{"data":{"id":"us-ky/krs-304.17a-515","jurisdiction":"us-ky","citation":"KRS 304.17A-515","heading":"Requirements for managed care plan.","body":"(1) A managed care plan shall arrange for a sufficient number and type of primary care\nproviders and specialists throughout the plan's service area to meet the needs of\nenrollees. Each managed care plan shall demonstrate that it offers:\n(a) An adequate number of accessible acute care hospital services, where\nphysically available;\n(b) An adequate number of accessible primary care providers, including family\npractice and general practice physicians, internists,\nobstetricians/gynecologists, and pediatricians, where available;\n(c) An adequate number of accessible specialists and subspecialists, and when the\nspecialist needed for a specific condition is not represented on the plan's list of\nparticipating specialists, enrollees have access to nonparticipating health c are\nproviders with prior plan approval;\n(d) The availability of specialty services; and\n(e) A provider network that meets the following accessibility requirements:\n1. For urban areas, a provider network that is available to all persons\nenrolled in the plan  within thirty (30) miles or thirty (30) minutes of\neach person's place of residence or work, to the extent that services are\navailable; or\n2. For areas other than urban areas, a provider network that makes\navailable primary care physician services, hospit al services, and\npharmacy services within thirty (30) minutes or thirty (30) miles of each\nenrollee's place of residence or work, to the extent those services are\navailable. All other providers shall be available to all persons enrolled in\nthe plan within fifty (50) minutes or fifty (50) miles of each enrollee's\nplace of residence or work, to the extent those services are available.\n(2) A managed care plan shall provide telephone access to the plan during business\nhours to ensure plan approval of nonemergen cy care. A managed care plan shall\nprovide adequate information to enrollees regarding access to urgent and emergency\ncare.\n(3) A managed care plan shall establish reasonable standards for waiting times to obtain\nappointments, except as provided for emergency care.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=48417","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:47Z","sha256":"732447d86f55a83436738a47c52aafb42dd1d1b0fbc6820bd179c5c630249ab5","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-510","next":"us-ky/krs-304.17a-520"},"notice":"GroundRules: Original legal text. Not legal advice."}