Bill to allow some prior authorization exemptions for qualifying providers passes out of House

By Melissa Patrick
Kentucky Health News

A bill requiring health insurers to allow qualifying health care providers to bypass prior authorization requirements for certain services has passed out of the House. It will now head to the Senate for consideration.

Sponsor Rep. Kim Moser, R-Taylor Mill, said House Bill 423 is about “cutting red tape” and allowing health care providers to focus more on patient care and less on “bureaucratic barriers to care.”

“In streamlining the prior authorization process, we are making it easier for Kentuckians to get the treatment that they need without unnecessary delays waiting for approval from insurance companies,” she said.

HB 423, with a committee substitute to clarify that the prior authorization exemption program would not apply to Medicaid, passed out of the House Feb. 21 on a 91-0 vote.

Moser said the bill is the product of four years of work with insurance providers, stakeholders and health care providers, including behavioral health providers.

HB 423 would create a framework for insurers to establish a “gold carding” or a waiver program that would allow qualifying providers to be exempt from prior authorization requirements for certain services.

Moser said the bill exempts prescription drugs, “which we did want to include. But for right now, insurers are uncertain that they can operationalize that.” Moser said the language in the bill allows them to include exemptions for prescriptions later if they choose to.

“The bill would also mandate annual evaluations of providers to determine their eligibility for the program, based upon utilization thresholds and approval rates. It prohibits health insurers from requiring approval rates above 93%, and sets clear guidelines on how exemptions can be earned and revoked. Additionally, HB 423 would require that health insurers and the Kentucky Department for Medicaid Services provide annual reports on their prior authorization practices, ensuring greater transparency and oversight of these programs,” Moser said in a press release posted on her Facebook page.

Rep. Chad Aull, D-Lexington, commended Moser for the “dogged” work that had been done over the last four years to get this bill passed.

“And while this bill is not perfect and it won’t fix all the problems that we have with health care . . . it’s a critical first step in the direction of providing more critical access to health care in a more timely manner,” he said. “And I’m excited to pass this bill today.”

At the Feb. 19 House Banking and Insurance Committee meeting, Cory Meadows, deputy executive vice president and director of advocacy for the Kentucky Medical Association, voiced “very strong support” for HB 423.

“It’s the product of years of negotiation and compromise and a critical first step in addressing the most pressing concerns by streamlining certain aspects of the prior authorization process, reducing the overall number, hopefully, of prior authorizations and introducing measures for greater transparency and accountability,” he said. “This bill strikes a balance between ensuring appropriate utilization management and reducing unnecessary delays in patient care.”