2014 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 17A - Health Benefit Plans 17A.17A-578 Notice to health care provider of material change to managed care plan.
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304.17A-578 Notice to health care provider of material change to managed
care plan.
(1)
(2)
(3)
(4)
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 health care provider's payment or compensation or
changes the administrative procedures in a way that may reasonably be
expected to significantly increase 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 psychologist licensed under KRS Chapter 319, or an optometrist
licensed under KRS Chapter 320 that has entered into an agreement with
an insurer to provide health care services.
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 services, the insurer shall provide the participating provider with at
least ninety (90) days' written notice of the material change. The notice shall
include a description of the material change and a statement that the
participating provider has the option to withdraw from the agreement prior to
the material change becoming effective pursuant to subsection (3) of this
section.
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
withdrawal to the insurer no later than forty-five (45) days prior to the effective
date of the material change.
If an insurer issuing a managed care plan makes a change to an agreement
that changes an existing prior authorization, precertification, notification, or
referral program, or changes an edit program or specific edits, the insurer shall
provide notice of the change to the participating provider at least fifteen (15)
days prior to the change.
Effective:July 15, 2010
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.
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