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

      RELATES TO: KRS 312.200(3)

      STATUTORY AUTHORITY: KRS 312.019(9)

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 312.019(9) authorizes the board to adopt administrative regulations. KRS 312.200(3) provides that persons performing peer review of chiropractic claims be licensed by the board, complete annually a board approved utilization review course, 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 those review services.

      Section 1. Definitions. (1) "Accepted standards" means those standards of care, skill, and treatment which are recognized by a reasonably prudent chiropractor as being acceptable under similar conditions and circumstances.

      (2) "Appropriate chiropractic treatment" means a determination made of treatment and other services performed which, by virtue of a substantiated and properly diagnosed condition, appear to be of a type consistent with that diagnosis.

      (3) "Bill for treatment" means all services provided to a patient, regardless of the monetary consideration paid to the chiropractor.

      (4) "Patient" means an individual who receives treatment from a chiropractor.

      (5) "Peer review" is defined by KRS 312.015(4).

      (6) "Properly utilized services" means appropriate treatment services rendered, including frequency and duration, which are substantiated as being necessary and reasonable by clinical records and reports prepared by the treating chiropractor.

      (7) "Unconscionable fees" means charges or bills for treatment submitted for services performed that are unreasonable charges for those services as compared to the usual and customary charges by chiropractors for the same or similar services in the locality where the services were performed.

      Section 2. Requirements for Licensure and Registration. In order to be licensed to perform a chiropractic peer review, a chiropractor

      (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, he shall have previously successfully completed a course consisting of a minimum of 100 hours of utilization review and independent medical examination from a chiropractic college accredited by the Council on Chiropractic Education; and

      (b) for each year thereafter that a person seeks to register to perform peer review, he shall have completed six (6) hours of utilization review offered by a chiropractic college 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 set out in this section and of having met the education requirements of KRS 312.175; and

      (b) Paying a registration fee of twenty (20).

      Section 3. 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 set forth in 201 KAR 21:015; and

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

      (5) Sign all reports, except when 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.

      Section 4. Incorporation by Reference. (1) "Registration/Renewal for Persons Performing Peer Review of Chiropractic Claims in Kentucky", 6/09, 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 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.)