KRS 304.17A-265: Insurer may not restrict assignment of benefits to substance abuse or

mental health facility -- Exceptions -- Requirements for assignment --

Construction.

(1) As used in this section:

(a) "Health insurance policy":

1. Includes any health insurance policy, certificate, plan, or contract or

managed care plan, as defined in KRS 304.17A -500, regardless of

whether the policy, certificate, plan, or contract was issued or delivered

in this state; and

2. Does not include Medicare or Medicaid benefits;

(b) "Insurer":

1. Means any domestic, foreign, or alien insurer, self -insurer, self-insured

plan, or self-insured group; and

2. Includes any domestic, foreign, or alien:

a. Health maintenance organization;

b. Limited health service organization;

c. Provider-sponsored integrated health delivery network; and

d. Nonprofit hospital, medical -surgical, dental, and health service

corporation; and

(c) "Substance abuse or mental health facility" means a structurally dis tinct

public or private health care establishment, institution, or facility located and

licensed in this state that is primarily constituted, staffed, and equipped to

deliver substance abuse or mental health treatment services, or both substance

abuse and mental health treatment services, to the general public.

(2) To the extent permitted under federal law, an insurer or its agent:

(a) Shall not prohibit or restrict, except as provided in paragraph (b) of this

subsection, an insured under a health insurance policy from making a written

assignment of any substance abuse or mental health treatment benefits

available under the policy to a substance abuse or mental health facility; and

(b) May require a substance abuse or mental health facility that receives a w ritten

assignment of benefits from an insured to:

1. Provide the following information to the insured prior to performing a

health care service associated with the benefits:

a. A statement informing the insured that the facility, as applicable:

i. Is an out-of-network provider;

ii. May charge the insured for services not covered under the

health insurance policy; and

iii. May charge the insured the balance of any bill for services

that are covered under the health insurance policy;

b. A schedule of all appl icable charges for the services that the

facility may provide to the insured;

c. Any terms of payment that may apply to the insured; and

d. Whether interest will apply to, and the amount of interest that will

be charged against, any payment owed by the ins ured to the

facility;

2. Submit claims associated with the benefits within ninety (90) days of the

date of service;

3. Maintain records of claims associated with the benefits;

4. Respond to any inquiry regarding the benefits from an investigative unit

established under KRS 304.47-080 or other similar unit; and

5. Make a good -faith effort to abide by the standards of care set forth by

the following, as applicable:

a. The American Society of Addiction Medicine;

b. The American Association for Community Psychi atry's Level of

Care Utilization System (LOCUS); or

c. The American Association for Community Psychiatry's and the

American Academy of Child and Adolescent Psychiatry's Child

and Adolescent Level of Care/Service Intensity Utilization System

(CALOCUS-CASII).

(3) For an assignment of benefits made in accordance with this section:

(a) The assignment shall:

1. Be valid as of the effective date contained in the assignment; and

2. Remain in effect until the earlier of the following:

a. The date the insured is discharged from the care of the substance

abuse or mental health facility; or

b. The date the substance abuse or mental health facility receives

written notice of the insured's termination of the assignment; and

(b) Upon notice of the assignment, the insurer shall make payments directly to the

substance abuse or mental health facility for all services rendered by the

facility to the insured for the duration of the assignment.

(4) This section shall not be construed to:

(a) Provide a coverage or benefit that is not otherwise available under the health

insurance policy;

(b) Prohibit an insurer from enforcing any terms or conditions of the health

insurance policy that are not in conflict with this section;

(c) Relieve an insured from the contractual obligation to pay deductibles,

copayments, or coinsurance;

(d) Permit a substance abuse or mental health facility to waive deductibles,

copayments, or coinsurance by the notice of assignment; or

(e) Violate:

1. 29 U.S.C. sec. 1185a, as amended; or

2. KRS 304.17A-660 to 304.17A-669.