02RS SB38


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SB 38 (BR 1211) - T. Buford

     AN ACT relating to health insurance.
     Amend KRS 304.17A-600 to remove automatic certification of accredited entities as independent review entities, and make technical correction; amend KRS 304.17A-607
to extend the time frame for utilization review if additional information is required, to clarify that a description of alternative benefits shall be provided only if alternatives are available, and to decrease the effective date for utilization review policies and procedures from 30 days after filing with the commissioner to the date filed; amend KRS 304.17A-617 to clarify that the time frame for an expedited internal appeal begins to run upon receipt of the request and that an internal appeal denial letter shall include instructions for initiating an external review, to require that upon notification from the department that coverage denial is inappropriate the insurer is to provide written notice to the Department and the covered person within 30 days of its intent to cover the service or permit an external review, and to require an insurer to cover a service or afford an external review when the covered person is no longer enrolled with the insurer; amend KRS 304.17A-623 to require disclosure of the internal appeal process after notice of an adverse determination or coverage denial, to clarify that the cost of treatment will be at least $100 in the absence of insurance, and to require that an independent review entity make a determination within 24 hours of receipt of all required information; amend KRS 304.17A-625 to require an insurer to implement the decision of an independent review entity even if the covered person is no longer enrolled with the insurer, and to require an insurer to give written notification to the department within 30 days of an independent review entity decision favorable to the covered person; amend KRS 304.17A-700 to amend the definitions of "clean claim", "health claim attachment" and "utilization review"; amend KRS 304.17A-702 to make a technical correction; amend KRS 304.17A-704 to clarify that an insurer, its agent, or designee shall acknowledge a nonelectronic claim to a provider, its billing agent, or designee that submitted the claim, and to require that a notification of all missing information or errors in the billing instrument be given at the time of acknowledgment; amend KRS 304.17A.706 to require that an insurer, for purposes of delay in payment, have reasonable grounds to believe a clean claim involves a preexisting condition, coordination of benefits, or third party liability, to delete the requirement that an insurer pay any uncontested portion of a claim pending appeal of a contested portion of a claim, to require that provider manuals or other claims filing procedure documents include the required health claim attachments, and to require the insurer to notify the provider, covered person or other insurer of needed information in a contest of a claim due to pre-existing conditions, coordination of benefits or third party liability, to provide that retrospective review shall be completed within 20 business days of receipt of additional information, and to provide that the insurer is not required to pay interest if the provider does not submit the requested additional information within 20 days of receipt of notice, and to provide that if the additional information for a contested claim is not received within 20 days the insurer may deny the claim; amend KRS 304.17A-722, relating to insurers reporting requirements, to require reporting of the percentage of contested clean claims, to provide that the reporting of the clean claim time frame be based upon when the claims were paid, rather than when adjudicated; and, amend KRS 304.17A-730 to clarify the reporting interval time frames; repeal KRS 304.17A-350 which establishes the procedure for the payment and contest of claims and specifies the circumstances under which an insurer may delay payment or require additional information from a provider.


     SCS - Retain original provisions; add and amend KRS 304.17-3163 and KRS 304.17A-134 to require coverage for medical and surgical benefits with respect to a mastectomy; add and amend KRS 304.17A-527 to enhance managed care plan contract requirements; add and amend KRS 304.17A-605 to conform; amend KRS 304.17A-607 to require the conduct of utilization reviews during regular business hours and on Monday and Friday through six p.m., require a decision within 24 hours of receipt of request, authorize electronic transmission of a written notice, require an explanation of the appeal process, and allow compliance with the standards of any nationally-recognized accrediting entity if accredited thereby; add and amend KRS 304.17A-609 to require that administrative regulations adopted by the department provide for documentation that actively-practicing providers are involved in development of the review criteria, and to allow evidence of accreditation in lieu of disclosing information; add and amend KRS 304.17A-613 to require the department to accept accreditation or certification by a nationally recognized accreditation organization; amend KRS 304.17A-617 to require expeditious handling of an internal appeal decision and provide for coverage only 30 days after disenrollment; amend KRS 304.17A-623 and 304.17A.625 to conform, and to reduce from 30 days to 10 days the allotted time for notification to the department that a decision was implemented; amend KRS 304.17A-700 to add psychologists and social workers; amend KRS 304.17A-706 to authorize an insurer to contest, but not delay payment of, a clean claim and to reduce from 20 days to 15 days the time a provider may submit information to the insurer for a retrospective review, and to authorize resubmission of a claim by the provider; amend KRS 304.17A-704 to delete the term "billing" from the phrase "billing agent"; add and amend KRS 304.17A-714 to modify requirements for insurers and providers in the event of claim overpayment; add and amend KRS 304.17A-722 to provide that the department's administrative regulations require insurer reports on a quarterly calendar basis with specified information; amend KRS 304.17A-730 to conform, and to reduce the time period from which interest will accrue from 90 days to 60 days; add and amend KRS 304.99-123 to redefine insurer compliance for purposes of imposing a fine for violation; add and amend KRS 304.18-0983, KRS 304.32-1593 and KRS 304.38-1934 to conform; add and amend KRS 304.32-320 to require notice of the name of a third party administrator; and repeal KRS 304.17A-350.

     HFA (1, M. Marzian) - Amend to add requirement that an insurer provide written notice to a covered person of the availability of women's reproductive health benefits.

     (Prefiled by the sponsor(s))

     Jan 8-introduced in Senate
     Jan 10-to Health and Welfare (S)
     Feb 28-reported favorably, 1st reading, to Consent Calendar with Committee Substitute
     Mar 1-2nd reading, to Rules
     Mar 6-posted for passage in the Consent Orders of the Day for Thursday, March 7, 2002
     Mar 7-3rd reading, passed 38-0 with Committee Substitute
     Mar 8-received in House
     Mar 11-to Banking and Insurance (H)
     Mar 12-posted in committee; posting waived
     Mar 13-reported favorably, 1st reading, to Calendar
     Mar 14-2nd reading, to Rules
     Mar 15-recommitted to Appropriations and Revenue (H)
     Mar 25-posting waived
     Mar 26-reported favorably, to Rules; posted for passage in the Regular Orders of the Day for Wednesday, March 27, 2002; floor amendment (1) filed
     Mar 27-3rd reading, passed 94-0; received in Senate
     Mar 28-enrolled, signed by each presiding officer; delivered to Governor
     Apr 2-signed by Governor (Acts ch. 181)

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