House Bill 317

Actions
Last Action 02/08/24: to Banking & Insurance (H)
Title AN ACT relating to prior authorization.
Bill Documents Introduced
Fiscal Impact Statements Actuarial Analysis
Health Mandate
Local Mandate
Bill Request Number 941
Sponsors K. Moser, R. Duvall, C. Aull, K. Banta, D. Bentley, T. Bojanowski, S. Bratcher, A. Camuel, A. Gentry, D. Grossberg, M. Hart, R. Palumbo, J. Raymond, R. Roberts, T. Smith, S. Stalker, K. Timoney, R. White, W. Williams
Summary of Original Version Amend KRS 304.17A-600 to define "health care provider"; make conforming amendments; 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; 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; require the commissioner of the Department of Insurance to establish forms; 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; amend KRS 304.17A-611 to 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; 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 conform; amend KRS 205.536 to require 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, 2025.
Index Headings of Original Version Health Benefit Mandate - Prior authorization requirements
Effective Dates, Delayed - Prior authorization requirements, January 1, 2025
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
Medicaid - Managed care organizations, prior authorization requirements
Conflict of Interest - Independent review entity, external review, prior authorization
Reports Mandated - Commissioner, Department of Insurance, external reviews, prior authorization
Reports Mandated - External review entity, prior authorization
Local Mandate - Managed care organizations, prior authorization requirements
Actuarial Analysis - Cabinet for Health and Family Services, Medicaid, waiver application

Actions

Top
01/19/24
  • introduced in House
  • to Committee on Committees (H)
02/08/24
  • to Banking & Insurance (H)


Last updated: 2/29/2024 5:57 PM (EST)