{"data":{"id":"us-ky/krs-304.17a-235","jurisdiction":"us-ky","citation":"KRS 304.17A-235","heading":"Notice of proposed material change in health benefit plan's agreement","body":"with participating provider.\n(1) As used in this section, unless the context requires otherwise:\n(a) \"Material change\" means a change to a contract, the occurrence and timing of\nwhich is not otherwise clearly identified in the contract, that decreases the\nhealth care provider's payment or compensation or changes the administrative\nprocedures in a way that may reasonably be expected to significantly increase\nthe provider's admin istrative expense, and includes any changes to provider\nnetwork requirements, or inclusion in any new or modified insurance\nproducts; and\n(b) \"Participating provider\" means a provider that has entered into an agreement\nwith an insurer to provide health care services.\n(2) Each insurer offering a health benefit plan shall establish procedures for changing\nan existing agreement with a participating provider that shall include the\nrequirements of this section.\n(3) If an insurer offering a health benefit plan ma kes any material change to an\nagreement it has entered into with a participating provider for the provision of\nhealth care services, the insurer shall provide the participating provider with at least\nninety (90) days' notice of the material change. The not ice of a material change\nrequired under this section shall:\n(a) Provide the proposed effective date of the change;\n(b) Include a description of the material change;\n(c) Include a statement that the participating provider has the option to either\naccept or reject the proposed material change in accordance with this section;\n(d) Provide the name, business address, telephone number, and electronic mail\naddress of a representative of the insurer to discuss the material change, if\nrequested by the participating provider;\n(e) Provide notice of the opportunity for a meeting using real -time\ncommunication to discuss the proposed changes if requested by the\nparticipating provider. For purposes of this paragraph, \"real -time\ncommunication\" means any mode of telecommunic ations in which all users\ncan exchange information instantly or with negligible latency and includes the\nuse of traditional telephone, mobile telephone, teleconferencing, and\nvideoconferencing. If requested by the provider, the opportunity to\ncommunicate to discuss the proposed changes may occur via electronic mail\ninstead of real-time communication; and\n(f) Provide notice that upon three (3) material changes in a twelve (12) month\nperiod, the provider may request a copy of the contract with material change s\nconsolidated into it. Provision of the copy of the contract by the insurer shall\nbe for informational purposes only and shall have no effect on the terms and\nconditions of the contract.\n(4) If a material change relates to the participating provider's inc lusion in any new or\nmodified insurance products, or proposes changes to the participating provider's\nmembership networks:\n(a) The material change shall only take effect upon the acceptance of the\nparticipating provider, evidenced by a written signature; and\n(b) The notice of the proposed material change shall be sent by certified mail,\nreturn receipt requested.\n(5) For any other material change not addressed in subsection (4) of this section:\n(a) 1. The material change shall take effect on the date provided in the notice\nunless the participating provider objects to the change in accordance\nwith this paragraph;\n2. A participating provider who objects under this paragraph shall do so in\nwriting and the written protest shall be delivered to the insurer within\nthirty (30) days of the participating provider's receipt of notice of the\nproposed material change;\n3. Within thirty (30) days following the insurer's receipt of the written\nobjection, the insurer an d the participating provider shall confer in an\neffort to reach an agreement on the proposed change or any counter -\nproposals offered by the participating provider; and\n4. If the insurer and participating provider fail to reach an agreement\nduring the thirt y (30) day negotiation period described in subparagraph\n3. of this paragraph, then thirty (30) days shall be allowed for the parties\nto unwind their relationship, provide notice to patients and other affected\nparties, and terminate the contract pursuant to its original terms; and\n(b) The notice of proposed material change shall be sent in an orange -colored\nenvelope with the phrase \"ATTENTION! CONTRACT AMENDMENT\nENCLOSED!\" in no less than fourteen (14) point boldface Times New Roman\nfont printed on the front  of the envelope. This color of envelope shall be used\nfor the sole purpose of communicating proposed material changes and shall\nnot be used for other types of communication from an insurer.\n(6) If an insurer issuing a health benefit plan makes a change to  an agreement that\nchanges an existing prior authorization, precertification, notification, or referral\nprogram, or changes an edit program or specific edits, the insurer shall provide\nnotice of the change to the participating provider at least fifteen (15 ) days prior to\nthe change.\n(7) Any notice required to be mailed pursuant to this section shall be sent to the\nparticipating provider's point of contact, as set forth in the provider agreement. If no\npoint of contact is set forth in the provider agreement,  the insurer shall send the\nrequisite notice to the provider's place of business addressed to the provider.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=45438","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:46Z","sha256":"d81987015713589e01308df2e32cf32e88e4d85447d9a403c54dd0756b2b3e32","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-230","next":"us-ky/krs-304.17a-240"},"notice":"GroundRules: Original legal text. Not legal advice."}