UNOFFICIAL COPY 24 RS BR 941
Page 1 of 32
XXXX 1/2/2024 8:57 AM Jacketed
AN ACT relating to prior authorization. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
Section 1. KRS 304.17A-600 is amended to read as follows: 3
As used in KRS 304.17A-600 to 304.17A-633: 4
(1) (a) "Adverse determination" means a determination by an insurer or its designee 5
that the health care services furnished or proposed to be furnished to a 6
covered person are: 7
1. Not medically necessary, as determined by the insurer, or its designee or 8
experimental or investigational, as determined by the insurer, or its 9
designee; and 10
2. Benefit coverage is therefore denied, reduced, or terminated. 11
(b) "Adverse determination" does not mean a determination by an insurer or its 12
designee that the health care services furnished or proposed to be furnished to 13
a covered person are specifically limited or excluded in the covered person's 14
health benefit plan; 15
(2) "Authorized person" means a parent, guardian, or other person authorized to act on 16
behalf of a covered person with respect to health care decisions; 17
(3) "Concurrent review" means utilization review conducted during a covered person's 18
course of treatment or hospital stay; 19
(4) "Covered person" means a person covered under a health benefit plan; 20
(5) "External review" means a review that is conducted by an independent review 21
entity[ which meets specified criteria as established in KRS 304.17A-623, 304.17A-22
625, and 304.17A-627]; 23
(6) "Health benefit plan" has the same meaning as in KRS 304.17A-005, except that for 24
purposes of KRS 304.17A-600 to 304.17A-633, the term includes short-term 25
coverage policies; 26
(7) "Health care provider" or "provider" has the same meaning as in KRS 304.17A-27 UNOFFICIAL COPY 24 RS BR 941
Page 2 of 32
XXXX 1/2/2024 8:57 AM Jacketed
005 except that, for purposes of Sections 2, 3, 4, 5, 6, and 7 of this Act and 1
subsections (3) and (4) of Section 10 of this Act, the term includes, if practicing 2
independently, any: 3
(a) Licensed clinical alcohol and drug counselor licensed under KRS Chapter 4
309; 5
(b) Licensed psychologist, licensed psychological practitioner, or certified 6
psychologist with autonomous functioning licensed or certified under the 7
provisions of KRS Chapter 319; 8
(c) Licensed professional clinical counselor licensed under KRS Chapter 335; 9
(d) Licensed marriage and family therapist licensed under KRS Chapter 335; 10
(e) Licensed professional art therapist licensed under KRS Chapter 309; and 11
(f) Licensed clinical social worker licensed under KRS Chapter 335; 12
(8)[(7)] "Health care service" has the same meaning as in KRS 304.17A-005, 13
except that, for purposes of Sections 2, 3, 4, and 6 of this Act, the term does not 14
include the provision of Schedules II, III, IV, or V controlled substances, as 15
described in KRS Chapter 218A; 16
(9) "Independent review entity" means an individual or organization certified by the 17
department to perform external reviews[ under KRS 304.17A-623, 304.17A-625, 18
and 304.17A-627]; 19
(10)[(8)] "Insurer" means any of the following entities authorized to issue health 20
benefit plans[ as defined in subsection (6) of this section]: 21
(a) An insurance company;[,] 22
(b) A health maintenance organization; 23
(c) A self-insurer or multiple employer welfare arrangement not exempt from 24
state regulation by ERISA; 25
(d) A provider-sponsored integrated health delivery network; 26
(e) A self-insured employer-organized association; 27 UNOFFICIAL COPY 24 RS BR 941
Page 3 of 32
XXXX 1/2/2024 8:57 AM Jacketed
(f) A nonprofit hospital, medical-surgical, or health service corporation; or 1
(g) Any other entity authorized to transact health insurance business in Kentucky; 2
(11)[(9)] "Internal appeals process" means a formal process, as set forth in KRS 3
304.17A-617, established and maintained by the insurer, its designee, or agent 4
whereby the covered person, an authorized person, or a provider may contest an 5
adverse determination rendered by the insurer, its designee, or private review agent; 6
(12)[(10)] "Nationally recognized accreditation organization": 7
(a) Means a private nonprofit entity that: 8
1. Sets national utilization review and internal appeal standards; and 9
2. Conducts review of insurers, agents, or independent review entities for 10
the purpose of accreditation or certification; and 11
(b) Shall include the Accreditation Association for Ambulatory Health Care 12
(AAAHC), the National Committee for Quality Assurance (NCQA), the 13
American Accreditation Health Care Commission (URAC), the Joint 14
Commission, or any other organization identified by the department; 15
(13)[(11)] "Private review agent" or "agent": 16
(a) Means a person or entity performing utilization review that is either affiliated 17
with, under contract with, or acting on behalf of any insurer or other person 18
providing or administering health benefits to citizens of this Commonwealth; 19
and 20
(b) Does not include an independent review entity that[which] performs external 21
reviews[review] of adverse determinations; 22
(14)[(12)] "Prospective review": 23
(a) Means a utilization review that is conducted prior to the provision of health 24
care services; and[. "Prospective review" also ] 25
(b) Includes any insurer's or agent's requirement that a covered person or provider 26
notify the insurer or agent prior to providing a health care service, including 27 UNOFFICIAL COPY 24 RS BR 941
Page 4 of 32
XXXX 1/2/2024 8:57 AM Jacketed
but not limited to prior authorization, step therapy protocol, preadmission 1
review, pretreatment review, utilization, and case management; 2
(15)[(13)] "Qualified personnel" means a licensed physician, registered nurse, licensed 3
practical nurse, medical records technician, or other licensed medical personnel 4
who, through training and experience, shall render consistent decisions based on the 5
review criteria; 6
(16)[(14)] "Registration" means an authorization issued by the department to an insurer 7
or a private review agent to conduct utilization review; 8
(17)[(15)] "Retrospective review": 9
(a) Means utilization review that is conducted after health care services have been 10
provided to a covered person; and 11
(b) Does not include the review of a claim that is limited to an evaluation of 12
reimbursement levels[,] or adjudication of payment; 13
(18)[(16) (a)] "Urgent health care services": 14
(a) Means health care or treatment with respect to which the application of the 15
time periods for making nonurgent determination: 16
1. Could seriously jeopardize the life or health of the covered person or the 17
ability of the covered person to regain maximum function; or 18
2. In the opinion of a physician with knowledge of the covered person's 19
medical condition, would subject the covered person to severe pain that 20
cannot be adequately managed without the care or treatment that is the 21
subject of the utilization review; and[.] 22
(b) Includes[Urgent health care services include] all requests for hospitalization 23
and outpatient surgery; 24
(19)[(17)] (a) "Utilization review" means a review of the medical necessity and 25
appropriateness of hospital resources and medical services given or proposed 26
