Kentucky Statutes 304.17A-144 – Liaison for autism spectrum disorders treatment benefits
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(1) An insurer offering a health benefit plan that provides benefits for the treatment of autism spectrum disorders shall make available to members a liaison to facilitate communication between the member and the insurer.
(2) The responsibilities of the liaison shall include but not be limited to:
(a) Explaining to the member the benefits for the treatment of autism under the member’s health benefit plan and the specific process to access those benefits;
(b) Explaining to the member the process for prior authorization of treatment, including communicating specific documentation needed from the member or provider for the insurer to consider the request;
(c) Monitoring the adjudication of the member’s claims for the treatment of autism services;
(d) Explaining to the member the proper coding to use when submitting claims for applied behavioral analysis therapy and any supporting documentation required to be attached to the claim;
(e) Explaining to the member, upon request, how claims for the treatment of autism services were adjudicated, including the application of any deductibles, copayments, coinsurance, and benefit limitations; and
(f) Explaining to the member, upon request, any appeal rights the member may have regarding coverage for the treatment of autism that has been denied or limited.
Effective: July 15, 2016
History: Created 2016 Ky. Acts ch. 102, sec. 1, effective July 15, 2016.
(2) The responsibilities of the liaison shall include but not be limited to:
Terms Used In Kentucky Statutes 304.17A-144
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Insurer: means any insurance company. See Kentucky Statutes 304.17A-005
- provider: means any:
(a) Advanced practice registered nurse licensed under KRS Chapter 314. See Kentucky Statutes 304.17A-005 - Treatment: when used in a criminal justice context, means targeted interventions
that focus on criminal risk factors in order to reduce the likelihood of criminal behavior. See Kentucky Statutes 446.010
(a) Explaining to the member the benefits for the treatment of autism under the member’s health benefit plan and the specific process to access those benefits;
(b) Explaining to the member the process for prior authorization of treatment, including communicating specific documentation needed from the member or provider for the insurer to consider the request;
(c) Monitoring the adjudication of the member’s claims for the treatment of autism services;
(d) Explaining to the member the proper coding to use when submitting claims for applied behavioral analysis therapy and any supporting documentation required to be attached to the claim;
(e) Explaining to the member, upon request, how claims for the treatment of autism services were adjudicated, including the application of any deductibles, copayments, coinsurance, and benefit limitations; and
(f) Explaining to the member, upon request, any appeal rights the member may have regarding coverage for the treatment of autism that has been denied or limited.
Effective: July 15, 2016
History: Created 2016 Ky. Acts ch. 102, sec. 1, effective July 15, 2016.