KY HB176

Requires health insurers to offer prior authorization exemption programs where participating providers with at least a 93% approval rate for a specific health care service during a 12-month evaluation period can qualify to bypass prior authorization for that service

Insurers must annually evaluate providers for exemption eligibility and notify qualifying providers within 30 days; exemptions can be revoked for fraud, abuse, or if utilization exceeds 110% of the previous evaluation period

Eligible providers include physicians and independently practicing mental health professionals such as licensed clinical social workers, psychologists, marriage and family therapists, and licensed professional clinical counselors

Requires annual reports by September 30 from both the Insurance Commissioner and Medicaid Services Commissioner detailing prior authorization approval/denial rates, processing times, and services requiring authorization

Exempts prescription drugs from the exemption program requirements (though insurers may voluntarily include them); Medicaid programs are explicitly excluded from the prior authorization exemption requirements; effective January 1, 2028 for private insurers