to be given to a covered person for purposes of determining the availability of 27 UNOFFICIAL COPY 24 RS BR 941
Page 5 of 32
XXXX 1/2/2024 8:57 AM Jacketed
payment. 1
(b) Areas of review include concurrent, prospective, and retrospective review; 2
and 3
(20)[(18)] "Utilization review plan" means a description of the procedures governing 4
utilization review activities performed by an insurer or a private review agent. 5
SECTION 2. A NEW SECTION OF KRS 304.17A-600 TO 304.17A-633 IS 6
CREATED TO READ AS FOLLOWS: 7
(1) As used in this section, "evaluation period" means a six (6) month period of time 8
during which a health care provider's prior authorization experience for a 9
particular health care service is evaluated by an insurer or private review agent 10
for purposes of determining eligibility for an exemption under subsection (3)(a) 11
of this section. 12
(2) An insurer or its private review agent shall not require a covered person, 13
authorized person, or health care provider to obtain prior authorization for a 14
particular health care service if, at the time the health care service was provided, 15
the health care provider: 16
(a) Qualified for or had an exemption under subsection (3)(a) of this section 17
for that health care service; or 18
(b) Qualified under the exemption of another health care provider in 19
accordance with subsection (3)(b) of this section for that health care 20
service. 21
(3) (a) A health care provider shall qualify for an exemption for a particular health 22
care service if, in the most recent evaluation period, the insurer or its 23
private review agent approved not less than ninety percent (90%) of the 24
prior authorization requests submitted by the health care provider for that 25
health care service. 26
(b) Subject to paragraph (c) of this subsection, a health care provider shall be 27 UNOFFICIAL COPY 24 RS BR 941
Page 6 of 32
XXXX 1/2/2024 8:57 AM Jacketed
qualified under the exemption of another health care provider for a 1
particular health care service if: 2
1. The following requirements are met: 3
a. The health care provider is an advanced practice registered 4
nurse or physician assistant; 5
b. The health care provider's collaborating or supervising 6
physician has an exemption for the health care service under 7
paragraph (a) of this subsection; 8
c. The health care service is within the scope of practice of an 9
advanced practice registered nurse or physician assistant; and 10
d. The health care provider submits the claim for the health care 11
service under the collaborating or supervising physician's 12
national provider identifier in a manner consistent with 13
applicable law; or 14
2. The health care provider is supervising or providing a health care 15
service ordered by a health care provider with an exemption for the 16
health care service under paragraph (a) of this subsection. 17
(c) 1. For health care services provided under paragraph (b) of this 18
subsection, the health care provider shall include the name and 19
national provider identifier of the collaborating or supervising 20
physician, or the ordering health care provider, on the claim forms for 21
the health care service. 22
2. The insurer or its private review agent may provide coding guidance to 23
health care providers submitting claim forms under subparagraph 1. 24
of this paragraph to ensure that information is appropriately captured 25
on the claim. 26
3. If the information required under subparagraph 1. of this paragraph 27 UNOFFICIAL COPY 24 RS BR 941
Page 7 of 32
XXXX 1/2/2024 8:57 AM Jacketed
is not included on claim forms submitted for the health care service, 1
the insurer or its private review agent may treat the claim as subject to 2
an otherwise applicable prior authorization requirement. 3
(4) (a) An insurer or its private review agent shall evaluate, once every six (6) 4
months, whether a health care provider qualifies for an exemption under 5
subsection (3)(a) of this section for each health care service: 6
1. Provided by the provider during the evaluation period, regardless of 7
the number of prior authorization requests submitted by the provider 8
for the health care service during the evaluation period; and 9
2. For which: 10
a. The insurer or private review agent requires prior authorization; 11
and 12
b. The provider does not have an exemption under subsection (3)(a) 13
of this section. 14
(b) An insurer or its private review agent shall not: 15
1. Include prior authorization requests that have not been finalized in its 16
evaluation under paragraph (a) of this subsection; or 17
2. Require a health care provider to request an exemption in order to 18
qualify for the exemption. 19
(5) (a) Except as provided in paragraph (b) of this subsection, not later than five 20
(5) days after conducting an evaluation under subsection (4) of this section, 21
an insurer or its private review agent shall provide, in accordance with 22
Section 5 of this Act, the health care provider with a notice that includes: 23
1. A statement notifying the health care provider: 24
a. That the provider has been granted an exemption under 25
subsection (3)(a) of this section; and 26
b. Of the duration of the exemption under subsection (7) of this 27 UNOFFICIAL COPY 24 RS BR 941
Page 8 of 32
XXXX 1/2/2024 8:57 AM Jacketed
section; and 1
2. A list of the health care services and plans to which the exemption 2
applies. 3
(b) An insurer or its private review agent may deny an exemption under 4
subsection (3)(a) of this section not later than five (5) days after conducting 5
an evaluation under subsection (4) of this section if the insurer or private 6
review agent provides, in accordance with Section 5 of this Act, the health 7
care provider with the following: 8
1. Actual statistics and data for the relevant evaluation period; 9
2. Detailed information sufficient to demonstrate that the health care 10
provider does not meet the exemption criteria for the particular health 11
care service; and 12
3. A plain language explanation of how the health care provider may 13
seek an external review of the denial under Section 4 of this Act. 14
(6) If a health care provider submits a prior authorization request for a health care 15
service for which the health care provider qualifies for an exemption under 16
subsection (3)(a) of this section, the insurer or its private review agent shall 17
promptly provide, in accordance with Section 5 of this Act, the health care 18
provider with a notice that includes: 19
(a) The information required under subsection (5)(a) of this section; and 20
(b) The insurer's payment requirements. 21
(7) An exemption that a health care provider qualifies for or has under subsection 22
(3)(a) of this section shall remain in effect until it is rescinded under Section 3 of 23
this Act. 24
(8) When a health care provider's exemption has been denied under subsection (5)(b) 25
of this section or rescinded under Section 3 of this Act, the health care provider 26
may qualify for or have an exemption under subsection (3)(a) of this section for 27 UNOFFICIAL COPY 24 RS BR 941
Page 9 of 32
XXXX 1/2/2024 8:57 AM Jacketed
the same health care service beginning six (6) months after the effective date of 1
the rescission or denial. 2
SECTION 3. A NEW SECTION OF KRS 304.17A-600 TO 304.17A-633 IS 3
CREATED TO READ AS FOLLOWS: 4
