|
The following Advisory Opinion is to advise the
reader of the current position of the Kentucky Department of
Insurance ("the Department") on the specified issue. The Advisory
Opinion is not legally binding on either the Department or the
reader.
Kentucky Department of
Insurance
Advisory Opinion 2000-01
In re: Providers Protected Under the
Any Willing Provider Law
RELEVANT FACTS AND STATUTES: Questions have emerged concerning who is protected under KRS
304.17A-270, Kentucky’s any willing provider law. The statutes that
are relevant are KRS 304.17A-270, KRS 304.17A-250, KRS
304.17A-005(18), 806 KAR 17:180.
KRS 304.17A-250 required the commissioner to, "… by
administrative regulations promulgated under KRS Chapter 13A, define
one (1) standard health benefit plan that shall provide health
insurance coverage in the individual and small group markets after
June 30, 1998." In 806 KAR 17:180 the Department established the
standard health benefit plan.
DEPARTMENT’S POSITION:
It is the Department’s position that the
providers specifically listed in KRS 304.17A-005(18) that are
willing to meet the health benefit plan’s terms and conditions must
be allowed to participate as a network provider. Every health
benefit plan issued by an insurer must comply with the any willing
provider law in relation to these providers. However, if a person is
not specifically licensed as cited in KRS 304.17A-005(18) that
person is not a provider for purposes of the any willing provider
law.
In contrast, all the providers listed
in the definition of provider in the standard health benefit
plan, as defined in 806 KAR 17:180, must be allowed to participate
as a network provider for the standard health benefit plan.
The Department, in developing the
standard health benefit plan, sets the standards under which the
plan is to operate. For this reason, the Department is of the
opinion that all providers listed in the definition of
provider found in the standard health benefit plan must be allowed
to participate with that plan. Therefore, any such provider cannot
be excluded from rendering services under the standard health
benefit plan unless the provider does not meet any standards
developed pursuant to KRS 304.17A-525.
Any questions regarding this matter
may be directed to Shaun T. Orme, Counsel for the Department at
(502) 564-6032.
______________________________
George Nichols III,
Commissioner
Kentucky Department of
Insurance
|
