Kentucky Statutes 304.17A-530 – Prohibition against contract limiting disclosure to patient of patient medical condition or treatment options
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(1) A managed care plan may not contract with a health care provider to limit the provider’s disclosure to an enrollee, or to another person on behalf of an enrollee, of any information relating to the enrollee’s medical condition or treatment options.
(2) A health care provider shall not be penalized, or a health care provider’s contract with a managed care plan terminated, because the provider discusses medically necessary or appropriate care with an enrollee or another person on behalf of an enrollee.
(a) The health care provider may not be prohibited by the plan from discussing all treatment options with the enrollee.
(b) Other information determined by the health care provider to be in the best interests of the enrollee may be disclosed by the provider to the enrollee or to another person on behalf of an enrollee.
(3) (a) A health care provider shall not be penalized for discussing financial incentives and financial arrangements between the provider and the insurer with an enrollee.
(b) Upon request, a managed care plan shall inform its enrollees in writing of the type of financial arrangements between the plan and participating providers if those arrangements include an incentive or bonus.
Effective: April 10, 1998
History: Created 1998 Ky. Acts ch. 496, sec. 31, effective April 10, 1998.
(2) A health care provider shall not be penalized, or a health care provider’s contract with a managed care plan terminated, because the provider discusses medically necessary or appropriate care with an enrollee or another person on behalf of an enrollee.
Terms Used In Kentucky Statutes 304.17A-530
- Contract: A legal written agreement that becomes binding when signed.
- Insurer: means any insurance company. See Kentucky Statutes 304.17A-005
- Managed care: means systems or techniques generally used by third-party payors or their agents to affect access to and control payment for health care services and that integrate the financing and delivery of appropriate health care services to covered persons by arrangements with participating providers who are selected to participate on the basis of explicit standards for furnishing a comprehensive set of health care services and financial incentives for covered persons using the participating providers and procedures provided for in the plan. 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) The health care provider may not be prohibited by the plan from discussing all treatment options with the enrollee.
(b) Other information determined by the health care provider to be in the best interests of the enrollee may be disclosed by the provider to the enrollee or to another person on behalf of an enrollee.
(3) (a) A health care provider shall not be penalized for discussing financial incentives and financial arrangements between the provider and the insurer with an enrollee.
(b) Upon request, a managed care plan shall inform its enrollees in writing of the type of financial arrangements between the plan and participating providers if those arrangements include an incentive or bonus.
Effective: April 10, 1998
History: Created 1998 Ky. Acts ch. 496, sec. 31, effective April 10, 1998.