(1) As used in this section, "evaluation period" means a six (6) month period of time 5
during which a health care provider's claims experience for a particular health 6
care service is evaluated by an insurer or private review agent for purposes of 7
determining whether an exemption may be rescinded under this section. 8
(2) (a) Subject to this section and except as provided in subsection (6) of Section 4 9
of this Act, an insurer or its private review agent may, during the months of 10
January and July of each year, rescind an exemption granted in accordance 11
with subsection (3)(a) of Section 2 of this Act, if the insurer or private 12
review agent: 13
1. Makes a determination, based on a retrospective review of a random 14
sample of not less than five (5) and not more than twenty (20) claims 15
submitted by the health care provider for the particular health care 16
service during the most recent evaluation period, that less than ninety 17
percent (90%) of the claims met the medical necessity criteria that 18
would have been used during the relevant evaluation period by the 19
insurer or private review agent when conducting a prior authorization 20
review for that health care service; and 21
2. Notifies the health care provider of the rescission in accordance with 22
Section 5 of this Act and paragraph (b) of this subsection. 23
(b) The notification required under paragraph (a) of this subsection shall 24
include: 25
1. An identification of the health care services and plans for which the 26
exemption is being rescinded; 27 UNOFFICIAL COPY 24 RS BR 941
Page 10 of 32
XXXX 1/2/2024 8:57 AM Jacketed
2. The date the notification was issued; 1
3. The date the rescission will become effective under subsection (3)(c)2. 2
of this section; 3
4. A statement that includes: 4
a. The total number of payable claims submitted by or in 5
connection with the health care provider that were eligible to be 6
reviewed under paragraph (a)1. of this subsection for each 7
health care service subject to the rescission; 8
b. Identification of each claim included in the random sample 9
referenced in paragraph (a)1. of this subsection; 10
c. The insurer's or private review agent's determination of whether 11
each claim identified under subdivision b. of this subparagraph 12
met the insurer's or private review agent's medical necessity 13
criteria; and 14
d. For each claim identified under subdivision b. of this 15
subparagraph that was determined to not have met the insurer's 16
or private review agent's medical necessity criteria: 17
i. The principal reasons for the determination, including, if 18
applicable, a statement that the determination was based on 19
a failure to submit specified medical records; 20
ii. The clinical basis for the determination; 21
iii. A description of the medical necessity criteria sources that 22
were used as guidelines in making the determination; and 23
iv. The professional specialty of the health care provider who 24
made the determination; 25
5. A plain language explanation of how the health care provider may 26
seek an external review of the rescission under Section 4 of this Act; 27 UNOFFICIAL COPY 24 RS BR 941
Page 11 of 32
XXXX 1/2/2024 8:57 AM Jacketed
6. A form, prescribed by the commissioner under Section 7 of this Act, 1
for the health care provider to request an external review of the 2
rescission under Section 4 of this Act that includes: 3
a. The name, address, contact information, and national provider 4
identifier of the health care provider; 5
b. An indication of whether the health care provider is requesting 6
the independent review entity to review an additional random 7
sample of claims, as provided in subsection (4)(a) of Section 4 of 8
this Act; 9
c. The date of the external review request; and 10
d. An instruction for the health care provider to: 11
i. Submit the completed form to the insurer or private review 12
agent before the date the rescission becomes effective 13
under subsection (3)(c)2.a. of this section; and 14
ii. Include applicable medical records for any determination 15
that was based on a failure to provide medical records; 16
7. Options for the health care provider to submit the form referenced in 17
subparagraph 6. of this paragraph by mail, email, or other electronic 18
methods; and 19
8. The address and contact information for submitting, through the 20
means provided under subparagraph 7. of this paragraph, the form 21
referenced in subparagraph 6. of this paragraph. 22
(c) An insurer or its private review agent shall not rescind an exemption of a 23
health care provider that has less than five (5) claims subject to review 24
under paragraph (a) of this subsection. 25
(3) (a) 1. Except as provided in subparagraph 2. of this paragraph, the review 26
periods under subsection (2)(a)1. of this section shall be January 27 UNOFFICIAL COPY 24 RS BR 941
Page 12 of 32
XXXX 1/2/2024 8:57 AM Jacketed
through June and July through December of each year. 1
2. If six (6) months has not elapsed since the date of the notification 2
provided under subsection (5)(a) or (6) of Section 2 of this Act, 3
whichever is earlier, the review period shall be extended to include the 4
next full review period set forth in subparagraph 1. of this paragraph. 5
(b) An insurer or private review agent shall not include claims that have not 6
been finalized in its review under subsection (2)(a)1. of this section. 7
(c) A rescission determination under subsection (2) of this section shall: 8
1. Be made by an individual: 9
a. Licensed to practice medicine in this state; and 10
b. When relating to a physician, who has the same or similar 11
specialty as the physician, when possible; and 12
2. Subject to subsection (4) of this section, take effect: 13
a. Except as provided in subdivision b. of this subparagraph, on the 14
thirty-first day after the date the health care provider receives the 15
rescission determination; or 16
b. If the health care provider timely requests an external review of 17
the rescission under subsection (2)(a)1. of Section 4 of this Act, 18
on the fifth day after the date the independent review entity 19
affirms the rescission. 20
(4) If a notice under subsection (2) of this section is sent in a manner inconsistent 21
with Section 5 of this Act, the notice shall be defective and any exemption 22
referenced in the defective notice shall remain in effect. 23
SECTION 4. A NEW SECTION OF KRS 304.17A-600 TO 304.17A-633 IS 24
CREATED TO READ AS FOLLOWS: 25
(1) As used in this section, "evaluation period" has the same meaning as in Section 3 26
of this Act. 27 UNOFFICIAL COPY 24 RS BR 941
Page 13 of 32
XXXX 1/2/2024 8:57 AM Jacketed
(2) (a) 1. Except as provided in paragraph (b) of this subsection, a health care 1
provider may, within thirty (30) days of receiving an exemption denial 2
under Section 2 of this Act or an exemption rescission under Section 3 3
of this Act, submit a request for an external review of the rescission or 4
denial to the insurer or its private review agent. An external review 5
requested under this subparagraph shall be conducted by an 6
independent review entity. 7
2. Requests for an external review under subparagraph 1. of this 8
paragraph shall be forwarded by the insurer or its private review agent 9
