Section 304.17A-605 - Requirements and procedures for utilization review - Exception for private review agent operating under contract with the federal government(1)KRS 304.17A-600, 304.17A-603, 304.17A-605, 304.17A-607, 304.17A-609, 304. 17A-611, 304.17A-613, and 304.17A-615 set forth the requirements and procedures regarding utilization review and shall apply to: (a) Any insurer or its private review agent that provides or performs utilization review in connection with a health benefit plan or a limited health service benefit plan; and(b) Any private review agent that performs utilization review functions on behalf of any person providing or administering health benefit plans or limited health service benefit plans.(2) Where an insurer or its agent provides or performs utilization review, and in all instances where internal appeals as set forth in KRS 304.17A-617 are involved, the insurer or its agent shall be responsible for: (a) Monitoring all utilization reviews and internal appeals carried out by or on behalf of the insurer;(b) Ensuring that all requirements of KRS 304.17A-600 to 304.17A-633 are met;(c) Ensuring that all administrative regulations promulgated in accordance with KRS 304.17A-609, 304.17A-613, and 304.17A-629 are complied with; and(d) Ensuring that appropriate personnel have operational responsibility for the performance of the insurer's utilization review plan.(3) A private review agent that operates solely under contract with the federal government for utilization review or patients eligible for hospital services under Title XVIII of the Social Security Act shall not be subject to the registration requirements set forth in KRS 304.17A-607, 304.17A-609, and 304.17A-613.Effective:7/15/2002
Amended 2002, Ky. Acts ch. 105, sec. 1, effective7/15/2002. -- Created 2000, Ky. Acts ch. 262, sec. 3, effective 7/14/2000.