UNOFFICIAL COPY 24 RS BR 1073
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AN ACT relating to prior authorization. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
SECTION 1. 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: 5
(a) "Health care provider" means any: 6
1. Facility or service required to be licensed under KRS Chapter 216B; 7
and 8
2. Physician, osteopath, or podiatrist licensed under KRS Chapter 311; 9
and 10
(b) "Participating provider" means a health care provider that has entered into 11
an agreement with an insurer to provide health care services under a health 12
benefit plan. 13
(2) All health benefit plans shall offer a program established by the insurer offering 14
the health benefit plan to reduce or eliminate prior authorization requirements 15
for participating providers. 16
(3) For the program offered under subsection (2) of this section: 17
(a) The insurer offering the health benefit plan shall: 18
1. Notify participating providers of the requirements that providers must 19
meet in order to participate in the program; and 20
2. If the insurer determines that a participating provider qualifies to 21
participate in the program, send a notice to the provider that includes 22
the following: 23
a. A statement that the provider qualifies to participate in the 24
program; and 25
b. A list of each type of health care service, or the code for each 26
type of health care service, that is subject to the elimination or 27 UNOFFICIAL COPY 24 RS BR 1073
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reduction of prior authorization requirements under the 1
program; and 2
(b) A participating provider that qualifies for, and chooses to participate in, the 3
program shall enter into the following agreements with the insurer offering 4
the health benefit plan: 5
1. A value-based healthcare reimbursement agreement wherein the 6
provider takes downside risk; and 7
2. An electronic medical records access agreement. 8
(4) Nothing in this section shall be construed to prevent an insurer or health benefit 9
plan from requiring a health care provider to provide additional information 10
about a health care service rendered to a covered person. 11
Section 2. Section 1 of this Act applies to health benefit plans issued or 12
renewed on or after January 1, 2026. 13