UNOFFICIAL COPY 25 RS HB 662/EN
Page 1 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
AN ACT relating to personally identifiable information. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
SECTION 1. A NEW SECTION OF KRS CHAPTER 61 IS CREATED TO 3
READ AS FOLLOWS: 4
(1) As used in this section: 5
(a) "Covered person" means a judicial officer or an immediate family member 6
of a judicial officer; 7
(b) "Disclose" means to post, display, publish, or otherwise make publicly 8
available; 9
(c) "Immediate family member" means: 10
1. A spouse, child, parent, or person under the familial custody or care of 11
a judicial officer; or 12
2. Any other familial relative who resides in the same household as the 13
judicial officer; 14
(d) "Judicial officer" means any active or senior judge and includes a: 15
1. Justice of the United States or a judge of the United States as those 16
terms are defined in 28 U.S.C. sec. 451; 17
2. Bankruptcy judge appointed under 28 U.S.C. sec. 152 or recalled 18
pursuant to 28 U.S.C. sec. 375; 19
3. United States magistrate judge appointed under 28 U.S.C. sec. 631 or 20
recalled pursuant to 28 U.S.C. sec. 375; 21
4. Judge confirmed by the United States Senate and empowered by 22
statute in any commonwealth, territory, or possession to perform the 23
duties of a federal judge; 24
5. Judge of the United States Court of Federal Claims appointed under 25
28 U.S.C. sec. 171; and 26
6. Justice, judge, trial commissioner, or domestic relations commissioner 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 2 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
of the Kentucky Court of Justice; 1
(e) "Personally identifiable information" means data that can identify a 2
covered person and includes: 3
1. Date of birth; 4
2. Biometric, health, or medical data, or insurance information; 5
3. Residence addresses of the covered person; 6
4. Home or cellular telephone numbers; 7
5. Personal email addresses; 8
6. Identities of the children of a judicial officer and names and locations 9
of schools and daycare facilities they attend; 10
7. Social Security number; and 11
8. The name of an immediate family member's employer; and 12
(f) "Written request" means a notice signed by a covered person requesting a 13
government agency refrain from posting or displaying publicly available 14
content that includes the personally identifiable information of the covered 15
person. 16
(2) (a) A government agency shall not disclose the personally identifiable 17
information of any covered person if the covered person has made a written 18
request to the government agency that this personally identifiable 19
information not be disclosed. 20
(b) Upon receipt of the written request, personally identifiable information 21
shall be removed from publicly available content within seventy-two (72) 22
hours. 23
(c) A request under this subsection may be made on behalf of a minor who is a 24
covered person by a parent or guardian of the minor. 25
(3) After the government agency has removed the personally identifiable information 26
from publicly available content, the government agency shall not publicly post or 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 3 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
otherwise release the information unless the covered person voluntarily publishes 1
the information on the internet after the effective date of this Act. 2
(4) A covered person may bring a civil action seeking injunctive or declaratory relief 3
to enforce this section in any court of competent jurisdiction. 4
Section 2. KRS 304.17A-540 is amended to read as follows: 5
(1) Any insurer that limits coverage for any treatment, procedure, a drug, or device 6
shall define the limitations and fully disclose those limits in the health insurance 7
policy or certificate coverage. 8
(2) (a) Any insurer that denies coverage for a treatment, procedure, a drug that 9
requires prior approval, or device for an enrollee shall provide the enrollee 10
with a denial letter that shall include: 11
1. The [name, license number, ]state of licensure[,] and title of the person 12
making the decision; 13
2. A statement setting forth the specific medical and scientific reasons for 14
denying coverage of a service, if the coverage is denied for reasons of 15
medical necessity; and 16
3. Instructions for initiating or complying with the plan's grievance or 17
appeal procedure stating at a minimum whether the appeal must be in 18
writing, any time limitations or schedules for filing appeals and the 19
name and phone number of a contact person who can provide additional 20
information. 21
(b) The denial letter shall be provided within: 22
1. Two (2) regular working days of the submitted request where 23
preauthorization for a treatment, procedure, drug, or device is involved; 24
2. Twenty-four (24) hours of the submitted request where hospital 25
preadmission review is sought; 26
3. Twenty (20) working days of the receipt of requested medical 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 4 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
information where the plan has initiated a retrospective review; and 1
4. Twenty (20) working days of the initiation of the review process in all 2
other instances. 3
Section 3. KRS 304.17A-545 is amended to read as follows: 4
(1) A managed care plan shall appoint a medical director who: 5
(a) Is a physician licensed to practice in this state; 6
