{"data":{"id":"us-ky/krs-304.17a-613","jurisdiction":"us-ky","citation":"KRS 304.17A-613","heading":"Emergency administrative regulations governing registration of","body":"insurers and private review agents seeking to conduct utilization reviews --\nProcedure for handling complaints.\n(1) The department shall, through the promulgation of emergency administ rative\nregulations, develop a process:\n(a) For the review of applications for registration of insurers or private review\nagents seeking to conduct utilization reviews;\n(b) For the review of applications for insurers or private review agents seeking\nregistration renewal to continue as a utilization review entity;\n(c) Ensuring that no registration shall be approved unless the commissioner has\ndocumentation or findings that all applicants seeking registration or renewal to\nconduct utilization review are in com pliance with the requirements and\nprocedures established regarding utilization review, and as to renewals, have\ncomplied with KRS 304.17A -600 to 304.17A -633 and administrative\nregulations promulgated to enforce and to administer KRS 304.17A -600 to\n304.17A-633; and\n(d) Establishing fees for applications and renewals in an amount sufficient to pay\nthe administrative costs of the program and any other costs associated with\ncarrying out the provisions of KRS 304.17A-600, 304.17A-603, 304.17A-605,\n304.17A-607, 304.17A-609, 304.17A-611, 304.17A-613, and 304.17A-615.\n(2) The registration issued in accordance with this section expires on the second\nanniversary of the effective date unless it is renewed.\n(3) The registration issued under this section is not transferable.\n(4) The commissioner may revoke or suspend the utilization review registration of any\ninsurer or private review agent who does not comply with the requirements and\nprocedures established regarding utilization review or any administrative\nregulations promulgated thereunder.\n(5) The department shall establish reporting requirements to:\n(a) Evaluate the effectiveness of insurers and private review agents; and\n(b) Determine if the utilization review plans are in compliance with the\nrequirements and procedu res established regarding utilization review and\napplicable administrative regulations.\n(6) Upon request of any provider, authorized person, or covered person whose care is\nsubject to review, the department shall provide copies of policies or procedures of\nany insurer or private review agent that has been issued a registration by the\ndepartment to conduct review in this state.\n(7) Notwithstanding any provision to the contrary, an insurer or private review agent\nregistered and in good standing under the prov isions of KRS 211.461 to 211.466,\nprior to July 14, 2000, shall be deemed in compliance with requirements and\nprocedures established in KRS 304.17A -600 to 304.17A -633 regarding utilization\nreview and registered accordingly.\n(8) Upon receipt of written comp laints from covered persons, authorized persons, or\nproviders stating that an insurer or a private review agent has failed to perform a\nreview in accordance with the utilization review plan or the requirements and\nprocedures established regarding utilizati on review, or administrative regulations\npromulgated thereunder, the commissioner shall:\n(a) Send a copy of the complaint to the insurer or the private review agent within\nten (10) days of receipt of the complaint, and require that any written reply be\nsent to the commissioner within ten (10) days; and\n(b) Review the complaint and any written repl y received from the insurer or\nprivate review agent within the time frames set forth in paragraph (a) of this\nsubsection and make a recommendation to the insurer or private review agent\nand the covered person, authorized person, or provider.\n(9) The commis sioner shall consider complaints before issuing or renewing any\nregistration or renewal of a registration to an insurer or a private review agent.\n(10) Notwithstanding any provision in this section to the contrary, the department shall\naccept accreditation  or certification by a nationally recognized accreditation\norganization as sufficient documentation or finding for purposes of subsections (1)\nand (5) of this section that the insurer or private review agent meets the application\nrequirements for registrat ion or renewal. Insurers or private review agents\naccredited or certified by a nationally recognized accreditation organization shall be\ndeemed compliant with the utilization review and internal appeals requirements of\nthis section and KRS 304.17A -600, 304 .17A-607, 304.17A -609, 304.17A -617,\n304.17A-623, and 304.17A -625 and administrative regulations to the extent the\nstandards of such nationally recognized accreditation organization sufficiently meet\nthese requirements. The department shall have a simplifie d process in\nadministrative regulations for insurers and private review agents to register using\naccreditation or certification and shall limit any additional documentation only for\ndemonstrating compliance with requirements in this section and KRS 304.17A -600,\n304.17A-607, 304.17A-609, 304.17A-617, 304.17A-623, and 304.17A-625 not met\nby the standards of a nationally recognized accreditation organization.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17456","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:47Z","sha256":"1c393b4ab598b2ea785bc1b7b91249dafc1857320dfa9f5ff4e088d8fafa9494","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-611","next":"us-ky/krs-304.17a-615"},"notice":"GroundRules: Original legal text. Not legal advice."}