Page 1 of 1
304.17A-578 Notice to health care provider of material change to managed care
plan.
(1) As used in this section, unless the context requires otherwise:
(a) "Material change" means a change to a contract, the occurrence and timing of
which is not otherwise clearly identified in the contract, that decreases the <br>health care provider's payment or compensation or changes the administrative <br>procedures in a way that may reasonably be expected to significantly increase <br>the provider's administrative expense; and
(b) "Participating provider" means a physician licensed under KRS Chapter 311,
an advanced practice registered nurse licensed under KRS Chapter 314, a <br>psychologist licensed under KRS Chapter 319, or an optometrist licensed <br>under KRS Chapter 320 that has entered into an agreement with an insurer to <br>provide health care services.
(2) If an insurer issuing a managed care plan makes a material change to an agreement
it has entered into with a participating provider for the provision of health care <br>services, the insurer shall provide the participating provider with at least ninety (90) <br>days' written notice of the material change. The notice shall include a description of <br>the material change and a statement that the participating provider has the option to <br>withdraw from the agreement prior to the material change becoming effective <br>pursuant to subsection (3) of this section.
(3) A participating provider who opts to withdraw following notice of a material
change pursuant to subsection (2) of this section shall send written notice of <br>withdrawal to the insurer no later than forty-five (45) days prior to the effective date <br>of the material change.
(4) If an insurer issuing a managed care plan makes a change to an agreement that
changes an existing prior authorization, precertification, notification, or referral <br>program, or changes an edit program or specific edits, the insurer shall provide <br>notice of the change to the participating provider at least fifteen (15) days prior to <br>the change.
Effective: July 15, 2010 <br>History: Amended 2010 Ky. Acts ch. 85, sec. 48, effective July 15, 2010. -- Created
2008 Ky. Acts ch. 169, sec. 4, effective July 15, 2008.
Disclaimer: These codes may not be the most recent version. Kentucky may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