to the independent review entity within twenty-four (24) hours of 10
receipt by the insurer or private review agent. 11
3. The department shall establish a system for each insurer or its private 12
review agent to be assigned an independent review entity for external 13
reviews conducted under subparagraph 1. of this paragraph. 14
4. The system established under subparagraph 3. of this paragraph shall: 15
a. Be prospective; and 16
b. Require insurers and private review agents to utilize independent 17
review entities on a rotating basis so that an insurer or private 18
review agent does not have the same independent review entity 19
for two (2) consecutive external reviews. 20
5. For purposes of the system established under subparagraph 3. of this 21
paragraph, the department shall contract with not less than two (2) 22
independent review entities. 23
(b) 1. A health care provider may submit a request for an external review of 24
any rescission notice alleged to have been sent in a manner 25
inconsistent with Section 5 of this Act. An external review requested 26
under this subparagraph shall be conducted by the department. 27 UNOFFICIAL COPY 24 RS BR 941
Page 14 of 32
XXXX 1/2/2024 8:57 AM Jacketed
2. The commissioner shall promulgate an administrative regulation to 1
establish procedures for an external review requested under 2
subparagraph 1. of this paragraph. 3
(c) An insurer or its private review agent shall: 4
1. Not require a health care provider to engage in an internal appeal 5
before requesting an external review under this subsection; and 6
2. Provide options for a health care provider to submit a request for an 7
external review under paragraph (a)1. of this subsection by mail, 8
email, or other electronic methods. 9
(3) For an external review of an exemption denial under Section 2 of this Act, the 10
independent review entity shall base its decision on the criteria established under 11
subsection (3)(a) of Section 2 of this Act. 12
(4) For an external review of an exemption rescission under Section 3 of this Act: 13
(a) A health care provider may request that the independent review entity, as 14
part of its review, consider, if available, another random sample of not less 15
than five (5) and not more than twenty (20) claims submitted to the insurer 16
or its private review agent by the health care provider during the relevant 17
evaluation period for the relevant health care service; 18
(b) The independent review entity shall base its decision on the criteria 19
established under subsection (2)(a)1. of Section 3 of this Act, as determined 20
by the medical necessity of the following sample of claims: 21
1. The claims reviewed by the insurer or its private review agent under 22
subsection (2)(a)1. of Section 3 of this Act; and 23
2. If the health care provider makes a request under paragraph (a) of 24
this subsection, the additional claims, if available, submitted for 25
review under this subsection; and 26
(c) In making its decision, the independent review entity shall take into account 27 UNOFFICIAL COPY 24 RS BR 941
Page 15 of 32
XXXX 1/2/2024 8:57 AM Jacketed
all of the following: 1
1. Information submitted by the insurer or its private review agent and 2
the health care provider, including: 3
a. The relevant medical records for the claims being reviewed; 4
b. The standards, criteria, and clinical rationale used by the insurer 5
or private review agent to make its determination; and 6
c. The insurer's health plan; 7
2. Findings, studies, research, and other relevant documents of 8
government agencies and nationally recognized organizations, 9
including the National Institutes of Health, the National Cancer 10
Institute, the National Academy of Sciences, the United States Food 11
and Drug Administration, the Centers for Medicare and Medicaid 12
Services of the United States Department of Health and Human 13
Services, and the Agency for Health Care Research and Quality; and 14
3. Relevant findings in peer-reviewed medical or scientific literature, 15
published opinions of nationally recognized medical specialists, and 16
clinical guidelines adopted by relevant national medical societies. 17
(5) (a) The independent review entity shall issue an external review decision to the 18
health care provider, insurer or its private review agent, and department not 19
later than thirty (30) days after the date the health care provider submits a 20
request under subsection (2)(a)1. of this section. 21
(b) The external review decision issued under this subsection shall include: 22
1. The findings for either the health care provider or the insurer or its 23
private review agent regarding each exemption under review; 24
2. The relevant provisions of the insurer's health plan and how the 25
provisions applied; and 26
3. The relevant provisions of any nationally recognized and peer-27 UNOFFICIAL COPY 24 RS BR 941
Page 16 of 32
XXXX 1/2/2024 8:57 AM Jacketed
reviewed medical or scientific documents used in the external review. 1
(6) If an insurer's or private review agent's denial or rescission is overturned by an 2
independent review entity under this section, the insurer or private review agent: 3
(a) Shall be bound by the decision; 4
(b) Shall not attempt to rescind the exemption reviewed by the independent 5
review entity before the end of the next evaluation period that occurs; and 6
(c) May only deny or rescind the exemption reviewed by the independent review 7
entity after the insurer or private review agent complies with this section 8
and Sections 2 and 3 of this Act. 9
(7) An insurer or its private review agent shall pay: 10
(a) For any external review requested under this section; and 11
(b) A reasonable fee determined by the Kentucky Board of Medical Licensure 12
for any copies of medical records or other documents requested from a 13
health care provider during an external review under this section. 14
(8) The external review process shall be confidential and shall not be subject to KRS 15
61.805 to 61.850 or 61.870 to 61.884. 16
(9) (a) The insurer, private review agent, or health care provider involved in an 17
external review under subsection (2)(a)1. of this section may submit a 18
written complaint to the department regarding any independent review 19
entity's actions believed to be an inappropriate application of this section. 20
(b) 1. The department shall promptly review the complaint, and if the 21
department determines that the actions of the independent review 22
entity were inappropriate, the department shall take corrective 23
measures, including decertification or suspension of the independent 24
review entity from further participation in external reviews. 25
2. The department's actions under subparagraph 1. of this paragraph 26
shall be subject to the powers and administrative procedures set forth 27 UNOFFICIAL COPY 24 RS BR 941
Page 17 of 32
XXXX 1/2/2024 8:57 AM Jacketed
in this chapter. 1
SECTION 5. A NEW SECTION OF KRS 304.17A-600 TO 304.17A-633 IS 2
CREATED TO READ AS FOLLOWS: 3
(1) For purposes of sending forms and notices to a health care provider under 4
Sections 2, 3, and 4 of this Act, an insurer or its private review agent shall solicit 5
from each health care provider the provider's preferred: 6
(a) Method of contact; and 7
(b) Contact information. 8
(2) An insurer or its private review agent shall: 9
