40-22a06. Same; certificate not required for certain review activities; certain provisions not applicable to certain organizations.
40-22a06
40-22a06. Same; certificate not required for certainreview activities; certain provisions not applicable to certainorganizations.(a) No certificate shall be required for utilization review activitiesconducted by or on behalf of:
(1) An agency of the federal government;
(2) a person, agency or utilization review organization acting on behalf ofthe federal government, but only to the extent such person, agency ororganization is providing services under federal regulation;
(3) a federally qualified health maintenance organization authorized totransact business in Kansas which is administering a quality assurance programand performing utilization review activities for its own members as required by42 U.S.C. 300e(c)(8) and 42 U.S.C. 300e(c)(6) respectively;
(4) a person employed or used by a utilization review organizationauthorized to perform utilization review in Kansas, including, but not limitedto, individual nurses and other health care providers. This exemption shallnot apply with respect to individual persons performing utilization reviewactivities in conjunction with any insurance contract or health benefit planpursuant to a direct contractual relationship with a health maintenanceorganization, group-funded self-insurance plan or insurance company;
(5) a health benefit plan that is self-insured and qualified under thefederal employee retirement income security act of 1974 as amended;
(6) hospitals, home health agencies, clinics, private health care provideroffices or any other authorized health care facility or entity conductinggeneral, in-house utilization review unless such review is for the purpose ofapproving or denying payment for hospital or medical services in a particularcase; or
(7) utilization review organizations conducting utilization review onlywith respect to mental health, chemical dependency, chiropractic, optometric,podiatric, dental or any other health care service or services other than thepractice of medicine and surgery, until utilization review standards governingsuch treatment or service are incorporated in rules and regulations adoptedpursuant to K.S.A. 40-22a04, and amendments thereto.
(b) The provisions of K.S.A. 40-22a04 (b)(2), (3), (4), (5), (6)and subsection (c), and amendments thereto, shall not apply to:
(1) Utilization review organizations accredited by and adhering to thenational utilization review standards approved by the American accreditationhealth care commission; or
(2) such other utilization review organizations as the advisorycommittee may recommend and the commissioner approves.
History: L. 1994, ch. 238, § 6;L. 1998, ch. 14, § 1; July 1.