98RS HB847


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HB 847 (BR 2676) - J. Gray, J. Haydon

     AN ACT relating to workers' compensation.
     Amend KRS 342.020 to permit injured employees to choose their own primary care provider from providers within a managed care plan; permit injured employees to have access to specialists, in or out of the network, if their medical condition warrants it; require managed care plans to provide for second opinions and make these referrals to qualified doctors located in areas convenient to an employee; allow employees to appeal denials of coverage in a manner prescribed by the commissioner; require plans to offer out-of-network services, and require plans that do not offer such services to do so within 365 days of the effective date of this Act; and require plans to establish a drug utilization program as part of the current utilization review procedure; create new sections of KRS Chapter 342 to require the disclosure of information about the terms, conditions, and changes made to a plan's health care contract to covered employees at the time of treatment, referral, or upon request; require plans to provide an employee with a provider directory including information on participating health care facilities and other providers, customary waiting times for appointments for routine and emergency care, and information on whether a provider is board certified, has been disciplined in the past five (5) year, or has charges for medical malpractice or malfeasance pending; require plans to establish objective criteria for the consideration of and maintenance of providers in their network, and prohibit plans from discriminating against providers based on their location, type of practice (e.g., work-related injuries and occupational diseases) or the populations they serve; require plans to have an adequate number of providers (primary care and specialists) throughout the plan's service area; require plans to cover emergency room services that a prudent lay person would reasonably believe constitute an emergency; require plans to notify employees and arrange for continuing treatment when their provider is suspended or terminated from the plan; require the medical director of a plan to notify state licensing official, the commissioner, the employee, and his or her employer when a provider is determined to present an imminent danger to a patient or the public health; prohibit a plan from limiting a provider's disclosure about services or financial incentives to an employee or another person on behalf of the employee; require that any limits or restriction placed on services be fully disclosed in the health insurance policy or certificate of coverage; require that any insurer denying an employee coverage notify the employee in writing in a manner prescribed by the commissioner; and require a plan to develop quality assurance standards.

     Mar 3-introduced in House
     Mar 4-to Labor and Industry (H)

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