26RS HB 176

House Bill 176

Actions

Last Action	01/07/26: to Committee on Committees (H)
Title	AN ACT relating to prior authorization.
Bill Documents	Introduced
Bill Request Number	119
Sponsors	K. Moser, R. Duvall
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; amend KRS 205.536 to conform; apply the provisions to contracts delivered, entered, renewed, extended, or amended on or after January 1, 2028; EFFECTIVE, in part, January 1, 2027, and January 1, 2028.
Index Headings of Original Version	Administrative Regulations And Proceedings - Department for Medicaid Services, commissioner, prior authorization, report Administrative Regulations And Proceedings - Department of Insurance, commissioner, prior authorization, report Effective Dates, Delayed - Department for Medicaid Services, prior authorization report, January 1, 2027 Effective Dates, Delayed - Prior authorization, exemption program, January 1, 2028 Health And Medical Services - Prior authorization, exemption program Insurance, Health - Prior authorization, exemption program Medicaid - Prior authorization, report Reports Mandated - Department for Medicaid Services, commissioner, prior authorization Reports Mandated - Department of Insurance, commissioner, prior authorization State Agencies - Department for Medicaid Services, prior authorization, report State Agencies - Department of Insurance, commissioner, prior authorization State Employees - Health plan, prior authorization, exemption program