KANSAS
INSURANCE DEPARTMENT
Notice of Hearing on
Proposed
Administrative
Regulations
A public
hearing will be conducted at 1:30 p.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.
40-4-41.
Utilization review organizations; application; definitions.
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
particular regulation define the terms that are included in other utilization
review regulations and are used in the utilization review process.
Some of the definitions require
individuals and entities that perform certain utilization review functions to
possess certain credentials and be trained in utilization review
procedures.
Definitions have been added and
deleted to accurately reflect those services that are subject to regulations
regarding utilization review organizations.
Language within existing definitions have been
changed to update current terminology.
Other changes include the addition and deletion of statutory citations
and technical changes.
The entities most impacted are
utilization review organizations and health insurance carriers who perform
utilization review activities and consumers of health insurance. The economic
impact on those entities who perform utilization
review functions is justified in the protection of
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
that perform utilization review functions is justified in the protection of
This regulation was 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.
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 that perform utilization review functions is justified in the
protection of
This
regulation was 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.
K.A.R. 40-4-29a. Same; renewability of individual hospital, medical, or surgical expense policy. The purpose of the proposed
amendments it to specify information in regards to individual hospital, medical, or surgical expense policies for insureds who are
eligible for Medicare. Section (a)
prohibits termination of these policies if an insured wishes to continue
coverage. Section (b) requires insurers
to mail to its current individual medical policies who
are approaching the age of 65 a notice informing policyholders of their rights
under Federal and State laws.
There will be little or no economic
impact on insurance companies, consumers, the Kansas Insurance Department, and
other governmental agencies, if any.
K.A.R. 40-7-1. This regulation lists exceptions to the requirement that
employees of insurance companies be licensed as insurance agents. The Kansas Insurance Department is proposing
that this regulation be revoked because this regulation is no longer
necessary.
The impact on companies, the Kansas
Insurance Department, and other governmental agencies is nonexistent
K.A.R. 40-7-24. Agencies; agents;
employees. This
regulation specifies which agencies must have a licensed agent in its employ
and the exceptions. The proposed change
adds automobile rental products as an exception. The remaining changes to
K.A.R. 40-7-24 are technical only.
There may be a positive economic
impact on some business entities in that businesses who offer auto rental
products will now be exempted from having a licensed insurance agent in its
employ while there may be a negative impact on agents. There will be little or no economic impact on
consumers, the Kansas Insurance Department, and other governmental agencies, if
any.
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 these regulations and/or 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.