Ky. Rev. Stat. § 304.17A-545. Medical director for managed care plan; duties; quality assurance or improvement standards; process to select health care providers; uniform application form and guidelines for health care provider evaluations: Managed Care Plans – Kentucky

Status: Enacted
Year Enacted: 1998
Year Amended: 2010
File: Download

The medical director shall ensure that any utilization management decision to deny, reduce, or terminate a health care benefit or to deny payment for a health care service because that service is not medically necessary shall be made by a physician. A managed care plan shall develop comprehensive quality assurance or improvement standards adequate to identify, evaluate, and remedy problems relating to access, continuity, and quality of health care services.

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