304.17C-080 Plan for selection and reevaluation of providers.
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Each insurer shall have a process for the selection of health care providers who will
be on the plan's list of participating providers, with written policies and procedures
for review and approval used by the plan.
The plan shall establish minimum professional requirements for participating health
care providers. An insurer may not discriminate against a provider solely on the
basis of the provider's license by the state.
The plan shall demonstrate that it has consulted with appropriately qualified health
care providers to establish the minimum professional requirements.
The plan's selection process shall include verification of each health care provider's
license, history of license suspension or revocation, and liability claims history.
An insurer shall establish a formal written, ongoing process for the reevaluation of
each participating health care provider within a specified number of years after the
provider's initial acceptance into the plan. The reevaluation shall include an update
of the previous review criteria and an assessment of the provider's performance
pattern based on criteria such as enrollee clinical outcomes, number of complaints,
and malpractice actions.
Effective: July 15, 2002
History: Created 2002 Ky. Acts ch. 105, sec. 9, effective July 15, 2002.
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