KANSAS
INSURANCE DEPARTMENT
Notice of Hearing on
Proposed
Administrative
Regulations
A public
hearing will be conducted at 9:30 a.m.,
The 60-day
notice of the public hearing shall constitute a public comment period for
purpose of receiving written public comments on the proposed rules and
regulations. All interested parties may
submit written comments prior to the hearing to
A summary of the regulations and their
economic impact follows.
K.A.R.
40-4-41c.
Utilization review organizations; written procedures. The purpose of the proposed amendments is to reflect changes
made by the American Accreditation Health Commission a/k/a as URAC. This is one of the major entities that accredits utilization review organizations nationally. These
amendments were also made after consulting with the Utilization Review Advisory
Committee. The amendments to this
regulation set out the procedures and deadlines that utilization review
organizations are to follow in conducting utilization reviews. This regulation also gives the provider one
day to discuss the decision with the peer reviewer after receiving the
decision. It also sets out who is to be
notified of a utilization review decision and what information should be
contained in that decision.
This regulation sets out the written
procedures for some of the functions utilization review organizations shall
have and maintain, and what elements, at a minimum, these written procedures
should contain. This regulation sets out
the requirements for written procedures for certain utilization review
organization functions. These
requirements could result in additional costs to the utilization review
organizations in designing and implementing these written procedures. However, with the increase of managed care as
a mechanism to deliver health care to consumers, these requirements are needed
to safeguard consumers and insure that they obtain the care that they
need. The economic impact on those
entities who perform utilization review functions is
justified in the protection of
K.A.R.
40-4-41d.
Utilization review organizations; appeal procedures. The purpose of the proposed
amendments is to reflect changes made by the American Accreditation Health
Commission a/k/a as URAC. This is one of
the major entities that accredits utilization review
organizations nationally. These
amendments were also made after consulting with the Utilization Review Advisory
Committee. The amendments to this
regulation set out the procedures and deadlines that utilization review organizations
are to follow in conducting appeals of utilization review decisions. This regulation also gives the provider
access to the reviewer who conducted the review a day after receiving the
decision to discuss the decision with the reviewer. This regulation also sets out the credentials
that reviewers are to have in conducting these appeals.
This regulation sets out
requirements as to how utilization reviews appeals are to be conducted. This could result in additional costs to the
utilization review organizations in training their personnel in what in what
procedures need to be followed in conducting utilization reviews. Additional costs could also be incurred in
having properly credentialed individuals on staff to conduct these
appeals. However with the increase of
managed care as mechanism to deliver health care to consumers, these
requirements are needed to safeguard consumers and insure that they obtain the
care that they need. The economic impact
on those entities who perform utilization review
functions is justified in the protection of
K.A.R.
40-4-41e.
Utilization review organizations; staff requirements.
The purpose of the
proposed amendments is to reflect changes made by the American Accreditation
Health Commission a/k/a as URAC. This is
one of the major entities that accredits utilization
review organizations nationally. These
amendments were also made after consulting with the Utilization Review Advisory
Committee. The amendments to this
regulation set out what non-clinical staff of utilization review organizations
can do and what qualifications and training they should have. This regulation also sets out the procedures
should be followed by a utilization review organization conducting initial
reviews. The regulation further sets out the procedure that should be followed
when utilization review organizations perform peer clinical review.
This regulation sets out
requirements as to what non clinical staff of utilization review organizations
can do, what procedure should be followed in initial clinical review procedures
and how peer clinical reviews are to be conducted. This could result in additional costs to the
utilization review organizations in training their personnel in what procedures
need to be followed in conducting initial clinical reviews and peer clinical
review. Additional costs could also be
incurred in having properly credentialed individuals on staff to conduct peer
clinical reviews and initial clinical reviews.
Additional training cost may be incurred for non-clinical staff as to
what tasks they should be performing and how they should be performed. However, with the increase of managed care as
mechanism to deliver health care to consumers, these requirements are needed to
safeguard consumers and insure that they obtain the care that they need. The
economic impact on those entities who perform
utilization review functions is justified in the protection of
These
regulations were not mandated by federal law. The entities most impacted are
utilization review organizations and health insurance carriers who perform
utilization review activities and consumers of health insurance.
Any
individual with a disability may request accommodation in order to participate
in the public hearing and may request the proposed regulations and economic
impact statements in an accessible format.
Requests for accommodation to participate in the hearing should be made
at least 5 working days in advance by contacting Deletria
Nash at (785) 296-4140 or via email at dnash@ksinsurance.org. Any individual desiring a copy of this
regulation and the policy and procedure that is being adopted by reference, if
applicable, may obtain a copy from our website, www.ksinsurance.org,
under the Legal Issues link or by contacting Deletria
Nash by phone at (785)296-4140 or via email at dnash@ksinsurance.org. The charge for copies is fifty cents per
page.