{"data":{"id":"us-ky/krs-304.17a-643","jurisdiction":"us-ky","citation":"KRS 304.17A-643","heading":"Treatment of covered person under special circumstances.","body":"(1) \"Special circumstances\" includes a circumstance in which a covered person has a\ndisability, a congenital condition, a life -threatening illness, or is past the twenty -\nfourth week of pregnancy where disruption of the covered person's continuity of\ncare could cause medical harm.\n(2) Any special circumstance shall be identified by the treating provider, who may\nrequest, with the concurrence of the covered person or authorized person, that the\ncovered person be permitted to continue treatment under the provider' s care even\nwhen the provider is no longer participating in the network, unless the provider has\nbeen terminated for a reason related to quality. The treating, non network provider\nshall agree to care for the covered person under the same guidelines and pa yment\nschedule as required by the plan, and shall report to the plan on the care being\nprovided.\n(3) Procedures for resolving disputes regarding the necessity for continued treatment by\na provider shall be established by the plan and shall provide for revi ew through the\nplan's internal appeal process.\n(4) This section does not extend the obligation of the plan to pay a terminated or\nnonrenewed provider for ongoing treatment of a covered person with \"special\ncircumstances\":\n(a) Beyond the ninetieth day after  the effective date of the termination or\nnonrenewal;\n(b) Beyond nine (9) months in the case of a covered person who at the time of the\ntermination has been diagnosed with a terminal illness; or\n(c) If the covered person is beyond the twenty -fourth week of  pregnancy, the\nplan's obligation to pay for services extends through the delivery of the child,\nimmediate postpartum care, and examination within the first six (6) weeks\nfollowing delivery.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=29320","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:47Z","sha256":"2b96e4534ad3f669080917cde8701718b66be37405fe5d8f5720ce4667b2c6c1","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-641","next":"us-ky/krs-304.17a-645"},"notice":"GroundRules: Original legal text. Not legal advice."}