A Kentucky bill introduced Jan. 21 would require the state’s insurers to offer prior authorization exemptions in the state.
The bill has bipartisan backing and includes two Republican healthcare professionals — state Reps. Kimberly Moser and Robert Duvall — as sponsors.
These programs would allow participating providers to bypass prior authorization requirements for a service if they have a strong history of approvals. The bulk of the bill would not take effect until 2028, and the law would include a Medicaid carve-out.
Under the bill, insurers would have to establish an evaluation period and thresholds for achieving an exemption. However, approval rates cannot exceed 93%. Insurers must review providers annually, alert qualifying providers within 30 days of a decision and share requirements for achieving an exemption.
Insurers have the option to offer prior authorization exemptions for any prescription drug, grant exemptions to provider groups versus individuals, set certain conditions for provider eligibility, establish service utilization requirements, and make parameters for revoking exemptions based on fraud, abuse or utilization. For example, insurers can encourage value-based arrangements and electronic health record data access.
Insurers must also report data on services with prior authorization requirements, approval and denial rates, decision times, and urgent and nonurgent requests.
