Session of 1998
SENATE BILL No. 662
By Senators Brownlee, Harrington, Jordan, Salmans,
AN ACT relating to managed care; patient protection
11 K.S.A. 1997 Supp.
40-4602 and 40-4607 and repealing the existing
14 Be it enacted by the Legislature of the
State of Kansas:
15 Section 1. K.S.A.
1997 Supp. 40-4602 is hereby amended to read as
16 follows: 40-4602. As used in this act:
17 (a) ``Emergency medical
condition'' means the sudden and, at the
18 time, unexpected onset of a health
condition that requires immediate
19 medical attention, where failure to provide
medical attention would result
20 in serious or painful impairment to
bodily functions or serious dysfunction
21 of a bodily organ or part, or would place
the person's health in serious
23 (b) ``Emergency
services'' means ambulance services and health care
24 items and services furnished or required to
evaluate and treat an emer-
25 gency medical condition, as directed or
ordered by a physician.
26 (c) ``Health benefit
plan'' means any hospital or medical expense pol-
27 icy, health, hospital or medical service
corporation contract, a plan pro-
28 vided by a municipal group-funded pool, a
policy or agreement entered
29 into by a health insurer or a health
maintenance organization contract
30 offered by an employer or any certificate
issued under any such policies,
31 contracts or plans. ``Health benefit plan''
does not include policies or
32 certificates covering only accident,
credit, dental, disability income,
33 long-term care, hospital indemnity,
medicare supplement, specified dis-
34 ease, vision care, coverage issued as a
supplement to liability insurance,
35 insurance arising out of a workers
compensation or similar law, automo-
36 bile medical-payment insurance, or
insurance under which benefits are
37 payable with or without regard to fault and
which is statutorily required
38 to be contained in any liability insurance
policy or equivalent self-insur-
40 (d) ``Health insurer''
means any insurance company, nonprofit med-
41 ical and hospital service corporation,
municipal group-funded pool, fra-
42 ternal benefit society, health maintenance
organization, or any other en-
43 tity which offers a health benefit plan
subject to the Kansas Statutes
2 (e) ``Insured''
means a person who is covered by a health benefit plan.
(f) ``Participating provider'' means a provider who, under a
4 with the health insurer or with its
contractor or subcontractor, has agreed
5 to provide one or more health care
services to insureds with an expec-
6 tation of receiving payment, other
than coinsurance, copayments or de-
7 ductibles, directly or indirectly
from the health insurer.
8 (g) ``Provider''
means a physician, hospital or other person which is
9 licensed, accredited or certified to
perform specified health care services.
10 (h) ``Provider network''
means those participating providers who have
11 entered into a contract or agreement with a
health insurer to provide
12 items or health care services to
individuals covered by a health benefit
13 plan offered by such health insurer.
14 (i) ``Physician'' means
a person licensed by the state board of healing
15 arts to practice medicine and surgery.
16 Sec. 2. K.S.A. 1997
Supp. 40-4607 is hereby amended to read as
17 follows: 40-4607. (a) A health insurer
providing a health benefit plan shall
18 maintain a provider network that is
sufficient in numbers and types of
19 providers to assure that all covered
services to an insured will be acces-
20 sible without unreasonable delay.
Sufficiency of the provider network
21 shall be determined in accordance with the
requirements of this section,
22 and may be established by reference to any
reasonable criteria used by
23 the health insurer, including but not
limited to: provider-insured ratios
24 by specialty; primary care provider-insured
ratios; geographic accessibility
25 to the residence or place of employment
of the insured; waiting times for
26 appointments with participating providers;
hours of operation; and the
27 availability of technological and specialty
services to serve the needs of
28 insureds requiring technologically advanced
or specialty care. In order to
29 be considered reasonable under this
subsection, primary care providers
30 shall be subject to contact for the
purpose of referral by the easiest means
31 of communication, including telephone,
fax and other electronic means of
32 communication. In the temporary absence
of the primary care provider,
33 an alternative provider shall be
available 24 hours per day, seven days a
34 week, without a referral required in the
case of an acute, nonemergency
36 (b) A health insurer
shall have a plan by which an insured with a life-
37 threatening, chronic, degenerative or
disabling condition or disease,
38 which requires specialized medical care
over a prolonged period of time,
39 may receive a referral to a specialist with
expertise in treating such disease
40 or condition who shall be responsible for
and capable of providing and
41 coordinating the insured's specialty care.
Such a referral shall have a
42 duration of effectiveness of two years,
beginning on the day the referral
43 is made.
1 (c) Nothing in
this section shall require a health insurer to provide
2 benefits not otherwise covered by the
terms of the health benefits plan.
3 (d) A provider
network shall not be determined to be insufficient for
4 failure to contract with any provider
unwilling to contract under the same
5 terms and conditions, including
reimbursement levels, as such health in-
6 surer offers to other similarly
situated health care providers.
Sec. 3. When a health insurer designates or requires the
8 ignation of a primary care physician
such physician, in the case of a female
9 insured or her female dependent, may
be an obstetrician/gynecologist.
10 Sec. 4. K.S.A. 1997
Supp. 40-4602 and 40-4607 are hereby repealed.
11 Sec. 5. This act
shall take effect and be in force from and after its
12 publication in the statute book.