40-22a05.Same; advisory committee; membership;rules and regulations; act not applicable to certain reviews andprograms.(a) There is hereby created an advisory committee which shallassist the commissioner in the adoption of rules and regulations to implementthe provisions of this act. The advisory committee shall consist of 13 personsappointed by the commissioner as follows:
(1) The commissioner, or the designee of the commissioner, who shall be thechairperson;
(2) one member appointed from the public at large;
(3) four members who are representatives of utilization revieworganizations; and
(4) seven members who are representatives of health care providers, one ofwhich shall be a representative of a Kansas hospital, and two of which shall bepersons licensed to practice medicine and surgery in Kansas.
(b) Members of the advisory committee shall be appointed for a term ofthree years, except that the first term of office of two membersrepresenting utilization review organizations and two members representinghealth care providers shall be for a term of two years, and the firstterm for two members representing health care providers and onemember representing utilization review organizations shall be for a term ofone year.
(c) The advisory committee shall be attached to the insurance department,and all administrative functions of the advisory committee shall be under thedirection and supervision of the commissioner. Within available appropriationstherefor, members of the advisory committee shall be paid subsistenceallowances, mileage and other expenses as provided in subsection (e) of K.S.A.75-3223 and amendments thereto.
(d) Before adopting rules and regulations to carry out the provisions ofthis act, the commissioner with the advice of the advisory committee shall:
(1) Establish utilization review standards which provide for uniformity inthe procedures for interaction between utilization review organizations andhealth care providers, payors and consumers of health care;
(2) establish utilization review procedures that prevent unnecessary andinappropriate disruption to the health care delivery system;
(3) strive to achieve an efficient process for the certification ofutilization review organizations; and
(4) specify the kinds of insurance or types of insurance products to whichthe standards apply and the scope of such application.
(e) This act shall not apply to:
(1) Utilization review of health care services provided to patients underthe authority of the Kansas workers compensation act (K.S.A. 44-501 etseq., and amendments thereto);
(2) reviews conducted by any insurance company, health maintenanceorganization, prepaid service plan, group-funded self-insured plan or similarentity solely for the purpose of determining compliance with the specific termsand conditions of an insurance policy, agreement or contract as a part of thenormal claim settlement process; or
(3) any medical programs operated by the secretary of social andrehabilitation services or any entity to the extent it is acting under contractwith the secretary.
40-22a05.Same; advisory committee; membership;rules and regulations; act not applicable to certain reviews andprograms.(a) There is hereby created an advisory committee which shallassist the commissioner in the adoption of rules and regulations to implementthe provisions of this act. The advisory committee shall consist of 13 personsappointed by the commissioner as follows:
(1) The commissioner, or the designee of the commissioner, who shall be thechairperson;
(2) one member appointed from the public at large;
(3) four members who are representatives of utilization revieworganizations; and
(4) seven members who are representatives of health care providers, one ofwhich shall be a representative of a Kansas hospital, and two of which shall bepersons licensed to practice medicine and surgery in Kansas.
(b) Members of the advisory committee shall be appointed for a term ofthree years, except that the first term of office of two membersrepresenting utilization review organizations and two members representinghealth care providers shall be for a term of two years, and the firstterm for two members representing health care providers and onemember representing utilization review organizations shall be for a term ofone year.
(c) The advisory committee shall be attached to the insurance department,and all administrative functions of the advisory committee shall be under thedirection and supervision of the commissioner. Within available appropriationstherefor, members of the advisory committee shall be paid subsistenceallowances, mileage and other expenses as provided in subsection (e) of K.S.A.75-3223 and amendments thereto.
(d) Before adopting rules and regulations to carry out the provisions ofthis act, the commissioner with the advice of the advisory committee shall:
(1) Establish utilization review standards which provide for uniformity inthe procedures for interaction between utilization review organizations andhealth care providers, payors and consumers of health care;
(2) establish utilization review procedures that prevent unnecessary andinappropriate disruption to the health care delivery system;
(3) strive to achieve an efficient process for the certification ofutilization review organizations; and
(4) specify the kinds of insurance or types of insurance products to whichthe standards apply and the scope of such application.
(e) This act shall not apply to:
(1) Utilization review of health care services provided to patients underthe authority of the Kansas workers compensation act (K.S.A. 44-501 etseq., and amendments thereto);
(2) reviews conducted by any insurance company, health maintenanceorganization, prepaid service plan, group-funded self-insured plan or similarentity solely for the purpose of determining compliance with the specific termsand conditions of an insurance policy, agreement or contract as a part of thenormal claim settlement process; or
(3) any medical programs operated by the secretary of social andrehabilitation services or any entity to the extent it is acting under contractwith the secretary.
40-22a05.Same; advisory committee; membership;rules and regulations; act not applicable to certain reviews andprograms.(a) There is hereby created an advisory committee which shallassist the commissioner in the adoption of rules and regulations to implementthe provisions of this act. The advisory committee shall consist of 13 personsappointed by the commissioner as follows:
(1) The commissioner, or the designee of the commissioner, who shall be thechairperson;
(2) one member appointed from the public at large;
(3) four members who are representatives of utilization revieworganizations; and
(4) seven members who are representatives of health care providers, one ofwhich shall be a representative of a Kansas hospital, and two of which shall bepersons licensed to practice medicine and surgery in Kansas.
(b) Members of the advisory committee shall be appointed for a term ofthree years, except that the first term of office of two membersrepresenting utilization review organizations and two members representinghealth care providers shall be for a term of two years, and the firstterm for two members representing health care providers and onemember representing utilization review organizations shall be for a term ofone year.
(c) The advisory committee shall be attached to the insurance department,and all administrative functions of the advisory committee shall be under thedirection and supervision of the commissioner. Within available appropriationstherefor, members of the advisory committee shall be paid subsistenceallowances, mileage and other expenses as provided in subsection (e) of K.S.A.75-3223 and amendments thereto.
(d) Before adopting rules and regulations to carry out the provisions ofthis act, the commissioner with the advice of the advisory committee shall:
(1) Establish utilization review standards which provide for uniformity inthe procedures for interaction between utilization review organizations andhealth care providers, payors and consumers of health care;
(2) establish utilization review procedures that prevent unnecessary andinappropriate disruption to the health care delivery system;
(3) strive to achieve an efficient process for the certification ofutilization review organizations; and
(4) specify the kinds of insurance or types of insurance products to whichthe standards apply and the scope of such application.
(e) This act shall not apply to:
(1) Utilization review of health care services provided to patients underthe authority of the Kansas workers compensation act (K.S.A. 44-501 etseq., and amendments thereto);
(2) reviews conducted by any insurance company, health maintenanceorganization, prepaid service plan, group-funded self-insured plan or similarentity solely for the purpose of determining compliance with the specific termsand conditions of an insurance policy, agreement or contract as a part of thenormal claim settlement process; or
(3) any medical programs operated by the secretary of social andrehabilitation services or any entity to the extent it is acting under contractwith the secretary.
