UTILIZATION REVIEWS
- Section 304.17A-600 - Definitions for KRS 304.17A-600 to 304.17A-633
- Section 304.17A-603 - Application of KRS 304.17A-600 to 304.17A-633 - Written procedures for coverage and utilization review determinations to be accessible on insurers' Web sites - Preauthorization review requirements for insurers
- Section 304.17A-605 - Requirements and procedures for utilization review - Exception for private review agent operating under contract with the federal government
- Section 304.17A-607 - Duties of insurer or private review agent performing utilization reviews - Requirement for registration - Consequences of insurer's failure to make timely utilization review determination - Requirement that insurer or private review agent submit changes to the department - Requirement that private review agent provide timely notice of entities for whom it is providing review
- Section 304.17A-609 - Emergency administrative regulations governing utilization review and internal appeal to be promulgated by the department
- Section 304.17A-611 - Prohibition against retrospective denial of coverage for health care services under certain circumstances - Prohibition against prospective or concurrent review of prescription drug for alcohol or opioid use disorder
- Section 304.17A-613 - Emergency administrative regulations governing registration of insurers and private review agents seeking to conduct utilization reviews - Procedure for handling complaints
- Section 304.17A-615 - Prohibition against denying or reducing payments under certain circumstances
- Section 304.17A-617 - Internal appeals process - Procedures - Review of coverage denials
- Section 304.17A-619 - Duty of covered person, authorized person, or provider to provide insurer with new information regarding internal appeal - Time frame for insurer to render a decision based on new information - Insurer's failure to make timely determination or provide written notice
- Section 304.17A-621 - Independent External Review Program established
- Section 304.17A-623 - External review of adverse determination - Who may request - Criteria for review - Fee - Conditions under which covered person not entitled to review - Resolution of disputes - Confidentiality - Expedited external review
- Section 304.17A-625 - Factors to be considered by independent review entity conducting external review - Basis for decision - Insurer's responsibilities - Contents, admissibility, and effect of decision - Consequence of insurer's failure to provide coverage - Liability - Written complaints
- Section 304.17A-627 - Certification as independent review entity - Requirements and restrictions
- Section 304.17A-629 - Administrative regulations to implement provisions of KRS 304.17A-621, 304.17A-623, 304.17A-625, 304.17A-627, 304.17A-629, and 304.17A-631
- Section 304.17A-631 - Time for insurers to comply with administrative regulations
- Section 304.17A-633 - Commissioner to report to Interim Joint Committee on Banking and Insurance and to Governor - Contents of report