(a) Send all forms and notices required to be sent to a health care provider 10
under Sections 2, 3, and 4 of this Act, or administrative regulations 11
promulgated pursuant thereto, in the manner designated by the health care 12
provider under subsection (1) of this section; and 13
(b) Provide a process for health care providers to update the preferences 14
designated under subsection (1) of this section. 15
SECTION 6. A NEW SECTION OF KRS 304.17A-600 TO 304.17A-633 IS 16
CREATED TO READ AS FOLLOWS: 17
Nothing in Section 2, 3, 4, 5, 6, 7, or 10 of this Act shall be construed to: 18
(1) Authorize a health care provider to provide a health care service outside the scope 19
of the provider's applicable license; or 20
(2) Require an insurer or its private review agent to pay for a health care service 21
described in subsection (1) of this section that is performed in violation of the 22
laws of this state. 23
SECTION 7. A NEW SECTION OF KRS 304.17A-600 TO 304.17A-633 IS 24
CREATED TO READ AS FOLLOWS: 25
For every process relating to an exemption from prior authorization requirements 26
under Section 2, 3, 4, and 5 of this Act, the commissioner shall, by administrative 27 UNOFFICIAL COPY 24 RS BR 941
Page 18 of 32
XXXX 1/2/2024 8:57 AM Jacketed
regulation, establish standardized forms that shall be used by insurers, private review 1
agents, and health care providers. 2
Section 8. KRS 304.17A-605 is amended to read as follows: 3
(1) Sections 2, 3, 4, 5, 6, and 7 of this Act and KRS 304.17A-600, 304.17A-603, 4
304.17A-605, 304.17A-607, 304.17A-609, 304.17A-611, 304.17A-613, and 5
304.17A-615 set forth the requirements and procedures regarding utilization review 6
and shall apply to: 7
(a) Any insurer or its private review agent that provides or performs utilization 8
review in connection with a health benefit plan or a limited health service 9
benefit plan; and 10
(b) Any private review agent that performs utilization review functions on behalf 11
of any person providing or administering health benefit plans or limited health 12
service benefit plans. 13
(2) Where an insurer or its agent provides or performs utilization review, and in all 14
instances where internal appeals as set forth in KRS 304.17A-617 are involved, the 15
insurer or its agent shall be responsible for: 16
(a) Monitoring all utilization reviews and internal appeals carried out by or on 17
behalf of the insurer; 18
(b) Ensuring that all requirements of KRS 304.17A-600 to 304.17A-633 are met; 19
(c) Ensuring that all administrative regulations promulgated in accordance with 20
KRS 304.17A-609, 304.17A-613, and 304.17A-629 are complied with; and 21
(d) Ensuring that appropriate personnel have operational responsibility for the 22
performance of the insurer's utilization review plan. 23
(3) A private review agent that operates solely under contract with the federal 24
government for utilization review or patients eligible for hospital services under 25
Title XVIII of the Social Security Act shall not be subject to the registration 26
requirements set forth in KRS 304.17A-607, 304.17A-609, and 304.17A-613. 27 UNOFFICIAL COPY 24 RS BR 941
Page 19 of 32
XXXX 1/2/2024 8:57 AM Jacketed
Section 9. KRS 304.17A-607 is amended to read as follows: 1
(1) An insurer or private review agent shall not provide or perform utilization reviews 2
without being registered with the department. A registered insurer or private review 3
agent shall: 4
(a) Have available the services of sufficient numbers of registered nurses, 5
medical records technicians, or similarly qualified persons supported by 6
licensed physicians with access to consultation with other appropriate 7
physicians to carry out its utilization review activities; 8
(b) Ensure that[, for any contract entered into on or after January 1, 2020,]: 9
1. For the provision of utilization review services, only licensed 10
physicians, who are of the same or similar specialty and subspecialty, 11
when possible, as the ordering provider, shall: 12
a.[1.] Make a utilization review decision to deny, reduce, limit, or 13
terminate a health care benefit or to deny, or reduce payment for, a 14
health care service because that service is not medically necessary, 15
experimental, or investigational except: 16
i. In the case of a health care service rendered by a chiropractor 17
or optometrist,[ where] the denial shall be made respectively 18
by a chiropractor or optometrist duly licensed in Kentucky; 19
and 20
ii. For the provision of utilization review services relating to 21
prior authorization, only physicians licensed in this state 22
shall make the utilization review decision; and 23
b.[2.] Supervise qualified personnel conducting case reviews; and 24
2. For the provision of utilization review services relating to prior 25
authorization for any prescription drug, the drug shall be the basis for 26
the prior authorization decision regardless of the dosage; 27 UNOFFICIAL COPY 24 RS BR 941
Page 20 of 32
XXXX 1/2/2024 8:57 AM Jacketed
(c) Have available the services of sufficient numbers of practicing physicians in 1
appropriate specialty areas to assure the adequate review of medical and 2
surgical specialty and subspecialty cases; 3
(d) Not disclose or publish individual medical records or any other confidential 4
medical information in the performance of utilization review activities except 5
as provided in the Health Insurance Portability and Accountability Act, 6
Subtitle F, secs. 261 to 264 and 45 C.F.R. pts.[secs.] 160 to 164 and other 7
applicable laws and administrative regulations; 8
(e) Provide a toll free telephone line for covered persons, authorized persons, and 9
providers to contact the insurer or private review agent and be accessible to 10
covered persons, authorized persons, and providers for forty (40) hours a 11
week during normal business hours in this state; 12
(f) Where an insurer, its agent, or private review agent provides or performs 13
utilization review, be available to conduct utilization review during normal 14
business hours and extended hours in this state on Monday and Friday through 15
6:00 p.m., including federal holidays; 16
(g) Provide decisions to covered persons, authorized persons, and all providers on 17
appeals of adverse determinations and coverage denials of the insurer or 18
private review agent, in accordance with this section and administrative 19
regulations promulgated in accordance with KRS 304.17A-609; 20
(h) Except for retrospective review of an emergency admission where the covered 21
person remains hospitalized at the time the review request is made, which 22
shall be considered a concurrent review, or as otherwise provided in this 23
subtitle, provide a utilization review decision in accordance with the 24
timeframes in paragraph (i) of this subsection and 29 C.F.R. pt.[part] 2560, 25
including written notice of the decision; 26
(i) 1. Render a utilization review decision concerning urgent health care 27 UNOFFICIAL COPY 24 RS BR 941
Page 21 of 32
XXXX 1/2/2024 8:57 AM Jacketed
services, and notify the covered person, authorized person, or provider 1
of that decision not[no] later than twenty-four (24) hours after obtaining 2
all necessary information to make the utilization review decision; and 3
2. If the insurer or agent requires a utilization review decision of nonurgent 4