(b) Is in good standing with the State Board of Medical Licensure; 7
(c) Has not had his or her license revoked or suspended[,] under KRS 311.530 to 8
311.620; and 9
(d) [Shall sign any denial letter required under KRS 304.17A-540; and 10
(e) ]Shall be responsible for the treatment policies, protocols, quality assurance 11
activities, and utilization management decisions of the plan. 12
(2) The medical director shall ensure that: 13
(a) Any utilization management decision to deny, reduce, or terminate a health 14
care benefit or to deny payment for a health care service because that service 15
is not medically necessary shall be made by a physician, except in the case of 16
a health care service rendered by a chiropractor or optometrist, that decision 17
shall be made respectively by a chiropractor or optometrist duly licensed in 18
Kentucky; 19
(b) A utilization management decision shall not retrospectively deny coverage for 20
health care services provided to a covered person when prior approval has 21
been obtained from the insurer for those services, unless the approval was 22
based upon fraudulent, materially inaccurate, or misrepresented information 23
submitted by the covered person or the participating provider; 24
(c) In the case of a managed care plan, a procedure is implemented whereby: 25
1. Participating physicians have an opportunity to review and comment on 26
all medical and surgical and emergency room protocols, respectively, of 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 5 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
the insurer; and[ whereby ] 1
2. Other participating providers have an opportunity to review and 2
comment on all of the insurer's protocols that are within the provider's 3
legally authorized scope of practice; 4
(d) The utilization management program is available to respond to authorization 5
requests for urgent services and is available, at a minimum, during normal 6
working hours for inquiries and authorization requests for nonurgent health 7
care services; and 8
(e) In the case of a managed care plan, a covered person is permitted to choose or 9
change a primary care provider from among participating providers in the 10
provider network and, when appropriate, choose a specialist from among 11
participating network providers following an authorized referral, if required 12
by the insurer, and subject to the ability of the specialist to accept new 13
patients. 14
(3) A managed care plan shall develop comprehensive quality assurance or 15
improvement standards adequate to identify, evaluate, and remedy problems 16
relating to access, continuity, and quality of health care services. These standards 17
shall be made available to the public during regular business hours and include: 18
(a) An ongoing written, internal quality assurance or improvement program; 19
(b) Specific written guidelines for quality of care studies and monitoring, 20
including attention to vulnerable populations; 21
(c) Performance and clinical outcomes-based criteria; 22
(d) A procedure for remedial action to correct quality problems, including written 23
procedures for taking appropriate corrective action; 24
(e) A plan for data gathering and assessment; and 25
(f) A peer review process. 26
(4) Each managed care plan shall have a process for the selection of health care 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 6 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
providers who will be on the plan's list of participating providers, with written 1
policies and procedures for review and approval used by the plan. 2
(a) The plan shall establish minimum professional requirements for participating 3
health care providers. An insurer may not discriminate against a provider 4
solely on the basis of the provider's license by the state; 5
(b) The plan shall demonstrate that it has consulted with appropriately qualified 6
health care providers to establish the minimum professional requirements; 7
(c) The plan's selection process shall include verification of each health care 8
provider's license, history of license suspension or revocation, and liability 9
claims history; 10
(d) A managed care plan shall establish a formal written, ongoing process for the 11
reevaluation of each participating health care provider within a specified 12
number of years after the provider's initial acceptance into the plan. The 13
reevaluation shall include an update of the previous review criteria and an 14
assessment of the provider's performance pattern based on criteria such as 15
enrollee clinical outcomes, number of complaints, and malpractice actions. 16
(5) The commissioner shall promulgate administrative regulations to establish a 17
uniform application form and guidelines for the evaluation and reevaluation of 18
health care providers, including psychologists, who will be on the plan's list of 19
participating providers in accordance with subsection (4) of this section. In 20
developing a uniform application and guidelines, the department shall consider 21
industry standards and guidelines adopted by the Council for Affordable Quality 22
Healthcare. The uniform application form and guidelines shall be used by all 23
insurers. 24
(6) A managed care plan shall not use a health care provider beyond, or outside of, the 25
provider's legally authorized scope of practice. 26
Section 4. KRS 304.17A-617 is amended to read as follows: 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 7 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
