STATEMENT: Kentucky Association of Health Plans on HB 134 (Prior Authorization)
HB 134 opens the door to more inappropriate care, higher premiums
Frankfort, Ky. (Feb. 23, 2023) — Today, the Kentucky Association of Health Plans (KAHP), the trade association representing commercial insurers and Medicaid managed care plans in the Commonwealth, issued the following statement in response to the passage of HB 134 out of the Kentucky House Standing Committee on Health Services, a bill that would lower medical management standards, risking patient safety and opening the door to more low-value, inappropriate, and fraudulent care.
“Prior authorization is based on medical evidence and nationally recognized clinical guidelines,” said Tom Stephens, President and CEO of Kentucky Association of Health Plans. “It promotes cutting-edge care by reinforcing providers to smooth out knowledge gaps in a world where medical knowledge now doubles every 73 days. Kentuckians deserve safe, medically appropriate care 100% of the time.”
The bill would force health plans to automatically waive prior authorization requirements for certain providers.
The federal government is in the process of finalizing comprehensive rules that, among other matters, will govern prior authorization processes and procedures of health plans.
“To avoid conflicting requirements, Kentucky should defer any legislative or regulatory action while these new federal rules are being finalized this year,” continued Stephens. “A more constructive focus would be to encourage more providers to submit electronically, rather than by fax.”
A recent national survey found 39% of prescriptions and 60% of medical services are still submitted manually.
The fiscal impact statement on HB 134 amounts to an increase of up to $12.44 per member per per month, or $591.84 per year for a family of 4. This does not include the state employee plans or Medicaid.
“Prior authorization encourages the use of generic medications, lowers the rates of abuse of opioid medications, steers patients and doctors away from low success procedures and treatments and red flags scenarios that are often the hallmarks of scam artists and bad actors. The more fraud and inappropriate care, the higher the per member per month premiums,” said Stephens.
A 2017 survey found doctors estimate 1/5th of care is unnecessary. According to the National Health Care Anti-Fraud Association, 10% of all Medicare/Medicaid dollars lost to fraud.
About the Kentucky Association of Health Plans
Kentucky Association of Health Plans is the trade organization representing the Kentucky health insurance community. KAHP is a leader on issues that strengthen the accessibility, value, and quality of health care in the Commonwealth. Members include Aetna, Anthem, CareSource, Humana, Passport Health Plan by Molina Healthcare, UnitedHealth Group and WellCare. For more information visit: www.kahp.org or follow @kyhealthplans on Twitter.