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House Bill 423

Actions | Amendments

Last Action	03/11/25: passed over and retained in the Orders of the Day
Title	AN ACT relating to prior authorization.
Bill Documents	Current Introduced
Fiscal Impact Statements	Actuarial Analysis Health Mandate Local Mandate State Employee Health Plan Impact Additional Fiscal Impact Statements Exist
Bill Request Number	278
Sponsors	K. Moser, R. Duvall, C. Aull, B. Chester-Burton, D. Grossberg, M. Lockett, S. Stalker, N. Tate
Summary of Original Version	Create new sections of KRS 304.17A-600 to 304.17A-633 to define terms; prohibit insurers of health benefit plans from requiring prior authorization for a health care service for which the provider has an exemption; require insurers of health benefit plans to establish a program under which participating providers may qualify for exemptions from prior authorization; establish mandatory and permitted provisions of an insurer's prior authorization exemption program; establish requirements for sending forms and notices; require the commissioner of the Department of Insurance to submit an annual report relating to prior authorization, provide a detailed briefing upon request, and promulgate administrative regulations; amend KRS 304.17A-605 to conform; amend KRS 304.17A-611 to prohibit conducting a retrospective review that is based solely on a participating provider having a prior authorization exemption; provide that certain utilization review timeframes do not apply to retrospective reviews conducted for the purposes of determining eligibility for a prior authorization exemption; create a new section of KRS Chapter 205 to require the commissioner of the Department for Medicaid Services to submit an annual report relating to prior authorization, provide a detailed briefing upon request, and promulgate administrative regulations; apply the provisions to contracts delivered, entered, renewed, extended, or amended on or after January 1, 2027; EFFECTIVE, in part, January 1, 2026, and January 1, 2027.
Index Headings of Original Version	Health and Medical Services - Medicaid, prior authorization, exemption program Local Mandate - Medicaid, prior authorization, exemption program Physicians and Practitioners - Medicaid, prior authorization, exemption program Public Medical Assistance - Medicaid, prior authorization, exemption program State Agencies - Department for Medicaid Services, Medicaid, prior authorization, exemption program Health Benefit Plan Mandate - Medicaid, prior authorization, exemption program Medicaid - Prior authorization, exemption program Actuarial Analysis - Medicaid, prior authorization, exemption program State Employee Health Plan Mandate - Medicaid, prior authorization, exemption program
Jump to Proposed Amendments	House Committee Substitute 1 with Fiscal Impact Statements Senate Committee Substitute 1 with Fiscal Impact Statements
Votes	Vote History

Actions

Top | Amendments

02/11/25	introduced in House to Committee on Committees (H)
02/14/25	to Banking & Insurance (H)
02/19/25	reported favorably, 1st reading, to Calendar with Committee Substitute (1)
02/20/25	2nd reading, to Rules posted for passage in the Regular Orders of the Day for Friday, February 21, 2025
02/21/25	3rd reading, passed 91-0 with Committee Substitute (1)
02/25/25	received in Senate to Committee on Committees (S)
02/27/25	to Banking & Insurance (S)
03/04/25	reported favorably, 1st reading, to Calendar with Committee Substitute (1)
03/05/25	2nd reading, to Rules
03/07/25	posted for passage in the Regular Orders of the Day for Tuesday, March 11, 2025
03/11/25	passed over and retained in the Orders of the Day

Proposed Amendments

Top | Actions

Amendment	House Committee Substitute 1
Fiscal Impact Statements	Actuarial Analysis to House Committee Substitute 1 Health Mandate to House Committee Substitute 1 Local Mandate to House Committee Substitute 1 State Employee Health Plan Impact to House Committee Substitute 1
Summary	Retain original provisions, except amend KRS 205.536 to conform.
Index Headings	Health and Medical Services - Medicaid, prior authorization, exemption program Physicians and Practitioners - Medicaid, prior authorization, exemption program Public Medical Assistance - Medicaid, prior authorization, exemption program State Agencies - Department for Medicaid Services, Medicaid, prior authorization, exemption program Medicaid - Prior authorization, exemption program

Amendment	Senate Committee Substitute 1
Fiscal Impact Statements	Actuarial Analysis to Senate Committee Substitute 1 Health Mandate to Senate Committee Substitute 1 Local Mandate to Senate Committee Substitute 1 State Employee Health Plan Impact to Senate Committee Substitute 1
Summary	Retain original provisions, except allow the commissioners of the Department of Insurance and the Department for Medicaid Services to include the reason or reasons for prior authorization denials in the reports submitted to the Legislative Research Commission.
Index Headings	Actuarial Analysis - Medicaid, prior authorization, report Health Benefit Plan Mandate - Medicaid, prior authorization, report Local Mandate - Medicaid, prior authorization, report State Employee Health Plan Mandate - Medicaid, prior authorization Insurance, Health - Prior authorization, report, reasons for denials Public Medical Assistance - Medicaid, prior authorization, report, reasons for denials State Agencies - Department for Medicaid Services, prior authorization report, reasons for denials State Agencies - Department of Insurance, prior authorization, report, reasons for denials Medicaid - Department for Medicaid Services, prior authorization report, reasons for denials

Last updated: 3/11/2025 9:25 PM (EDT)