KRS 304.32-330: Requirements for self -insured employer that provides health coverage

and requires utilization review of benefits.

(1) Every employer in this state which provides coverage of hospital benefits on a self -

insured basis and requires the utilization rev iew of such benefits by an insurer, its

designee, or a private review agent shall:

(a) Be a registered private review agent in accordance with KRS 304.17A -607

and administrative regulations promulgated under the authority of KRS

304.17A-613; or

(b) Contract with a private review agent that has been registered in accordance

with KRS 304.17A-607 and administrative regulations promulgated under the

authority of KRS 304.17A-613.

(2) Notwithstanding any other provision of KRS 304.17A-603, 304.17A-605, 304.17A-

607, 304.17A -609, 304.17A -611, 304.17A -613, and 304.17A -615, a self -insured

employer shall not deny or reduce payment of health benefits to any person,

licensed practitioner, or health facility for covered services which have been

rendered to an insured unless:

(a) Notice of denial has been issued; and

(b) The self-insured employer is in compliance with subsection (1) of this section.