Download as PDF
304.17C-060 Filing of agreements -- Provisions of agreements -- Filing of
risk-sharing 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.
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.