| Last Action | 03/12/24: returned 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 |
| 01/19/24 |
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| 02/08/24 |
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| 03/11/24 |
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| 03/12/24 |
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Last updated: 4/22/2024 3:57 PM (EDT)