BR 328 — AN ACT relating to reimbursement for pharmacist services.

Bill Text

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Compared against the Kentucky Revised Statutes as published AI-generated reading aid — verify against the official bill.

The bill establishes new provisions for pharmacist reimbursement and amends existing statutes regarding insurance claim forms for pharmacists.

• KRS 304.14-135

  A clean claim for pharmacists shall consist of: → A clean claim for pharmacists shall consist of: 1. For prescription drug claims, a universal claim form and data set approved by the National Council for Prescription Drug Programs; and 2. For all other claims for services or procedures that are within the scope of the practice of pharmacy, as defined in KRS 315.010, a 1500 Health Insurance Claim Form or its successor submitted on the designated paper or electronic format as adopted by the National Uniform Claim Committee.

  This change clarifies the requirements for pharmacists submitting clean claims for reimbursement.

• As used in this section: (a) "Insurer": 1. Means any insurer, self-insurer, self-insured plan, or self-insured group; and 2. Shall include any health maintenance organization, provider-sponsored integrated health delivery network, or nonprofit hospital, medical-surgical, dental, and health service corporation; (b) "Practice of pharmacy" has the same meaning as in KRS 315.010.

  This addition defines key terms related to the reimbursement for pharmacist services.

• To the extent permitted under federal law, for policies, plans, or contracts issued or renewed on or after the effective date of this Act, an insurer, or a third-party administrator for such insurer, shall provide reimbursement to a pharmacist for a service or procedure at a rate not less than that provided to other nonphysician practitioners if the service or procedure: (a) Is within the scope of the practice of pharmacy; (b) Would otherwise be covered under the policy, plan, or contract if the service or procedure were provided by a: 1. Physician; 2. Advanced practice registered nurse; or 3. Physician assistant; and (c) Is performed by the pharmacist in strict compliance with laws and administrative regulations related to the pharmacist's license.

  This provision mandates insurers to reimburse pharmacists for certain services at rates equal to those of other nonphysician practitioners.

• This section shall not be construed to limit coverage provided under a policy, plan, or contract, or required under any other law.

  This statement clarifies that the new reimbursement provisions do not limit existing insurance coverage requirements.

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