KANSAS
INSURANCE DEPARTMENT
Notice of Hearing on
Proposed
Administrative
Regulations
A public
hearing will be conducted at 10:30 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. 40-4-41b. Utilization review organizations; requirements for collecting
information. 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 accredit 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 standards and guidelines
that utilization review organizations are to follow in collecting information
to perform their utilization review functions.
This regulation also sets out what information the utilization review
organization shall use in making its utilization review decisions.
This
regulation sets out requirements as to what information shall be collected in
making utilization review decisions.
This could result in additional costs to the utilization review
organizations in training their personnel in what information is to be
collected and used in their decisions.
Training personnel in organizing and obtaining the information could be
needed so that it meets the requirements of the regulation. 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 get the care that they need.
Most of the
changes to this regulation are technical only.
The only substantive change is the requirement that utilization review
organizations must accept information from reasonably reliable sources that
will assist in the certification process.
The economic impact on those
entities that perform utilization review functions is justified in the
protection of
K.A.R. 40-4-41f. Utilization review organizations; review
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 accredit utilization review organizations nationally. These amendments
were also made after consulting with the Utilization Review Advisory
Committee. The amendments to this
particular regulation add a requirement that utilization review organizations
shall have a quality management program and what should be included in that
quality management program.
This
regulation adds the requirement that utilization review organizations have a
quality management program. This could
result in additional costs to the utilization review organizations in
implementing the quality management program.
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.
Most of the changes to this
regulation are technical only. The only
substantive change is the requirement that utilization review organizations
must ensure that the management process is not influenced by conflicts of
interest.
The economic impact on those
entities that perform utilization review functions is justified in the
protection of
K.A.R.
40-4-41i.
Utilization review organizations; program
qualifications. The purpose of this proposed
regulation is to reflect changes made by the American Accreditation Health
Commission a/k/a as URAC. This is one of
the major entities that accredit utilization review organizations nationally.
This regulation was proposed after consulting with the Utilization Review
Advisory Committee. This regulation sets
out the criteria that the scripted clinical screening or explicit clinical review
criteria shall meet if used by utilization review organizations.
This regulation sets out the
criteria that scripted clinical screening or explicit clinical review criteria
should meet if used by utilization review organizations. This could result in some additional cost to
utilization review organizations in ensuring that if they use explicit clinical
review criteria or scripted clinical screening that it meets these
criteria. 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.
There are two substantive changes
proposed in this regulation. The first
change adds the requirement that the medical director or clinical director of
each utilization review organizations must approve explicit clinical review
criteria or scripts for scripted clinical screening. The second change adds the requirement that
periodic performance evaluations must include a review of case files of each
member of the utilization review organization staff. The remaining changes are technical.
The economic impact on those
entities that perform utilization review functions is justified in the
protection of
K.A.R.
40-4-41j.
Utilization review organizations; written procedures
to maintain confidentiality. The purpose of this proposed regulation is to reflect
changes made by the American Accreditation Health Commission a/k/a as
URAC. This is one of the major entities
that accredit utilization review organizations nationally. This regulation was
proposed after consulting with the Utilization Review Advisory Committee. This regulation requires that utilization
review organizations have written polices and procedures to maintain
confidentiality of patient-specific information and what criteria those written
policies and procedure should contain.
This regulation requires utilization
review organizations have written policies and procedures to maintain
confidentiality of patient-specific information. This could result in some additional cost to
utilization review organizations in establishing and maintaining these
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 proposed regulation adds
requirements that utilization review organizations must have in its written
policies and procures as they relate to patient-specific information. The remaining changes are technical.
The economic impact on those
entities that perform utilization review functions is justified in the
protection of
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.