(1) (a) Every insurer shall have an internal appeal process to be utilized by the 1
insurer or its designee, consistent with this section and KRS 304.17A-619 and 2
which shall be disclosed to covered persons in accordance with KRS 3
304.17A-505(1)(g). 4
(b) An insurer shall disclose the availability of the internal process to the covered 5
person in the insured's timely notice of an adverse determination or notice of a 6
coverage denial which meets the requirements [set forth ]in KRS 304.17A-7
607(1)(j). 8
(c) For purposes of this section, "coverage denial" means an insurer's 9
determination that a service, treatment, drug, or device is specifically limited 10
or excluded under the covered person's health benefit plan. 11
(d) Where a coverage denial is involved, in addition to stating the reason for the 12
coverage denial, the required notice shall contain instructions for filing a 13
request for internal appeal. 14
(2) The internal appeals process may be initiated by the covered person, an authorized 15
person, or a provider acting on behalf of the covered person. 16
(3) The internal appeals process shall include adequate and reasonable procedures for 17
review and resolution of appeals concerning adverse determinations made under 18
utilization review and of coverage denials, including procedures for reviewing 19
appeals from covered persons whose medical conditions require expedited review. 20
At a minimum, these procedures shall include the following: 21
(a) Except as provided in KRS 304.17A-163: 22
1. Insurers or their designees shall provide decisions to covered persons, 23
authorized persons, and providers on internal appeals of adverse 24
determinations or coverage denials within thirty (30) days of receipt of 25
the request for internal appeal; and 26
2. Insurers or their designees shall render a decision not later than three (3) 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 8 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
business days after receipt of the request for an expedited appeal of 1
either an adverse determination or a coverage denial. An expedited 2
appeal is deemed necessary when a covered person is hospitalized or, in 3
the opinion of the treating provider, review under a standard time frame 4
could, in the absence of immediate medical attention, result in any of the 5
following: 6
a. Placing the health of the covered person or, with respect to a 7
pregnant woman, the health of the covered person or the unborn 8
child in serious jeopardy; 9
b. Serious impairment to bodily functions; or 10
c. Serious dysfunction of a bodily organ or part; 11
(b) Internal appeal of an adverse determination shall only be conducted by a 12
licensed physician who did not participate in the initial review and denial. 13
However, in the case of a review involving a medical or surgical specialty or 14
subspecialty, the insurer or agent shall, upon request by a covered person, 15
authorized person, or provider, utilize a board-eligible[board eligible] or 16
certified physician in the appropriate specialty or subspecialty area to conduct 17
the internal appeal; 18
(c) Those portions of the medical record that are relevant to the internal appeal, if 19
authorized by the covered person and in accordance with state or federal law, 20
shall be considered and providers given the opportunity to present additional 21
information; and 22
(d) In addition to any previous notice required under KRS 304.17A-607(1)(j), and 23
to facilitate expeditious handling of a request for external review of an 24
adverse determination or a coverage denial, an insurer or agent that denies, 25
limits, reduces, or terminates coverage for a treatment, procedure, drug, or 26
device for a covered person shall provide the covered person, authorized 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 9 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
person, or provider acting on behalf of the covered person with an internal 1
appeal determination letter that shall include: 2
1. A statement of the specific medical and scientific reasons for denying 3
coverage or identifying that provision of the schedule of benefits or 4
exclusions that demonstrates that coverage is not available; 5
2. The state of licensure[, medical license number,] and the title of the 6
person making the decision, except that an internal appeal 7
determination letter provided to a provider acting on behalf of the 8
covered person shall also include the medical license number of the 9
person making the decision; 10
3. Except for retrospective review, a description of alternative benefits, 11
services, or supplies covered by the health benefit plan, if any; and 12
4. Instructions for initiating an external review of an adverse 13
determination, or filing a request for review with the department if a 14
coverage denial is upheld by the insurer on internal appeal. 15
(4) (a) The department shall establish and maintain a system for receiving and 16
reviewing requests for review of coverage denials from covered persons, 17
authorized persons, and providers. 18
(b) For purposes of this subsection, "coverage denials" shall not include an 19
adverse determination as defined in KRS 304.17A-600 or subsequent denials 20
arising from an adverse determination. 21
(c) On receipt of a written request for review of a coverage denial from a covered 22
