{"data":{"id":"us-ky/krs-304.17a-527","jurisdiction":"us-ky","citation":"KRS 304.17A-527","heading":"Filing of provider agreements, risk -sharing arrangements, and","body":"subcontract agreements with commissioner -- Contents -- Disclosure of\nfinancial information not required.\n(1) A managed care plan shall file with the commissioner sample copies of any\nagreements it enters into with providers for the provision of health care services.\nThe commissioner shall promulgate administrative regulations prescribing the\nmanner and form of the filings required. The agreements shall include the\nfollowing:\n(a) A hold harmless clause that states that the provider may not, under any\ncircumstance, including:\n1. Nonpayment of moneys due the providers by the managed care plan,\n2. Insolvency of the managed care plan, or\n3. Breach of the agreement,\nbill, charge, collect a de posit, seek compensation, remuneration, or\nreimbursement from, or have any recourse against the subscriber, dependent\nof subscriber, enrollee, or any persons acting on their behalf, for services\nprovided in accordance with the provider agreement. This prov ision shall not\nprohibit collection of deductible amounts, copayment amounts, coinsurance\namounts, and amounts for noncovered services;\n(b) A continuity of care clause that states that if an agreement between the\nprovider and the managed care plan is termi nated for any reason, other than a\nquality of care issue or fraud, the insurer shall continue to provide services\nand the plan shall continue to reimburse the provider in accordance with the\nagreement until the subscriber, dependent of the subscriber, or t he enrollee is\ndischarged from an inpatient facility, or the active course of treatment is\ncompleted, whichever time is greater, and in the case of a pregnant woman,\nservices shall continue to be provided through the end of the post -partum\nperiod if the pr egnant woman is in her fourth or later month of pregnancy at\nthe time the agreement is terminated;\n(c) A survivorship clause that states the hold harmless clause and continuity of\ncare clause shall survive the termination of the agreement between the\nprovider and the managed care plan;\n(d) A clause stating that the insurer issuing a managed care plan will, upon\nrequest of a participating provider, provide or make available to a\nparticipating provider, when contracting or renewing an existing contract with\nsuch provider, the payment or fee schedules or other information sufficient to\nenable the provider to determine the manner and amount of payments under\nthe contract for the provider's services prior to the final execution or renewal\nof the contract and shal l provide any change in such schedules at least ninety\n(90) days prior to the effective date of the amendment pursuant to KRS\n304.17A-577; and\n(e) A clause requiring that if a provider enters into any subcontract agreement\nwith another provider to provide their licensed health care services to the\nsubscriber, dependent of the subscriber, or enrollee of a managed care plan\nwhere the subcontracted provider will bill the managed care plan or subscriber\nor enrollee directly for the subcontracted services, the s ubcontract agreement\nmust meet all requirements of this subtitle and that all such subcontract\nagreements shall be filed with the commissioner in accordance with this\nsubsection.\n(2) An insurer that offers a health benefit plan that enters into any risk -sharing\narrangement or subcontract agreement shall file a copy of the arrangement with the\ncommissioner. The insurer shall also file the following information regarding the\nrisk-sharing arrangement:\n(a) The number of enrollees affected by the risk-sharing arrangement;\n(b) The health care services to be provided to an enrollee under the risk -sharing\narrangement;\n(c) The nature of the financial risk to be shared between the insurer and entity or\nprovider, including but not limited to the method of compensation;\n(d) Any administrative functions delegated by the insurer to the entity or provider.\nThe insurer shall describe a plan to ensure that the entity or provider will\ncomply with KRS 304.17A -500 to 304.17A -590 in exercising any delegated\nadministrative functions; and\n(e) The insurer's oversight and compliance plan regarding the standards and\nmethod of review.\n(3) Nothing in this section shall be construed as requiring an insurer to submit the\nactual financial information agreed to between the insurer and the entity or provider.\nThe commissioner shall have access to a specific risk sharing arrangement with an\nentity or provider upon request to the insurer. Financial information obtained by the\ndepartment shall be considered to be a trade secret and shall not be s ubject to KRS\n61.872 to 61.884.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17432","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:47Z","sha256":"a1c9502635184bcf2b7b02b61a22ff2c780509734ae30d1db08a873ddebdda82","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-525","next":"us-ky/krs-304.17a-530"},"notice":"GroundRules: Original legal text. Not legal advice."}