KRS 304.17C-060: Filing of agreements -- Provisions of agreements -- Procedures for

changing agreement -- Filing of risk-sharing arrangements and subcontracts --

Availability of information.

(1) An insurer shall file with the commissioner sample copies of any ag reements it

enters into with providers for the provision of health care services. The

commissioner shall promulgate administrative regulations prescribing the manner

and form of the filings required. The agreements shall include the following:

(a) A hold h armless clause that states that the provider may not, under any

circumstance, including:

1. Nonpayment of moneys due to providers by the insurer;

2. Insolvency of the insurer; or

3. Breach of the agreement,

bill, charge, collect a deposit, seek compensati on, remuneration, or

reimbursement from, or have any recourse against the subscriber, dependent

of subscriber, enrollee, or any persons acting on their behalf, for services

provided in accordance with the provider agreement. This provision shall not

prohibit collection of deductible amounts, copayment amounts, coinsurance

amounts, and amounts for noncovered services;

(b) A survivorship clause that states the hold harmless clause and continuity of

care clause shall survive the termination of the agreement be tween the

provider and the insurer; and

(c) A clause requiring that if a provider enters into any subcontract agreement

with another provider to provide health care services to the subscriber,

dependent of the subscriber, or enrollee of a limited health se rvice benefit

plan, the subcontract agreement must meet all requirements of this subtitle

and that all such subcontract agreements shall be filed with the commissioner

in accordance with this subsection.

(2) Each insurer shall establish procedures for chan ging an existing agreement with a

participating provider, as defined in KRS 304.17A -235, which comply with KRS

304.17A-235.

(3) An insurer that enters into any risk -sharing arrangement or subcontract agreement

shall file a copy of the arrangement with the commissioner. The insurer shall also

file the following information regarding the risk-sharing arrangement:

(a) The number of enrollees affected by the risk-sharing arrangement;

(b) The health care services to be provided to an enrollee under the risk -sharing

arrangement;

(c) The nature of the financial risk to be shared between the insurer and entity or

provider, including but not limited to the method of compensation;

(d) Any administrative functions delegated by the insurer to the entity or provider.

The insurer shall describe a plan to ensure that the entity or provider will

comply with the requirements of this subtitle in exercising any delegated

administrative functions; and

(e) The insurer's oversight and compliance plan regarding the standards and

method of review.

(4) Nothing in this section shall be construed as requiring an insurer to submit the

actual financial information agreed to between the insurer and the entity or provider.

The commissioner shall have access to a specific risk -sharing arrangement with an

entity or provider upon request to the insurer. Financial information obtained by the

department shall be considered to be a trade secret and shall not be sub ject to KRS

61.872 to 61.884.