{"data":{"id":"us-ky/krs-304.17a-611","jurisdiction":"us-ky","citation":"KRS 304.17A-611","heading":"Prohibition against retrospective denial of coverage for health care","body":"services under certain circumstances -- Prohibition against prospective or\nconcurrent review of prescription drug for alcohol or opioid use disorder.\n(Effective until January 1, 2028)\n(1) A utilization review decision shall not retrospectively deny coverage for health care\nservices provided to a covered person when prior approval has been obtained from\nthe insurer or its designee for those services, unless the approval was based upon\nfraudulent, materially inaccurate, or misrepresented information submitted by the\ncovered person, authorized person, or the provider.\n(2) An insurer of a health benefit plan shall not require or conduct a prospective or\nconcurrent review for a prescription drug:\n(a) That:\n1. Is used in the treatment of alcohol or opioid use disorder; and\n2. Contains Methadone, Buprenorphine, an opioid antagonist, or\nNaltrexone; or\n(b) That was approved before January 1, 2022, by the United States Foo d and\nDrug Administration for the mitigation of opioid withdrawal symptoms.\nEffective: January 1, 2025","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=55784","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:47Z","sha256":"133487484d81b4ad1abd2abdd11ab5e70a81157f252d67315f0ba7746c8459a1","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-609","next":"us-ky/krs-304.17a-613"},"notice":"GroundRules: Original legal text. Not legal advice."}