CHAPTER 14 SENATE BILL No. 411 An Act concerning health insurers; relating to utilization review organizations; amending
K.S.A. 1997 Supp. 40-22a06 and repealing the existing section. Be it enacted by the Legislature of the State of Kansas:

Section 1. K.S.A. 1997 Supp. 40-22a06 is hereby amended to read
as follows: 40-22a06. (a) No certificate shall be required for utilization
review activities conducted by or on behalf of:

(1) An agency of the federal government;

(2) a person, agency or utilization review organization acting on be-
half of the federal government, but only to the extent such person, agency
or organization is providing services under federal regulation;

(3) a federally qualified health maintenance organization authorized
to transact business in Kansas which is administering a quality assurance
program and performing utilization review activities for its own members
as required by 42 U.S.C. 300e(c)(8) and 42 U.S.C. 300e(c)(6) respectively;

(4) a person employed or used by a utilization review organization
authorized to perform utilization review in Kansas, including, but not
limited to, individual nurses and other health care providers. This ex-
emption shall not apply with respect to individual persons performing
utilization review activities in conjunction with any insurance contract or
health benefit plan pursuant to a direct contractual relationship with a
health maintenance organization, group-funded self-insurance plan or in-
surance company;

(5) a health benefit plan that is self-insured and qualified under the
federal employee retirement income security act of 1974 as amended;

(6) hospitals, home health agencies, clinics, private health care pro-
vider offices or any other authorized health care facility or entity con-
ducting general, in-house utilization review unless such review is for the
purpose of approving or denying payment for hospital or medical services
in a particular case; or

(7) utilization review organizations conducting utilization review only
with respect to mental health, chemical dependency, chiropractic, opto-
metric, podiatric, dental or any other health care service or services other
than the practice of medicine and surgery, until utilization review stan-
dards governing such treatment or service are incorporated in rules and
regulations adopted pursuant to K.S.A. 1997 Supp. 40-22a04, and amend-
ments thereto.

(b) The provisions of K.S.A. 1997 Supp. 40-22a04 (b)(2), (3), (4), (5),
(6) and subsection (c), and amendments thereto, shall not apply to:

(1) Utilization review organizations accredited by and adhering to the
national utilization review standards approved by the utilization review
accreditation commission (URAC) American accreditation health care
commission; or

(2) utilization review organizations presenting evidence satisfactory
to the commissioner that they subscribe and are adhering to the voluntary
guidelines established by the Kansas City private review group. This ex-
emption shall apply only to Kansas City private review group participants
located within the Kansas City, Missouri, and Kansas Metropolitan Sta-
tistical Area established by the federal Office of Management and Budget
as of June 30, 1993; and

(3) (2) such other utilization review organizations as the advisory com-
mittee may recommend and the commissioner approves.

Sec. 2. K.S.A. 1997 Supp. 40-22a06 is hereby repealed.

Sec. 3. This act shall take effect and be in force from and after its
publication in the statute book.

Approved February 20, 1998

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