KRS 304.17C-080: Plan for selection and reevaluation of providers.

(1) Each insurer shall have a process for the selection of health care providers who will

be on the plan's list of participating providers, with written policies and procedures

for review and approval used by the plan.

(2) The plan shall establish minimum professional requirements for participating health

care providers. An insurer may not discriminate against a provider solely on the

basis of the provider's license by the state.

(3) The plan shall demonstrate that it has consulted with appropriately qualified health

care providers to establish the minimum professional requirements.

(4) The plan's selection process shall include verification of each health care provider's

license, history of license suspension or revocation, and liability claims history.

(5) An insurer shall establish a formal written, ongoing process for the reevaluation of

each participating health care provider within a specified number of years after the

provider's initial acceptance into the plan. The reevaluation shall include an update

of the previous review criteria and an assessment of the provider's performance

pattern based on criteria such as enrollee clinical outcomes, number of complaints,

and malpractice actions.