2011 Kentucky Revised Statutes Subtitle 17A. Health Benefit Plans 304.17A.605 Requirements and procedures for utilization review -- Exception for private review agent operating under contract with the federal government.
KY Rev Stat § 304.17A.605 (1996 through Reg Sess) What's This?
304.17A-605 Requirements and procedures for utilization review -- Exception for
private review agent operating under contract with the federal government.
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KRS 304.17A-600, 304.17A-603, 304.17A-605, 304.17A-607, 304.17A-609,
304.17A-611, 304.17A-613, and 304.17A-615 set forth the requirements and
procedures regarding utilization review and shall apply to:
(a) Any insurer or its private review agent that provides or performs utilization
review in connection with a health benefit plan or a limited health service
benefit plan; and
(b) Any private review agent that performs utilization review functions on behalf
of any person providing or administering health benefit plans or limited health
service benefit plans.
Where an insurer or its agent provides or performs utilization review, and in all
instances where internal appeals as set forth in KRS 304.17A-617 are involved, the
insurer or its agent shall be responsible for:
(a) Monitoring all utilization reviews and internal appeals carried out by or on
behalf of the insurer;
(b) Ensuring that all requirements of KRS 304.17A-600 to 304.17A-633 are met;
(c) Ensuring that all administrative regulations promulgated in accordance with
KRS 304.17A-609, 304.17A-613, and 304.17A-629 are complied with; and
(d) Ensuring that appropriate personnel have operational responsibility for the
performance of the insurer's utilization review plan.
A private review agent that operates solely under contract with the federal
government for utilization review or patients eligible for hospital services under
Title XVIII of the Social Security Act shall not be subject to the registration
requirements set forth in KRS 304.17A-607, 304.17A-609, and 304.17A-613.
Effective: July 15, 2002
History: Amended 2002 Ky. Acts ch. 105, sec. 1, effective July 15, 2002. -- Created
2000 Ky. Acts ch. 262, sec. 3, effective July 14, 2000.
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