and review of health care services for which a health care provider has a prior authorization exemption and establish exceptions; provide that nothing shall be construed to authorize a health care provider to act outside the provider's scope of practice or require an insurer or private review agent to pay for a health care service performed in violation of law; amend KRS 304.17A-600 to conform; amend KRS 304.17A-605 to establish applicability of provisions relating to prior authorization exemptions to certain insurers and private review agents; amend KRS 304.17A-621 to conform; amend KRS 304.17A-627 to prohibit conflicts of interest with independent review entities and reviewers of prior authorization exemption determinations and denials; require independent review entities and reviewers of prior authorization exemption determinations and denials to submit an annual report to the Department of Insurance; amend KRS 304.17A-633 to require the commissioner of the Department of Insurance to report on external reviews of prior authorization exemptions determinations and denials; amend KRS 205.536 to require the Department for Medicaid Services, or managed care organizations contracted to provide Medicaid benefits, to comply with the sections on prior authorization exemptions; apply the provisions to contracts delivered, entered, renewed, extended, or amended on or after the effective date of the Act; require the Cabinet for Health and Family Services to seek approval if they determine that such approval is necessary; EFFECTIVE, in part, January 1, 2023.
Index Headings of Original Version Effective Dates, Delayed - Prior authorization exemptions, January 1, 2023
Health and Medical Services - Prior authorization exemptions
Insurance, Health - Prior authorization exemptions
Physicians and Practitioners - Prior authorization exemptions
State Agencies - Cabinet for Health and Family Services, Medicaid, waiver application, prior authorization exemptions
State Agencies - Department of Insurance, prior authorization exemptions
Medicaid - Prior authorization exemptions
Conflict of Interest - Independent review entity, external review, prior authorization exemptions
Reports Mandated - Commissioner, Department of Insurance, external reviews, prior authorization exemptions
Reports Mandated - External review entity, prior authorization exemptions


  • introduced in House
  • to Committee on Committees (H)
  • to Health & Family Services (H)

Last updated: 5/25/2022 2:58 PM (EDT)
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