KRS 304.17A-643: Treatment of covered person under special circumstances.

(1) "Special circumstances" includes a circumstance in which a covered person has a

disability, a congenital condition, a life -threatening illness, or is past the twenty -

fourth week of pregnancy where disruption of the covered person's continuity of

care could cause medical harm.

(2) Any special circumstance shall be identified by the treating provider, who may

request, with the concurrence of the covered person or authorized person, that the

covered person be permitted to continue treatment under the provider' s care even

when the provider is no longer participating in the network, unless the provider has

been terminated for a reason related to quality. The treating, non network provider

shall agree to care for the covered person under the same guidelines and pa yment

schedule as required by the plan, and shall report to the plan on the care being

provided.

(3) Procedures for resolving disputes regarding the necessity for continued treatment by

a provider shall be established by the plan and shall provide for revi ew through the

plan's internal appeal process.

(4) This section does not extend the obligation of the plan to pay a terminated or

nonrenewed provider for ongoing treatment of a covered person with "special

circumstances":

(a) Beyond the ninetieth day after the effective date of the termination or

nonrenewal;

(b) Beyond nine (9) months in the case of a covered person who at the time of the

termination has been diagnosed with a terminal illness; or

(c) If the covered person is beyond the twenty -fourth week of pregnancy, the

plan's obligation to pay for services extends through the delivery of the child,

immediate postpartum care, and examination within the first six (6) weeks

following delivery.