Download as PDF
304.17A-527
Filing of provider agreements, risk-sharing arrangements, and
subcontract agreements with commissioner -- Contents -- Disclosure of
financial information not required.
(1)
A managed care plan 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 the providers by the managed care plan,
2.
Insolvency of the managed care plan, 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 continuity of care clause that states that if an agreement between the
provider and the managed care plan is terminated for any reason, other than a
quality of care issue or fraud, the insurer shall continue to provide services
and the plan shall continue to reimburse the provider in accordance with the
agreement until the subscriber, dependent of the subscriber, or the enrollee is
discharged from an inpatient facility, or the active course of treatment is
completed, whichever time is greater, and in the case of a pregnant woman,
services shall continue to be provided through the end of the post-partum
period if the pregnant woman is in her fourth or later month of pregnancy at
the time the agreement is terminated;
(c) 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 managed care plan;
(d) A clause stating that the insurer issuing a managed care plan will, upon
request of a participating provider, provide or make available to a
participating provider, when contracting or renewing an existing contract with
such provider, the payment or fee schedules or other information sufficient to
enable the provider to determine the manner and amount of payments under
the contract for the provider's services prior to the final execution or renewal
of the contract and shall provide any change in such schedules at least ninety
(90) days prior to the effective date of the amendment pursuant to KRS
304.17A-577; and
(e) A clause requiring that if a provider enters into any subcontract agreement
with another provider to provide their licensed health care services to the
(2)
(3)
subscriber, dependent of the subscriber, or enrollee of a managed care plan
where the subcontracted provider will bill the managed care plan or subscriber
or enrollee directly for the subcontracted services, 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 offers a health benefit plan 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 KRS 304.17A-500 to 304.17A-590 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. 1230, effective July 15, 2010. -Amended 2008 Ky. Acts ch. 169, sec. 6, effective July 15, 2008. -- Amended 2004
Ky. Acts ch. 157, sec. 3, effective July 13, 2004; and ch. 59, sec. 8, effective July 13,
2004. -- Amended 2002 Ky. Acts ch. 181, sec. 3, effective July 15, 2002. -- Created
2000 Ky. Acts ch. 500, sec. 1, effective July 14, 2000.
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.
