House Bill 134

Actions | Amendments
Last Action 02/24/23: recommitted to Banking & Insurance (H)
Title AN ACT relating to prior authorization.
Bill Documents Introduced
Fiscal Impact Statements Health Mandate
Additional Fiscal Impact Statements Exist
Bill Request Number 830
Sponsors K. Moser, C. Aull, N. Kulkarni, J. Raymond, S. Stalker, C. Stevenson, W. Williams
Summary of Original Version Create new sections of KRS 304.17A-600 to 304.17A-633 to establish eligibility criteria and requirements for prior authorization exemptions; establish requirements for rescinding prior authorization exemptions; set forth requirements for external reviews of prior authorization exemption denials and rescissions; establish requirements for sending forms and notices to health care providers; 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-607 to establish requirements for prior authorizations; provide that a lack of prior authorization shall not alone be a basis for a retrospective review; 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 denials and rescissions; require independent review entities and reviewers of prior authorization exemption denials and rescissions 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 denials and rescissions; amend KRS 304.17A-706 to prohibit contesting a clean claim by conducting a retrospective review based on a lack of prior authorization; 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 it is determined that such approval is necessary; EFFECTIVE, in part, January 1, 2024.
Index Headings of Original Version Effective Dates, Delayed - Prior authorization requirements, January 1, 2024
Health and Medical Services - Prior authorization requirements
Insurance, Health - Prior authorization requirements
Physicians and Practitioners - Prior authorization requirements
State Agencies - Cabinet for Health and Family Services, Medicaid, waiver application, prior authorization
State Agencies - Department of Insurance, prior authorization requirements
Reports Mandated - Commissioner, Department of Insurance, external reviews, prior authorization
Reports Mandated - External review entity, prior authorization
Medicaid - Prior authorization requirements
Conflict of Interest - Independent review entity, external review, prior authorization
Health Benefit Mandate - Prior authorization requirements
Jump to Proposed Amendments House Committee Substitute 1 with Fiscal Impact Statements

Actions

Top | Amendments
01/06/23
  • introduced in House
  • to Committee on Committees (H)
02/17/23
  • to Health Services (H)
02/23/23
  • reported favorably, 1st reading, to Calendar with Committee Substitute (1)
02/24/23
  • 2nd reading, to Rules
  • recommitted to Banking & Insurance (H)

Proposed Amendments

Top | Actions
Amendment House Committee Substitute 1
Fiscal Impact Statement Health Mandate to House Committee Substitute 1
Summary Retain original provisions, except define "evaluation period"; allow a provider supervising a health care service ordered by a health care provider with an exemption to utilize the ordering provider's exemption; replace "screening criteria" with "medical necessity criteria"; require that rescission determinations relating to a physician be made by an individual who has the same or similar specialty, when possible; expand the definition of "health care provider" to include certain mental health professionals; amend language relating to conducting prior authorizations; make technical corrections.
Index Headings Mental Health - Prior authorization requirements
Physicians and Practitioners - Prior authorization requirements
Technical Corrections - HB 134/HCS 1
Health and Medical Services - Prior authorization requirements
Insurance, Health - Prior authorization requirements

Last updated: 11/9/2023 3:03 PM (EST)