201 KAR 21:095. Licensure, registration, and standards of persons performing peer review.

 

      RELATES TO: KRS 312.175, 312.200(3)

      STATUTORY AUTHORITY: KRS 312.019(9)

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 312.019(9) authorizes the board to promulgate administrative regulations. KRS 312.200(3) requires that persons performing peer review of chiropractic claims be licensed by the board, complete annually a board approved utilization review course, and annually register with the board and pay a registration fee. This administrative regulation establishes the requirements for the licensure, review course, registration, and registration fee for persons to perform peer review services.

 

      Section 1. Requirements for Licensure and Registration. A person performing chiropractic peer review shall:

      (1) Hold a current active license to practice chiropractic within the Commonwealth of Kentucky;

      (2) (a) For the first year that a person seeks to register to perform peer review, have previously successfully completed a course consisting of a minimum of 100 hours of utilization review and independent medical examination from a chiropractic college or university accredited by the Council on Chiropractic Education; and

      (b) For each year thereafter that a person seeks to register to perform peer review, have completed six (6) hours of utilization review offered by a chiropractic college or university accredited by the Council on Chiropractic Education, which shall be obtained within the Commonwealth of Kentucky; and

      (3) Register annually with the board, by June 1 of each year, by:

      (a) Presenting evidence of satisfactory compliance with the requirements established in this section and of having met the education requirements of KRS 312.175;

      (b) Completing the Registration Form for Persons Performing Peer Review of Kentucky Chiropractic Claims; and

      (c) Paying a registration fee of fifty (50) dollars.

 

      Section 2. In performing peer review activities, a licensee shall:

      (1) Render the actual review service and documented report;

      (2) Personally retain a copy of all records associated with each peer review case for a minimum of seven (7) years;

      (3) Employ minimum standards associated with the practice of chiropractic and comply with the code of ethical conduct established in 201 KAR 21:015;

      (4) Provide a report that includes the rationale for the determination in order that the licensee provider is given adequate information to appeal;

      (5) Sign all reports, unless the review is performed under the Kentucky Chiropractic Board of Examiners Peer Review Committee, in which case, the board’s administrator or designee shall sign the determination;

      (6) Review in accordance with accepted standards as defined in 201 KAR 21:001;

      (7) Review thoroughly and rely on all documents provided to the reviewer;

      (8) List in the resulting report all documents provided to the reviewer and list all documents reviewed; and

      (9) Personally conduct the review and prepare the report.

 

      Section 3. Complaint Procedure Related to Peer Reviewers. A complaint against a peer reviewer alleging a violation of this administrative regulation or any other provision of KRS Chapter 312 or 201 KAR Chapter 21 shall be filed and processed according to the procedure established in 201 KAR 21:051.

 

      Section 4. Incorporation by Reference. (1) "Registration Form for Persons Performing Peer Review of Kentucky Chiropractic Claims", 2013, is incorporated by reference.

      (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Kentucky Board of Chiropractic Examiners, 209 South Green Street, Glasgow, Kentucky 42141, Monday through Friday, 8:00 a.m. to 4:30 p.m. (19 Ky.R. 1934; Am. 2238; eff. 3-17-1993; 35 Ky.R. 2126; 2770; 36 Ky.R. 29; eff. 7-31-2009; 40 Ky.R. 1421; eff. 3-20-2014.)