person, authorized person, or provider, the department shall notify the insurer 23
which issued the denial of the request for review and shall call for the insurer 24
to respond to the department regarding the request for review within ten (10) 25
business days of receipt of notice to the insurer. 26
(d) Within ten (10) business days of receiving the notice of the request for review 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 10 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
from the department, the insurer shall provide to the department the following 1
information: 2
1. Confirmation as to whether the person who received or sought the health 3
service for which coverage was denied was a covered person under a 4
health benefit plan issued by the insurer on the date the service was 5
sought or denied; 6
2. Confirmation as to whether the covered person, authorized person, or 7
provider has exhausted his or her rights under the insurer's appeal 8
process under this section; and 9
3. The reason for the coverage denial, including the specific limitation or 10
exclusion of the health benefit plan demonstrating that coverage is not 11
available. 12
(e) In addition to the information described in paragraph (d) of this subsection, 13
the insurer and the covered person, authorized person, or provider shall 14
provide to the department any information requested by the department that is 15
germane to its review. 16
(f) 1. On the receipt of the information described in paragraphs (d) and (e) of 17
this subsection, unless the department is not able to do so because 18
making a determination requires resolution of a medical issue, it shall 19
determine whether the service, treatment, drug, or device is specifically 20
limited or excluded under the terms of the covered person's health 21
benefit plan. 22
2. If the department determines that the treatment, service, drug, or device 23
is not specifically limited or excluded, it shall so notify the insurer, and 24
the insurer shall either cover the service, or afford the covered person an 25
opportunity for external review under KRS 304.17A-621, 304.17A-623, 26
and 304.17A-625, where the conditions precedent to the review are 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 11 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
present. 1
3. If the department notifies the insurer that the treatment, service, drug, or 2
device is specifically limited or excluded in the health benefit plan, the 3
insurer is not required to cover the service or afford the covered person 4
an external review. 5
(g) An insurer shall be required to cover the treatment, service, drug, or device 6
that was denied or provide notification of the right to external review in 7
accordance with paragraph (f) of this subsection whether the covered person 8
has disenrolled or remains enrolled with the insurer. 9
(h) If the covered person has disenrolled with the insurer, the insurer shall only be 10
required to provide the treatment, service, drug, or device that was denied for 11
a period not to exceed thirty (30) days or provide the covered person the 12
opportunity for external review. 13
Section 5. KRS 304.17A-607 is amended to read as follows: 14
(1) An insurer or private review agent shall not provide or perform utilization reviews 15
without being registered with the department. A registered insurer or private review 16
agent shall: 17
(a) Have available the services of sufficient numbers of registered nurses, 18
medical records technicians, or similarly qualified persons supported by 19
licensed physicians with access to consultation with other appropriate 20
physicians to carry out its utilization review activities; 21
(b) Ensure that, for any contract entered into on or after January 1, 2020, for the 22
provision of utilization review services, only licensed physicians, who are of 23
the same or similar specialty and subspecialty, when possible, as the ordering 24
provider, shall: 25
1. Make a utilization review decision to deny, reduce, limit, or terminate a 26
health care benefit or to deny, or reduce payment for a health care 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 12 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
service because that service is not medically necessary, experimental, or 1
investigational except in the case of a health care service rendered by a 2
chiropractor or optometrist where the denial shall be made respectively 3
by a chiropractor or optometrist duly licensed in Kentucky; and 4
2. Supervise qualified personnel conducting case reviews; 5
(c) Have available the services of sufficient numbers of practicing physicians in 6
appropriate specialty areas to assure the adequate review of medical and 7
surgical specialty and subspecialty cases; 8
(d) Not disclose or publish individual medical records or any other confidential 9
medical information in the performance of utilization review activities except 10
as provided in the Health Insurance Portability and Accountability Act, 11
Subtitle F, secs. 261 to 264 and 45 C.F.R. secs. 160 to 164 and other 12
applicable laws and administrative regulations; 13
(e) Provide a toll-free[toll free] telephone line for covered persons, authorized 14
persons, and providers to contact the insurer or private review agent and be 15
accessible to covered persons, authorized persons, and providers for forty (40) 16
hours a week during normal business hours in this state; 17