health care services, render a utilization review decision and notify the 5
covered person, authorized person, or provider of the decision within 6
five (5) days of obtaining all necessary information to make the 7
utilization review decision. 8
For purposes of this paragraph, "necessary information" is limited to: 9
a. The results of any face-to-face clinical evaluation; 10
b. Any second opinion that may be required; and 11
c. Any other information determined by the department to be 12
necessary to making a utilization review determination; 13
(j) Provide written notice of review decisions to the covered person, authorized 14
person, and providers. The written notice may be provided in an electronic 15
format, including e-mail or facsimile, if the covered person, authorized 16
person, or provider has agreed in advance in writing to receive the notices 17
electronically. An insurer or agent that denies a step therapy exception, as 18
defined in KRS 304.17A-163, or denies coverage or reduces payment for a 19
treatment, procedure, drug that requires prior approval, or device shall include 20
in the written notice: 21
1. A statement of the specific medical and scientific reasons for denial or 22
reduction of payment or identifying that provision of the schedule of 23
benefits or exclusions that demonstrates that coverage is not available; 24
2. The medical license number and the title of the reviewer making the 25
decision; 26
3. Except for retrospective review, a description of alternative benefits, 27 UNOFFICIAL COPY 24 RS BR 941
Page 22 of 32
XXXX 1/2/2024 8:57 AM Jacketed
services, or supplies covered by the health benefit plan, if any; and 1
4. Instructions for initiating or complying with the insurer's internal appeal 2
procedure, as set forth in KRS 304.17A-617, stating, at a minimum, 3
whether the appeal shall be in writing, and any specific filing 4
procedures, including any applicable time limitations or schedules, and 5
the position and phone number of a contact person who can provide 6
additional information; 7
(k) Afford participating physicians an opportunity to review and comment on all 8
medical and surgical and emergency room protocols, respectively, of the 9
insurer and afford other participating providers an opportunity to review and 10
comment on all of the insurer's protocols that are within the provider's legally 11
authorized scope of practice; and 12
(l) Comply with its own policies and procedures on file with the department or, if 13
accredited or certified by a nationally recognized accrediting entity, comply 14
with the utilization review standards of that accrediting entity where they are 15
comparable and do not conflict with state law. 16
(2) (a) The insurer's or private review agent's failure to make a determination and 17
provide written notice within the time frames set forth in this section shall be 18
deemed to be a prior authorization for the health care services or benefits 19
subject to the review. 20
(b) This subsection[provision] shall not apply where the failure to make the 21
determination or provide the notice results from circumstances which are 22
documented to be beyond the insurer's control. 23
(3) (a) An insurer or private review agent shall submit a copy of any changes to its 24
utilization review policies or procedures to the department. 25
(b) No change to utilization review policies and procedures shall be effective or 26
used until after it has been filed with and approved by the commissioner. 27 UNOFFICIAL COPY 24 RS BR 941
Page 23 of 32
XXXX 1/2/2024 8:57 AM Jacketed
(4) (a) A private review agent shall provide to the department the names of the 1
entities for which the private review agent is performing utilization review in 2
this state. 3
(b) Notice shall be provided to the department within thirty (30) days of any 4
change. 5
Section 10. KRS 304.17A-611 is amended to read as follows: 6
(1) A utilization review decision shall not retrospectively deny coverage for health care 7
services provided to a covered person when prior approval has been obtained from 8
the insurer or its designee for those services, unless the approval was based upon 9
fraudulent, materially inaccurate, or misrepresented information submitted by the 10
covered person, authorized person, or the provider. 11
(2) [For health benefit plans issued or renewed on or after January 1, 2022, ]An insurer 12
shall not require or conduct a prospective or concurrent review for a prescription 13
drug: 14
(a) That: 15
1. Is used in the treatment of alcohol or opioid use disorder; and 16
2. Contains Methadone, Buprenorphine, or Naltrexone; or 17
(b) That was approved before January 1, 2022, by the United States Food and 18
Drug Administration for the mitigation of opioid withdrawal symptoms. 19
(3) (a) An insurer or its private review agent shall not retrospectively: 20
1. Except as provided in paragraph (b) of this subsection, deny or reduce 21
payment for a health care service for which the provider: 22
a. Qualified for or had an exemption under subsection (3)(a) of 23
Section 2 of this Act; or 24
b. Qualified under the exemption of another health care provider 25
under subsection (3)(b) of Section 2 of this Act; or 26
2. Deny a health care service on the basis of a rescission under Section 3 27 UNOFFICIAL COPY 24 RS BR 941
Page 24 of 32
XXXX 1/2/2024 8:57 AM Jacketed
of this Act, regardless of whether an independent review entity affirms 1
the insurer's or private review agent's determination. 2
(b) Paragraph (a)1. of this subsection shall not apply if the health care 3
provider: 4
1. Knowingly and materially misrepresented the health care service in a 5
request for payment submitted to the insurer or private review agent 6
with the specific intent to deceive and obtain an unlawful payment 7
from the insurer or private review agent; or 8
2. Failed to substantially perform the health care service. 9
(4) Notwithstanding any other law to the contrary, an insurer or its private review 10
agent shall not conduct a retrospective review of a health care service for which 11
the health care provider qualified for or had an exemption under subsection 12
(3)(a) of Section 2 of this Act, or qualified under the exemption of another health 13
care provider under subsection (3)(b) of Section 2 of this Act, except: 14
(a) To determine if the health care provider continues to qualify for an 15
exemption; or 16
(b) When the insurer or private review agent has reasonable cause to suspect a 17
basis for denial exists under subsection (3)(b) of this section. 18
Section 11. KRS 304.17A-621 is amended to read as follows: 19
The Independent External Review Program is hereby established in the department. The 20
program shall provide covered persons with a formal, independent review to address 21
disagreements between the covered person and the covered person's insurer regarding an 22
adverse determination made by the insurer, its designee, or a private review agent. This 23
section and KRS 304.17A-623 and 304.17A-625 establish requirements and procedures 24
governing the program[external review and independent review entities]. 25
Section 12. KRS 304.17A-627 is amended to read as follows: 26
(1) To be certified as an independent review entity under this chapter, an organization 27 UNOFFICIAL COPY 24 RS BR 941
