KENTUCKY

Overview

In recent legislative terms, Kentucky introduced a number of bills aimed at addressing surprise billing (balance billing). However, none of the efforts passed at the end of the session for the past 4 years. A more narrow effort to promote price transparency in the area of air ambulance also failed in both 2015 (HB 171) and 2019 (SB 86).

The legislature had more success in regulating the prior authorization process. In 2019, the state passed SB 54, which requires insurers to develop processes for electronic prior authorizations and prohibits a requirement of a utilization review for emergency health care services, establishing a presumption of medical necessity.

In the 2018 legislative term, the legislature focused on healthcare price transparency legislation aimed at prescription drugs and regulation of pharmacy benefit managers (PBM). The state passed HB 463, which prohibits overpayment for prescription drugs (“clawbacks”) as well as “gag clauses” that forbid pharmacists from telling consumers about cheaper options. The legislature also passed SB 5, which requires PBMs to disclose their contracts with Kentucky managed care organizations and provides the state authority to review and approve the contracts. The legislation hopes to improve transparency to help make prescription medications more affordable.

The State Database

The Source tracks state activities impacting healthcare price and competition in both legislation and litigation in a searchable database to help stakeholders at the state level understand their legal and regulatory environment as they make efforts to improve access, quality, and efficiency, and reduce costs in healthcare.

LEGISLATION: The Database of State Laws Impacting Healthcare Cost and Quality (SLIHCQ), created by The Source on Healthcare Price & Competition and Catalyst for Payment Reform, catalogues state legislation governing price transparency, provider market power, provider payment, provider networks, and benefit design. The database also includes pharmaceutical legislation beginning in the 2017-2018 legislative session. *Note: Current legislative session bill updates are ongoing. Check back weekly for updates. 

LITIGATION: The Source tracks major litigation and antitrust enforcement action by federal entities (FTC or DOJ), state attorney generals, and private parties in the main provider and insurer markets, particularly legal challenges of healthcare consolidation and anticompetitive contract provisions. Additionally, the database contains major pharmaceutical cases including legislation challenges and significant appellate cases.

Search the database across all jurisdictions on the State Overview page, or view and filter existing legislation or litigation on individual state pages. The database allows customized search and filter by keyword, status, and/or key issue category. *Multiple filter/selections enabled. Click here for User Guide.

 

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© 2018-2019 The SLIHCQ DatabaseInitial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.
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Download User Guide

© 2018-2019 The SLIHCQ DatabaseInitial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.
Filter by Key Issue

Additional Resources

LEGISLATIVE CALENDAR

Kentucky’s latest legislative term ran from 1/8/2019 – 3/30/2019. Kentucky’s next legislative term will begin in 2020.

2018-2020 BUDGET

Annual appropriations are made in the biennial budget bills. The state’s fiscal year begins July 1 and extends to the following June 30. Kentucky enacted the 2018-2020 biennium budget in the regular 2018 legislative session. To view Kentucky’s spending on health and family services, visit pages here.

REGULATION & ENFORCEMENT

  • Kentucky was one of 16 states to file an amicus brief supporting the FTC’s winning position in the Ninth Circuit appeal of St. Luke’s Health Care Sys. v. FTC, No. 14-35173 (March 7, 2014), decided February 10, 2015. The States’ brief stated that the acceleration of health care costs due to the growth of large health care provider systems had become a matter of grave concern for the states.

KEY RESOURCES