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Bill > HB176

KY HB176

KY HB176
AN ACT relating to prior authorization.

summary

Introduced
01/07/2026
In Committee
03/18/2026
Crossed Over
01/22/2026
Passed
04/13/2026
Dead
Signed/Enacted/Adopted
04/13/2026

Introduced Session

2026 Regular Session

Bill Summary

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 time frames 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.

AI Summary

This bill establishes new provisions for prior authorization, a process where health insurance companies require approval before a patient receives certain medical services or prescriptions. It mandates that insurers create programs allowing healthcare providers (including certain counselors, psychologists, therapists, and social workers) to earn exemptions from prior authorization requirements for specific services if they meet certain criteria, such as demonstrating good performance over an "evaluation period" (a defined timeframe for assessing a provider's prior authorization history). The bill also outlines what these exemption programs must include, such as annual evaluations and notification to providers, and what they may include, such as offering exemptions for prescription drugs or to provider groups. Importantly, it prohibits insurers from conducting retrospective reviews (reviews after a service has been provided) solely based on a provider having an exemption, and it requires the Commissioner of the Department of Insurance to report annually on prior authorization practices and to create necessary regulations. Similar reporting and regulatory requirements are placed on the Commissioner of the Department for Medicaid Services regarding Medicaid benefits, though the new exemption program provisions do not apply to Medicaid. These changes are set to take effect for contracts starting January 1, 2028, with some provisions related to Medicaid reporting taking effect earlier on January 1, 2027.

Committee Categories

Business and Industry, Health and Social Services

Sponsors (7)

Last Action

signed by Governor (Acts Ch. 102) (on 04/13/2026)

Taxonomy

Banking, Finance, and Domestic Commerce
  • ‐ Insurance Regulation
Health
  • ‐ Health Insurance Reform
(1 Companion Bills)

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