Page 25 of 32
XXXX 1/2/2024 8:57 AM Jacketed
shall submit to the department an application on a form required by the department. 1
The application shall include the following: 2
(a) The name of each stockholder or owner of more than five percent (5%) of any 3
stock or options for an applicant; 4
(b) The name of any holder of bonds or notes of the applicant that exceeds one 5
hundred thousand dollars ($100,000); 6
(c) The name and type of business of each corporation or other organization that 7
the applicant controls or with which it is affiliated and the nature and extent of 8
the affiliation or control; 9
(d) The name and a biographical sketch of each director, officer, and executive of 10
the applicant and any entity listed under paragraph (c) of this subsection and a 11
description of any relationship the named individual has with an insurer as 12
defined in KRS 304.17A-600 or a provider of health care services; 13
(e) The percentage of the applicant's revenues that are anticipated to be derived 14
from independent reviews; 15
(f) A description of the minimum qualifications employed by the independent 16
review entity to select health care professionals to perform external review, 17
their areas of expertise, and the medical credentials of the health care 18
professionals currently available to perform external reviews; and 19
(g) The procedures to be used by the independent review entity in making review 20
determinations. 21
(2) If at any time there is a material change in the information included in the 22
application[,] required under[provided for in] subsection (1) of this section, the 23
independent review entity shall submit updated information to the department. 24
(3) An independent review entity shall not be a subsidiary of,[ or] in any way affiliated 25
with, or owned[,] or controlled by an insurer or a trade or professional association 26
of payors. 27 UNOFFICIAL COPY 24 RS BR 941
Page 26 of 32
XXXX 1/2/2024 8:57 AM Jacketed
(4) An independent review entity shall not be a subsidiary of,[ or] in any way affiliated 1
with, or owned[,] or controlled by a trade or professional association of providers. 2
(5) Health care professionals who are acting as reviewers for the independent review 3
entity shall hold in good standing a nonrestricted license in a state of the United 4
States. 5
(6) Health care professionals who are acting as reviewers for the independent review 6
entity shall: 7
(a) Hold a current certification by a recognized American medical specialty board 8
or other recognized health care professional boards in the area appropriate to 9
the subject of the review;[,] 10
(b) Be a specialist in the treatment of the covered person's medical condition 11
under review;[,] and 12
(c) Have actual clinical experience in that medical condition. 13
(7) The independent review entity shall: 14
(a) Have a quality assurance mechanism to ensure the timeliness and quality of 15
the review;[,] 16
(b) The qualifications and independence of the physician reviewer;[,] and 17
(c) The confidentiality of medical records and review material. 18
(8) Neither the independent review entity nor any reviewers of the entity[,] shall have 19
any material, professional, familial, or financial conflict of interest with any of the 20
following: 21
(a) For external reviews conducted under Section 11 of this Act and KRS 22
304.17A-623 and 304.17A-625: 23
1. The insurer involved in the review; 24
2.[(b)] Any officer, director, or management employee of the insurer; 25
3.[(c)] The provider proposing the service or treatment or any associated 26
independent practice association; 27 UNOFFICIAL COPY 24 RS BR 941
Page 27 of 32
XXXX 1/2/2024 8:57 AM Jacketed
4.[(d)] The institution at which the service or treatment would be 1
provided; 2
5.[(e)] The development or manufacture of the principal drug, device, 3
procedure, or other therapy proposed for the covered person whose 4
treatment is under review; or 5
6.[(f)] The covered person; and 6
(b) For external reviews conducted under subsection (2)(a)1. of Section 4 of 7
this Act: 8
1. The requesting health care provider; 9
2. The insurer or private review agent involved in the review; 10
3. Any officer, director, or management employee of the insurer or 11
private review agent; or 12
4. The development or manufacture of the principal drug, device, 13
procedure, or other therapy involved in the health care service that is 14
the subject of the exemption determination being reviewed. 15
(9) As used in this section, "conflict of interest" shall not be interpreted to include: 16
(a) A contract under which an academic medical center or other similar medical 17
center provides health care services to covered persons, except for academic 18
medical centers that may provide the service under review; 19
(b) Provider affiliations which are limited to staff privileges; or 20
(c) A specialist reviewer's relationship with an insurer as a contracting health care 21
provider, except for a specialist reviewer proposing to provide the service 22
under review. 23
(10) On an annual basis, the independent review entity shall report to the department the 24
following information: 25
(a) For external reviews conducted under Section 11 of this Act and KRS 26
304.17A-623 and 304.17A-625: 27 UNOFFICIAL COPY 24 RS BR 941
Page 28 of 32
XXXX 1/2/2024 8:57 AM Jacketed
1. The number of independent review decisions in favor of covered 1
persons; 2
2.[(b)] The number of independent review decisions in favor of insurers; 3
3.[(c)] The average turnaround time for an independent review decision; 4
4.[(d)] The number of cases in which the independent review entity did 5
not reach a decision in the time specified in statute or administrative 6
regulation; and 7
5.[(e)] The reasons for any delay; and 8
(b) For external reviews conducted under subsection (2)(a)1. of Section 4 of 9
this Act: 10
1. The number of external review decisions in favor of health care 11
providers; 12
2. The number of external review decisions in favor of insurers and 13
private review agents; 14
3. The average turnaround time for an independent review decision; 15
4. The number of cases in which the independent review entity did not 16
reach a decision in the time specified in statute or administrative 17
regulation; and 18
5. The reasons for any delay. 19
Section 13. KRS 304.17A-633 is amended to read as follows: 20
(1) The commissioner shall report every six (6) months to the Interim Joint Committee 21
on Banking and Insurance[,] and to the Governor on: 22
(a) The state of the Independent External Review Program established under 23
Section 11 of this Act; and 24
(b) The external reviews conducted under Section 4 of this Act. 25
(2) The report required under subsection (1) of this section shall include a summary 26
of: 27 UNOFFICIAL COPY 24 RS BR 941
Page 29 of 32
XXXX 1/2/2024 8:57 AM Jacketed
(a) The number of reviews conducted;[,] 1
(b) Medical specialties affected;[,] and 2
(c) [a summary of ]The findings and recommendations made by the independent 3
external review entity. 4
Section 14. KRS 304.17A-706 is amended to read as follows: 5
(1) An insurer may contest a clean claim only in the following instances: 6
(a) The insurer has reasonable documented grounds to believe that the clean 7
