KRS 205.5369: Report to the Legislative Research Commission on prior authorization.

(Effective January 1, 2027)

The commissioner of the Department for Medicaid Services shall:

(1) (a) Submit a written report not later than September 30 of each year to the

Legislative Research Commission for referral to the Interim Joint Committees

on Banking and Insurance and Health Services relating to prior authorization

in the provision of Medicaid benefits in Kentucky.

(b) The report required under paragraph (a) of this s ubsection shall include the

following, categorized by Medicaid managed care organization and fee for

service:

1. A list of all services, procedures, and other treatments, including

prescription drugs, that require prior authorization;

2. The percentage of prior authorization requests for nonurgent health care

services in aggregate and by specific service, procedure, prescription

drug, and other treatment:

a. That were approved without an extension;

b. For which the review was extended and the request approved; and

c. That were denied, which may include the reason or reasons for the

denials;

3. The percentage of prior authorization requests for urgent health care

services that were:

a. Approved; and

b. Denied, which may include the reason or reasons for the denials;

and

4. The average and median time between submission of a prior

authorization request and a prior authorization decision for:

a. Nonurgent health care services; and

b. Urgent health care services;

(2) Provide the Interim Joint Committees on Banking and Insurance and Health

Services with a detailed briefing, upon request, to discuss and explain any report

submitted under subsection (1) of this section; and

(3) Promulgate any administrative regu lation, including an emergency administrative

regulation, in accordance with KRS Chapter 13A that the commissioner deems

necessary to implement this section.