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.

Summary of Amendment: House Committee Substitute 1

Summary Retain original provisions, except amend KRS 205.536 to conform.

Summary of Amendment: 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.

Statutes affected:
House Committee Substitute 1: 205.536
Senate Committee Substitute 1: 205.536
Current: 205.536