2006 Kentucky Revised Statutes - .300 Provider-sponsored integrated health delivery network -- Qualifications -- Fees -- Network subject to provisions of other subtitles.304.17A-300 Provider-sponsored integrated health delivery network -- Qualifications -- Fees -- Network subject to provisions of other subtitles. (1) A provider-sponsored integrated health delivery network may be created by health care providers for the purpose of providing health care services. (2) No person shall in this Commonwealth be, act as, or hold itself out as a provider- sponsored integrated health delivery network unless it holds a certificate of filing from the executive director. Each provider-sponsored integrated health delivery network that seeks to offer services shall first be certified by the office. (3) To qualify as a provider-sponsored integrated health delivery network, an applicant shall submit information acceptable to the office to satisfactorily demonstrate that the provider-sponsored integrated health delivery network: (a) Is licensed and in good standing with the licensure boards for participating providers; (b) Has demonstrated the capacity to administer the health plans it is offering; (c) Has the ability, experience, and structure to arrange for the appropriate level and type of health care services; (d) Has the ability, policies, and procedures to conduct utilization management activities; (e) Has the ability to achieve, monitor, and evaluate the quality and cost effectiveness of care provided by its provider network; (f) Is financially solvent; (g) Has the ability to assure enrollees adequate access to providers, including geographic availability and adequate numbers and types; (h) Has the ability and procedures to monitor access to its provider network; (i) Has a satisfactory grievance procedure and the ability to respond to enrollees' inquiries and complaints; (j) Does not limit the participation of any health care provider in its provider network in another provider network; (k) Has the ability and policies that allow patients to receive care in the most appropriate, least restrictive setting; (l) Does not discriminate in enrolling members; (m) Participates in coordination of benefits; (n) Uses standardized electronic claims and billing processes and formats; and (o) Discloses to the cooperative reimbursement arrangements with providers. (4) Fees for the following services shall be paid to the executive director by every provider-sponsored integrated health delivery network, and the fees shall be the same as those for insurers as specified in Subtitle 4 of this chapter: (a) For filing an application for a certificate of filing or amendment thereto; (b) For filing an annual statement; and (c) For other services deemed necessary by the executive director. Page 1 of 2
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