KYACC Memo on HB 176: Prior Authorization Reform Enacted
KYACC is pleased to announce that prior authorization reform (HB 176) has successfully passed the Kentucky legislature and was signed into law by Governor Beshear. HB 176 introduces a thoughtful and practical approach to reform, with an emphasis on prior authorization exemptions and increased transparency. It includes the following key provisions:
- Prior Authorization Exemption (“Gold Carding”) Program: Physicians who have a prior authorization approval rate of at least 93 percent for a specific service or procedure will be eligible for an exemption from prior authorization for that service.
- Improved Reporting and Transparency: The law requires insurers and the state Medicaid program to disclose data on prior authorization activity, including requests, approvals, denials, and response timelines. It also calls for reporting on the use and effectiveness of exemption programs, offering policymakers and stakeholders clearer visibility into trends and supporting more informed decisions moving forward.
The enactment of HB 176 represents an important advancement in reducing administrative complexity and enhancing patient care delivery. By allowing physicians with strong approval histories to avoid unnecessary prior authorization steps, the law helps streamline workflows, minimize care delays, improve practice operations, and support clinician well-being. At the same time, comprehensive reporting requirements promote accountability and create a data-driven framework for continued refinement.
Applicability of HB 176
HB 176 applies to certain state-regulated health plans but does not cover all types of insurance. It includes plans offered through Kynect, the Kentucky Employees’ Health Plan, and select state-regulated commercial plans that are not governed by ERISA. However, it does not apply to Medicaid or Medicare, VA/Tricare, or self-funded ERISA plans, which fall under federal jurisdiction and are not subject to state-level reforms.
Additionally, the law does not automatically extend to prior authorization for prescription medications. While not required under the statute, insurers may choose to incorporate prescription drugs into their exemption programs at their discretion.
These parameters reflect the boundaries of state authority while still achieving meaningful reform for a substantial segment of Kentucky’s commercially insured population.
KYACC recognizes Representative Kim Moser for her strong leadership and dedication to advancing this legislation. Her efforts were critical in moving forward these impactful reforms and transparency measures related to prior authorization.
We also extend our appreciation to all KYACC members who reached out to their legislators to support and advance HB 176, and to the Kentucky Medical Association and other stakeholders whose collaboration and commitment made this achievement possible.
KYACC worked tirelessly over the past several years, in collaboration with our partner societies and legislators, to elevate this issue as a top advocacy priority. We are proud that the collective efforts of our members - your voices, your engagement, and your persistence - along with sustained advocacy in Frankfort and the dedicated work of the Advocacy Committee (led by Trish Grodecki, MD, FACC), our Governor (Dinesh Kalra, MD, FACC), Steve Leung, MD, FACC, John Johnstone, MD, FACC, Dongbo Yu, MD, FACC, Michele Friday, MD, FACC, and many others, helped bring this legislation to fruition.
This achievement is a clear reminder that coordinated physician advocacy can drive meaningful, patient-centered policy change. Together, we have taken an important step toward reducing administrative burden and improving timely access to care for our patients across Kentucky.
Thank you for your continued commitment to advocacy and to the patients we serve. We look forward to continuing our work to elevate the practice of Cardiology in the Commonwealth.