RELATES TO:

KRS 304.1-050(1) 304.9-020, 304.9-055, 304.17A-005(29), 304.17A-700, 304.17A-732

STATUTORY AUTHORITY:

KRS 304.2-110, 304.17A-732

NECESSITY, FUNCTION, AND CONFORMITY:

KRS 304.2-110 authorizes the Commissioner of Insurance to promulgate administrative regulations necessary for or as an aid to the effectuation of any provision of the Kentucky Insurance Code as defined in KRS 304.1-010. KRS 304.17A-732 requires insurers to annually report to the commissioner the number and type of providers that have prescribed medication for addiction treatment to its insureds in conjunction with behavioral therapy and not in conjunction with behavioral therapy. This administrative regulation sets forth the format and submission time frame for the data reporting requirements in KRS 304.17A-732.

1. Section 1. Definitions.

   1. (1) "Commissioner" is defined by KRS 304.1-050(1).
   2. (2) "Department" is defined in KRS 304.1-050(2).
   3. (3) "Insurer" is defined by KRS 304.17A-005(29).

   4. (4) "Medication for addiction treatment" means a prescription drug that:

      1. (a)

         1. 1. Is prescribed for use in the treatment of alcohol or opioid addiction; and
         2. 2.(b) Contains methadone, buprenorphine, or naltrexone; or
      2. (b)(c) Was approved before January 1, 2022 by the United States Food and Drug Administration for the mitigation of opioid withdrawal symptoms.
   5. (5) "Pharmacy Benefit Manager" is defined by KRS 304.9-020(15).

2. Section 2. Data Reporting Requirements.

   1. (1)

      1. (a) An insurer authorized to write health insurance in this state shall submit the data required by the Pharmacy Claims Standardized Data Request to the commissioner by March 31st of each year. A pharmacy benefit manger paying pharmacy claims on behalf of an insurer may submit the data required by the Pharmacy Claims Standardized Data request to the commissioner on behalf of the insurer.

      2. (b) The data required by the Pharmacy Claims Standardized Data Request shall:

         1. 1. Be submitted in an electronic format prescribed by the Commissioner;
         2. 2. Contain the prescribed data elements and information in the order prescribed; and
         3. 3. Contain data for claims received in the prior calendar year for prescriptions for medication for addiction treatment.

   2. (2)

      1. (a) The Department shall generate and provide a Medical Claims Standardized Data Request to each insurer based on the data submitted pursuant to subsection (1) of this section.
      2. (b) An insurer shall submit the data required by the Medical Claims Standardized Data Request within sixty (60) days of the date it is provided to the insurer, as described in paragraph (a) of this Section.

      3. (c) The data required by the Medical Claims Standardized Data Request shall:

         1. 1. Be submitted in an electronic format;
         2. 2. Contain the prescribed data elements and information in the order prescribed; and
         3. 3. Contain data for claims of identified insureds, as requested by the commissioner, that were received in the prior calendar year.

3. Section 3. Material Incorporated by Reference.

   1. (1) The following material is incorporated by reference:

      1. (a) "Pharmacy Claims Standardized Data Request", 10/2021; and
      2. (b) "Medical Claims Standardized Data Request", 10/2021.
   2. (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Kentucky Department of Insurance, Mayo-Underwood Building, 500 Mero Street, Frankfort, Kentucky 40601, Monday through Friday, 8 a.m. to 4:30 pm.

History

(48 Ky.R. 1684, 2413; eff. 5-31-2022.)

FILED WITH LRC: February 7, 2022

CONTACT PERSON: Abigail Gall, Executive Administrative Secretary, 500 Mero Street, Frankfort, Kentucky 40601, phone +1 (502) 564-6026, fax +1 (502) 564-1453, email abigail.gall@ky.gov.