KANSAS STATUTES AND CODES

40-22a16. Same; judicial review; limitation on duplicative reviews; contractual services; rules and regulations.

40-22a16

Chapter 40.--INSURANCE Article 22a.--UTILIZATION REVIEW

40-22a16. Same; judicial review; limitation onduplicative reviews; contractual services; rules and regulations.On and after January 1, 2000:

(a) The decision of theexternal review organization may be reviewed directly by the district court atthe request of either the insured, insurer or health insurance plan. Thereviewby the district court shall be de novo. The decision of theexternal review organization shall not preclude the insured, insurer or healthinsurance plan from exercising other available remedies applicable under stateor federal law. Seeking a review by the district court or any other availableremedies exercised by the insured, insurer or health insurance plan after thedecision of the external review organization will not stay the external revieworganization's decision as to the payment or provision of services to berendered during the pendency of the review by the insurer or health insuranceplan. All material used in an external review and the decision of the externalreview organization as a result of the external review shall be deemedadmissible in any subsequent litigation.

(b) In no event shall more than one external review be available during thesame year for any request arising out of the same set of facts. An insured maynot pursue, either concurrently or sequentially, an external review processunder both a federal and state law. In the event external review processes areavailable pursuant to federal law and this act, the insured shall have theoption of designating which external review process will be utilized.

(c) The commissioner of insurance is hereby authorized to negotiate and enterinto contracts necessary to perform the duties required by K.S.A.40-22a13 through 40-22a16, and amendments thereto.

(d) The commissioner of insurance shall adopt rules and regulations necessaryto carry out the purposes of K.S.A. 40-22a13 through 40-22a16, andamendments thereto. Therules and regulationsshall ensurethat the commissioner is able to provide for an effective and efficientexternal review of health care services.

History: L. 1999, ch. 162, § 9; July 1.