KRS 304.17A-6061: Commissioner to report to the Legislative Research Commission on

prior authorization exemption program -- Contents of report. (Effective

January 1, 2028)

The commissioner 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 health care benefits under this chapter.

(b) The report required under paragraph (a) of this subsection shall include:

1. Information relating to the implementation and effectuation of KRS

304.17A-606;

2. The number of insurers and private review agents offering a program

required under KRS 304.17A-606;

3. The number o f providers, by provider group, specialty, and county,

participating in one (1) or more programs offered under KRS 304.17A -

606;

4. A list of health care services, which shall include a description and

Current Procedural Terminology code for each service, f or which

exemptions have been granted under the programs required under KRS

304.17A-606;

5. The number of programs offered under KRS 304.17A -606, which shall

include:

a. The number of programs that grant exemptions for one (1) or more

prescription drugs; and

b. A list of the drugs for which exemptions are granted under a

program reported under subdivision a. of this subparagraph; and

6. With respect to any health insurance policy, certificate, plan, or contract

required to comply with KRS 304.17A-600 to 304.17A-633:

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

prescription drugs, that require prior authorization;

b. The percentage of prior authorization requests for nonurgent health

care services in aggregate and by specific service, procedure,

prescription drug, and other treatment:

i. That were approved without an extension;

ii. For which the review was extended and the request

approved; and

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

for the denials;

c. The percentage of prior authorization requests for urgent health

care services that were:

i. Approved; and

ii. Denied, which may include the reason or reasons for the

denials; and

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

authorization request and the prior authorization decision for:

i. Nonurgent health care services; and

ii. Urgent health care services;

(2) Provide the Interim Joint Committees on Banking and I nsurance 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 regulation, including an emergency administrative

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

necessary to implement this section.