claim involves a preexisting condition, coordination of benefits within the 8
meaning of KRS 304.18-085, or that another insurer is primarily responsible 9
for the claim; 10
(b) Unless prohibited by Section 10 of this Act or any other law, the insurer will 11
conduct a retrospective review of the services identified on the claim; 12
(c) The insurer has information that the claim was submitted fraudulently; or 13
(d) The covered person's or group's premium has not been paid. 14
(2) (a) If an insurer requires a provider to submit health claim attachments to the 15
claim before the claim will be paid, the insurer shall identify the specific 16
required health claim attachments in its provider manual or other document 17
that sets forth the procedure for filing claims with the insurer. The insurer 18
shall provide sixty (60) days' advance written notice of modifications to the 19
provider manual that materially change the type or content of the health claim 20
attachments or other documents to be submitted. 21
(b) If a provider submits a clean claim with the required health claim attachments 22
as specified in the provider manual or other document that sets forth the 23
procedure for filing claims with the insurer, the insurer shall pay or deny the 24
claim within the required claims payment time frame established in KRS 25
304.17A-702. 26
(c) If an insurer conducts a retrospective review of a claim and requires an 27 UNOFFICIAL COPY 24 RS BR 941
Page 30 of 32
XXXX 1/2/2024 8:57 AM Jacketed
attachment not specified in the provider manual or other document that sets 1
forth the procedure for filing claims, the insurer shall: 2
1. Notify the provider, in writing or electronically within the claims 3
payment time frame established in KRS 304.17A-702, of the service that 4
will be retrospectively reviewed and the specific information needed 5
from the provider regarding the insurer's review of a claim; 6
2. Complete the retrospective review within twenty (20) business days of 7
the insurer's receipt of the medical information described in this 8
subsection; and 9
3. Subject to paragraph (d) of this subsection, add interest to the amount of 10
the claim, to be paid at a rate of twelve percent (12%) per annum, or at a 11
rate in accordance with KRS 304.17A-730, accruing from the 12
appropriate claim payment time frame established in KRS 304.17A-613 13
after the claim was received by the insurer through the date upon which 14
the claim is paid. 15
(d) If the provider fails to submit the information requested under subparagraph 16
(c) 1. of this subsection within fifteen (15) business days from the date of the 17
receipt of the notice, the insurer shall not be required to pay interest. 18
(3) (a) If a claim or portion thereof is contested by an insurer on the basis that the 19
insurer has not received information reasonably necessary to determine 20
insurer liability for the claim or portion thereof, or if the insurer contests the 21
claim on the reasonable and documented belief that the claim involves the 22
coordination of benefits within the meaning of KRS 304.18-085, or questions 23
of pre-existing conditions, the insurer shall, within the applicable claims 24
payment time frame established in KRS 304.17A-702, provide written or 25
electronic notice to the provider, covered person, group policyholder, or other 26
insurer, as appropriate, with an itemization of all new, never-before-provided 27 UNOFFICIAL COPY 24 RS BR 941
Page 31 of 32
XXXX 1/2/2024 8:57 AM Jacketed
information that is needed. 1
(b) The insurer shall pay or deny the claim within thirty (30) calendar days of 2
receiving the additional information described in paragraph (a) of this 3
subsection. If the insurer does not receive the additional information described 4
in paragraph (a) of this subsection within fifteen (15) business days from the 5
date of receipt of the notice set forth in paragraph (a) of this subsection, the 6
insurer may deny the claim. Any claim denied under this paragraph may be 7
resubmitted by the provider and any resubmitted claim shall not be denied on 8
the basis of timeliness if the resubmitted claim is made with the timeframe for 9
submitting claims established by the insurer beginning on the date of denial. 10
Section 15. KRS 205.536 is amended to read as follows: 11
(1) A Medicaid managed care organization shall have a utilization review plan, as 12
defined in KRS 304.17A-600, that meets the requirements established in 42 C.F.R. 13
pts. 431, 438, and 456, and to the extent consistent with the regulations:[. ] 14
(a) If the Medicaid managed care organization utilizes a private review agent, as 15
defined in KRS 304.17A-600, the agent shall comply with all applicable 16
requirements of KRS 304.17A-600 to 304.17A-633;[.] 17
(b)[(2)] In conducting utilization reviews for Medicaid benefits, the[each] 18
Medicaid managed care organization shall use the medical necessity criteria 19
selected by the Department of Insurance pursuant to KRS 304.38-240, for 20
making determinations of medical necessity and clinical appropriateness 21
pursuant to the utilization review plan required by [subsection (1) of ]this 22
subsection; and 23
(c) The Medicaid managed care organization shall comply with Sections 2, 3, 4, 24
5, 6, and 7 of this Act and subsections (3) and (4) of Section 10 of this 25
Act[section]. 26
(2)[(3)] To the extent consistent with the federal regulations referenced in subsection 27 UNOFFICIAL COPY 24 RS BR 941
Page 32 of 32
XXXX 1/2/2024 8:57 AM Jacketed
(1) of this section, the Department for Medicaid Services or any managed care 1
organization contracted to provide Medicaid benefits pursuant to KRS Chapter 205 2
shall not require or conduct a prospective or concurrent review, as defined in KRS 3
304.17A-600, for a prescription drug: 4
(a) That: 5
1. Is used in the treatment of alcohol or opioid use disorder; and 6
2. Contains Methadone, Buprenorphine, or Naltrexone; or 7
(b) That was approved before January 1, 2022, by the United States Food and 8
Drug Administration for the mitigation of opioid withdrawal symptoms. 9
Section 16. KRS 222.422 is amended to read as follows: 10
(1) As used in this section, "third-party payor" means any person required to comply 11
with KRS 304.17A-611(2) or 205.536(2)[(3)]. 12
(2) Prior to the discharge of a patient that has received medication for addiction- 13
treatment, the treating facility shall submit a written discharge plan to the patient, 14
and the patient's third-party payor, if any, which shall describe arrangements for 15
additional services needed following discharge. 16
Section 17. This Act shall apply to contracts delivered, entered, renewed, 17
extended, or amended on or after the effective date of this Act. 18
Section 18. If the Cabinet for Health and Family Services determines that a 19
waiver or any other authorization from a federal agency is necessary to implement 20
Section 15 of this Act for any reason, including the loss of federal funds, the cabinet 21
shall, within 90 days of the effective date of this section, request the waiver or 22
authorization, and may only delay implementation of those provisions for which a waiver 23
was deemed necessary until the waiver or authorization is granted. 24
Section 19. Sections 1 to 17 of this Act take effect January 1, 2025. 25