Kentucky Statutes 304.38-075 – Requirements for transfer of risk to provider — Additional reserves may be required
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(1) Any health maintenance organization that contracts with a provider or provider organization for the transfer of risk to the provider shall take reasonable steps to ensure the transferee is able to accept and manage the risk to be transferred. The health maintenance organization shall submit a plan for evaluating a provider’s or provider organization’s ability to accept and manage risk to the department for approval at least forty-five (45) days prior to the proposed date of the transfer of any risk.
(2) If a health maintenance organization transfers risk to a provider:
(a) Not in compliance with the standards listed in its approved plan; or
(b) Prior to filing or receiving approval of its plan;
the commissioner may require the health maintenance organization to retain additional reserves to cover the risk transferred.
Effective: July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1505, effective July 15, 2010. — Created
2000 Ky. Acts ch. 255, sec. 3, effective July 14, 2000.
(2) If a health maintenance organization transfers risk to a provider:
Terms Used In Kentucky Statutes 304.38-075
- Commissioner: means the commissioner of the Department of Insurance. See Kentucky Statutes 304.38-030
- Health maintenance organization: means any person who undertakes to provide, directly or through arrangements with others, health care services to individuals enrolled with such an organization on a per capita or a predetermined, fixed prepayment basis. See Kentucky Statutes 304.38-030
- Provider: means a person or group of persons licensed to practice medicine, osteopathy, dentistry, podiatry, optometry, or another health profession in a state or licensed to act as a hospital or another health care facility. See Kentucky Statutes 304.38-030
(a) Not in compliance with the standards listed in its approved plan; or
(b) Prior to filing or receiving approval of its plan;
the commissioner may require the health maintenance organization to retain additional reserves to cover the risk transferred.
Effective: July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1505, effective July 15, 2010. — Created
2000 Ky. Acts ch. 255, sec. 3, effective July 14, 2000.