Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO:
KRS
312.175,
312.200(3)
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
312.019(9) authorizes the
board to promulgate administrative regulations consistent with KRS Chapter 312
governing the practice of chiropractic.
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 continuing education in topics specifically related to utilization
review and approved by the board to meet this requirement; 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 Application for
Chiropractic Peer Reviewer; 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) "Application for Chiropractic Peer
Reviewer", DPL-KBCE-02, March 2023, 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, 500 Mero Street, Frankfort, Kentucky 40601, Monday
through Friday, 8:00 a.m. to 4:00 p.m. This material is also available on the
board's Web site at
www.kbce.ky.gov.
STATUTORY AUTHORITY:
KRS
312.019(9)
