{"data":{"id":"us-ky/krs-304.17c-050","jurisdiction":"us-ky","citation":"KRS 304.17C-050","heading":"Standards for providers -- Mechanism for acting upon applications --","body":"Policy governing removal of providers from network.\n(1) Insurers shall establish relevant, objective standards for initial consideration of\nproviders and for providers to continu e as a participating provider in the plan.\nStandards shall be reasonably related to services provided. Selection or participation\nstandards based on the economics or capacity of a provider's practice shall be\nadjusted to account for case mix, severity of i llness, patient age, and other features\nthat may account for higher -than-expected or lower -than-expected costs. All data\nprofiling or other data analysis pertaining to participating providers shall be done in\na manner which is valid and reasonable. Plans shall not use criteria that would allow\nan insurer to avoid high -risk populations by excluding providers because they are\nlocated in geographic areas that contain populations or providers presenting a risk\nof higher than average claims, losses, or health se rvices utilization, or that would\nexclude providers because they treat or specialize in treating populations presenting\na risk of higher than average claims, losses, or health services utilization.\n(2) Each insurer shall establish mechanisms for soliciting  and acting upon applications\nfor provider participation in the plan in a fair and systematic manner. These\nmechanisms shall, at a minimum, include:\n(a) Allowing all providers who desire to apply for participation in the plan an\nopportunity to apply at any time during the year, or, where an insurer does not\nconduct open continuous provider enrollment, conducting a provider\nenrollment period at least annually with the date publicized to providers\nlocated in the geographic service area of the plan at least th irty (30) days in\nadvance of the enrollment period; and\n(b) Making criteria for provider participation in the plan available to all\napplicants.\n(3) An insurer that offers a limited health service benefit plan shall establish a policy\ngoverning the removal of and withdrawal by health care providers from the provider\nnetwork that includes the following:\n(a) The insurer shall inform a participating health care provider of the insurer's\nremoval and withdrawal policy at the time the insurer contracts with the health\ncare provider to participate in the provider network, and when changed\nthereafter;\n(b) If a participating health care provider's participation will be terminated or\nwithdrawn prior to the date of the termination of the contract as a result of a\nprofessional review action, the insurer and participating health care provider\nshall comply with the standards in 42 U.S.C. sec. 11112; and\n(c) If the insurer finds that a health care provider represents an imminent danger\nto an individual patient or to the publ ic health, safety, or welfare, the medical\ndirector shall promptly notify the appropriate professional state licensing\nboard.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=29408","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:49Z","sha256":"afc8f4ea7cb2fe35bc0aac9fa34858f69fff58a0ec5ac376b6c974676e9711d6","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17c-040","next":"us-ky/krs-304.17c-060"},"notice":"GroundRules: Original legal text. Not legal advice."}