2011 Kentucky Revised Statutes Subtitle 17C. Limited Health Service Benefit Plans 304.17C.060 Filing of agreements -- Provisions of agreements -- Filing of risk-sharing arrangements and subcontracts -- Availability of information.
KY Rev Stat § 304.17C.060 (1996 through Reg Sess) What's This?
304.17C-060 Filing of agreements -- Provisions of agreements -- Filing of risksharing arrangements and subcontracts -- Availability of information.
(1)
(2)
(3)
An insurer shall file with the commissioner sample copies of any agreements it
enters into with providers for the provision of health care services. The
commissioner shall promulgate administrative regulations prescribing the manner
and form of the filings required. The agreements shall include the following:
(a) A hold harmless clause that states that the provider may not, under any
circumstance, including:
1.
Nonpayment of moneys due to providers by the insurer;
2.
Insolvency of the insurer; or
3.
Breach of the agreement,
bill, charge, collect a deposit, seek compensation, remuneration, or
reimbursement from, or have any recourse against the subscriber, dependent
of subscriber, enrollee, or any persons acting on their behalf, for services
provided in accordance with the provider agreement. This provision shall not
prohibit collection of deductible amounts, copayment amounts, coinsurance
amounts, and amounts for noncovered services;
(b) A survivorship clause that states the hold harmless clause and continuity of
care clause shall survive the termination of the agreement between the
provider and the insurer; and
(c) A clause requiring that if a provider enters into any subcontract agreement
with another provider to provide health care services to the subscriber,
dependent of the subscriber, or enrollee of a limited health service benefit
plan, the subcontract agreement must meet all requirements of this subtitle
and that all such subcontract agreements shall be filed with the commissioner
in accordance with this subsection.
An insurer that enters into any risk-sharing arrangement or subcontract agreement
shall file a copy of the arrangement with the commissioner. The insurer shall also
file the following information regarding the risk-sharing arrangement:
(a) The number of enrollees affected by the risk-sharing arrangement;
(b) The health care services to be provided to an enrollee under the risk-sharing
arrangement;
(c) The nature of the financial risk to be shared between the insurer and entity or
provider, including but not limited to the method of compensation;
(d) Any administrative functions delegated by the insurer to the entity or provider.
The insurer shall describe a plan to ensure that the entity or provider will
comply with the requirements of this subtitle in exercising any delegated
administrative functions; and
(e) The insurer's oversight and compliance plan regarding the standards and
method of review.
Nothing in this section shall be construed as requiring an insurer to submit the
actual financial information agreed to between the insurer and the entity or provider.
The commissioner shall have access to a specific risk-sharing arrangement with an
entity or provider upon request to the insurer. Financial information obtained by the
department shall be considered to be a trade secret and shall not be subject to KRS
61.872 to 61.884.
Effective: July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1291, effective July 15, 2010. -- Created
2002 Ky. Acts ch. 105, sec. 7, effective July 15, 2002.
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