(f) Where an insurer, its agent, or private review agent provides or performs 18
utilization review, be available to conduct utilization review during normal 19
business hours and extended hours in this state on Monday and Friday through 20
6:00 p.m., including federal holidays; 21
(g) Provide decisions to covered persons, authorized persons, and all providers on 22
appeals of adverse determinations and coverage denials of the insurer or 23
private review agent, in accordance with this section and administrative 24
regulations promulgated in accordance with KRS 304.17A-609; 25
(h) Except for retrospective review of an emergency admission where the covered 26
person remains hospitalized at the time the review request is made, which 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 13 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
shall be considered a concurrent review, or as otherwise provided in this 1
subtitle, provide a utilization review decision in accordance with the 2
timeframes in paragraph (i) of this subsection and 29 C.F.R. Part 2560, 3
including written notice of the decision; 4
(i) 1. Render a utilization review decision concerning urgent health care 5
services, and notify the covered person, authorized person, or provider 6
of that decision no later than twenty-four (24) hours after obtaining all 7
necessary information to make the utilization review decision; and 8
2. If the insurer or agent requires a utilization review decision of nonurgent 9
health care services, render a utilization review decision and notify the 10
covered person, authorized person, or provider of the decision within 11
five (5) days of obtaining all necessary information to make the 12
utilization review decision. 13
For purposes of this paragraph, "necessary information" is limited to: 14
a. The results of any face-to-face clinical evaluation; 15
b. Any second opinion that may be required; and 16
c. Any other information determined by the department to be 17
necessary to making a utilization review determination; 18
(j) Provide written notice of review decisions to the covered person, authorized 19
person, and providers. The written notice may be provided in an electronic 20
format, including email[e-mail] or facsimile, if the covered person, authorized 21
person, or provider has agreed in advance in writing to receive the notices 22
electronically. An insurer or agent that denies a step therapy exception, as 23
defined in KRS 304.17A-163, or denies coverage or reduces payment for a 24
treatment, procedure, drug that requires prior approval, or device shall include 25
in the written notice: 26
1. A statement of the specific medical and scientific reasons for denial or 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 14 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
reduction of payment or identifying that provision of the schedule of 1
benefits or exclusions that demonstrates that coverage is not available; 2
2. The [medical license number and the ]title of the reviewer making the 3
decision, except that a written notice provided to a provider shall also 4
include the medical license number of the reviewer making the 5
decision; 6
3. Except for retrospective review, a description of alternative benefits, 7
services, or supplies covered by the health benefit plan, if any; and 8
4. Instructions for initiating or complying with the insurer's internal appeal 9
procedure, as set forth in KRS 304.17A-617, stating, at a minimum, 10
whether the appeal shall be in writing, and any specific filing 11
procedures, including any applicable time limitations or schedules, and 12
the position and phone number of a contact person who can provide 13
additional information; 14
(k) Afford participating physicians an opportunity to review and comment on all 15
medical and surgical and emergency room protocols, respectively, of the 16
insurer and afford other participating providers an opportunity to review and 17
comment on all of the insurer's protocols that are within the provider's legally 18
authorized scope of practice; and 19
(l) Comply with its own policies and procedures on file with the department or, if 20
accredited or certified by a nationally recognized accrediting entity, comply 21
with the utilization review standards of that accrediting entity where they are 22
comparable and do not conflict with state law. 23
(2) The insurer's or private review agent's failure to make a determination and provide 24
written notice within the time frames set forth in this section shall be deemed to be 25
a prior authorization for the health care services or benefits subject to the review. 26
This provision shall not apply where the failure to make the determination or 27 UNOFFICIAL COPY 25 RS HB 662/EN
Page 15 of 15
HB066220.100 - 1555 - XXXX 3/28/2025 10:21 AM Engrossed
provide the notice results from circumstances which are documented to be beyond 1
the insurer's control. 2
(3) An insurer or private review agent shall submit a copy of any changes to its 3
utilization review policies or procedures to the department. No change to policies 4
and procedures shall be effective or used until after it has been filed with and 5
approved by the commissioner. 6
(4) A private review agent shall provide to the department the names of the entities for 7
which the private review agent is performing utilization review in this state. Notice 8
shall be provided within thirty (30) days of any change. 9