KRS 304.17A-577: Disclosure of payment or fee schedule to managed care plan health

care provider -- Disclosure of schedule change -- Confidentiality of payment

information.

(1) (a) An insurer issuing a managed care plan shall, upon request of a health care

provider, provide or make available to the health care provider, when

contracting or renewing an existing contract with such provider, the payment

or fee schedules or other information sufficient to enable the health care

provider to determine the manner and amou nt of payments under the contract

for the health care provider's services prior to final execution or renewal of the

contract. The payment or fee schedule or other information submitted to a

health care provider pursuant to this section shall include a des cription of

processes and factors that may be applicable and that may affect actual

payment, including copayments, coinsurance, deductibles, risk sharing

arrangements, and liability of third parties. Nothing in this paragraph shall

prohibit a plan from mak ing any part of the information requested available

electronically or via a Web site.

(b) An insurer issuing a managed care plan, upon request of a health care

provider, shall provide or make available to the health care provider an

explanation of the meth odology, such as relative value unit system and

conversion factor, percentage of Medicare payment system, or percentage of

billed charges, used to determine actual payment for procedures frequently

performed by the provider that involve combinations of ser vices or payment

codes, if the actual payment for the procedures cannot be ascertained from the

fee schedule or other information submitted to a health care provider pursuant

to this section. As applicable, the methodology disclosure provided for in this

paragraph shall include:

1. The name of any relative value system;

2. The version, edition, or publication date of the relative value system;

and

3. Any applicable conversion or geographic factor.

Nothing in this paragraph shall prohibit a plan from making any part of the

information requested available electronically or via a Web site.

(c) The provisions of this subsection requiring the submission of a fee schedule or

other information upon renewal of an existing contract shall not be applicable

to renewal of an existing contract when the payment or fee schedule

previously provided to the health care provider has not changed.

(2) Any change to payment or fee schedules applicable to providers under contract with

an insurer issuing a managed care plan shall b e made available to such providers at

least ninety (90) days prior to the effective date of the amendment. This subsection

shall not apply to changes in standard codes and guidelines developed by the

American Medical Association or a similar organization.

(3) A health care provider receiving information pursuant to subsection (1) of this

section shall not share this information with an unrelated person without the prior

written consent of the insurer issuing a managed care plan. The remedies available

to an insurer issuing a managed care plan to enforce the provision of this subsection

shall include without limitation injunctive relief. An insurer issuing a managed care

plan seeking extraordinary relief to enforce this section shall not be required to

establish irreparable harm with regard to the sharing of competitively sensitive

information.