KANSAS INSURANCE DEPARTMENT
K.A.R. 40-4-41j. Utilization review
organizations; written procedures to maintain confidentiality.
(a) The Each utilization
review organization shall have written policies and procedures for assuring
ensuring that patient-specific information obtained during the
utilization management process meets the following criteria:
(1)
Be limited to only that
information necessary for utilization management, of the services
under review quality management, discharge planning, case management,
and claims payment; and
(2)
be shared with only those
entities who have authority to receive this information;
(3) be kept confidential in accordance with applicable law; and
(4) be shared only with those individuals who need access to
this information in order to conduct utilization management and related
processes.
(b)
If provider-specific data is to
be released to the public, the each utilization management
organization shall have policies and procedures for exercising due care in
compiling and releasing this data. These policies and procedures shall address
the following:
(1)
How data are obtained using
valid methodology and verified for accuracy;
(2)
how the subjects of these
disclosures are informed of the disclosures;
(3)
how potential users of the
information are informed about the uses and limitations of the data; and
(4)
how the release of the data complies with
applicable confidentiality laws and regulations. (Authorized by K.S.A. 40-103, K.S.A.
1999 Supp. 40-22a04, and 40-22a11; implementing K.S.A. 1999
Supp. 40-22a04, 40-22a06, 40-22a07, and 40-22a09, and
40-22a11; effective June 22, 2001; amended
P-__________________.)