906 KAR 1:150. Uniform evaluation and reevaluation of a health care professional

Link to law: http://www.lrc.ky.gov/kar/906/001/150.htm
Published: 2015

      906 KAR 1:150. Uniform evaluation

and reevaluation of a health care professional.

 

      RELATES TO: KRS

304.17A-545

      STATUTORY

AUTHORITY: KRS 216B.040(3)(a), 216B.042(1)

      NECESSITY,

FUNCTION, AND CONFORMITY: KRS 216B.040(3)(a) authorizes and KRS 216B.042(1) requires

the Cabinet for Health and Family Services to establish licensure standards and

procedures to ensure safe, adequate, and efficient health facilities and health

services. KRS 304.17A-545(5) requires the executive director of the Office of

Insurance to establish a uniform application form and guidelines for evaluating

and reevaluating health care providers. This administrative regulation

establishes the requirement for uniform credentialing of a health care

professional who provides services in a health care facility or service and is

implemented in accordance with KRS 304.17A-545(5) and 806 KAR 17:480.

 

      Section 1.

Definitions. (1) "Cabinet" means the Cabinet for Health and Family

Services.

      (2)

"Credentialing" means a process to be completed before a health care

professional is granted privileges at a health facility or health service.

      (3)

"Evaluation" means:

      (a) A process for

collecting and verifying the professional qualifications of a health care

professional; and

      (b) An assessment

of whether a health care professional meets specified criteria for professional

competence and conduct.

      (4) "Health

care professional" means a:

      (a) Physician or

osteopath who is required to be licensed by KRS 311.560;

      (b) Podiatrist who

is required to be licensed by KRS 311.400;

      (c) Chiropractor

who is required to be licensed by KRS 312.018;

      (d) Dentist who is

required to be licensed by KRS 313.020;

      (e) Optometrist

who is required to be licensed by KRS 320.220;

      (f) Physician

assistant who is required to be licensed by KRS 311.844;

      (g) Advanced

registered nurse practitioner who is required to be licensed by KRS 314.042;

      (h) Nurse who is

required to be licensed by KRS 314.041;

      (i) Respiratory

care practitioner who is required to be licensed by KRS 314A.110;

      (j) Psychologist

who is required to be licensed by KRS 319.005;

      (k) Occupational

therapist who is required to be licensed by KRS 319A.080;

      (l) Physical

therapist who is required to be licensed by KRS 327.020;

      (m) Speech

language pathologist or audiologist who is required to be licensed by KRS

334A.030;

      (n) Social worker

who is required to be licensed by KRS 335.030;

      (o) Professional

counselor who is required to be licensed by KRS 335.505; or

      (p) Other

individuals who are not licensed under the Kentucky Revised Statutes who

provide health care services under the direction and supervision of a licensed

practitioner.

      (5) "Health

care provider" means a health facility or health service required to be

licensed pursuant to KRS 216B.105.

      (6) "Health

facility" is defined by KRS 216B.015(12).

      (7) "Health

service" is defined by KRS 216B.015(13).

      (8) "KAPER-1,

Part B" means a part of the Uniform Application for Provider Credentialing

and Recredentialing that implements the requirements of KRS 304.17A-545(5) and

is incorporated by reference in 806 KAR 17:480.

      (9)

"Reevaluation" or "recredentialing" means a process for

identifying a change that may have occurred in a health care professional’s

qualifications since the last evaluation or credentialing.

 

      Section 2. Health

Care Provider Credentialing Requirement. (1) A health care provider that is

required under KRS 304.17A-545(5) to perform credentialing or recredentialing

activities of a health care professional on or after July 1, 2007 shall use

Form KAPER-1, Part B, for evaluation of the credentials of health care

professionals for whom the health care provider requires credentialing.

      (2) Pursuant to

subsection (1) of this section, a health care provider shall:

      (a) Have a

mechanism for making available and accepting from a health care professional a

handwritten or electronically submitted Form KAPER-1, Part B, for:

      1. Initial

credentialing; or

      2.

Recredentialing;

      (b) Within ninety

(90) days of receipt of a Form KAPER-1, Part B:

      1. Notify the

health care professional that the Form KAPER-1, Part B, is complete or that

omitted or questionable information is included on the form; and

      2. Offer

assistance to the health care professional, if applicable; and

      (c) Within 180

days of receipt of a complete Form KAPER-1, Part B, provide a final

determination and notification electronically or in writing to a health care

professional of the status of his credentialing. This time period shall be

extended if, due to extenuating circumstances:

      1. Additional time

is required by the health care provider to consider information submitted on

the Form KAPER-1, Part B; and

      2. The health care

professional is informed of the need for additional time and reason for the

delay.

      (3) A health care

provider that performs credentialing activities shall not require the health

care professional to provide information on Form KAPER-1, Part B, which is not

relevant to the professional competence, conduct, character, scope of practice,

health care setting, or service of the health care provider.

                (4) The health care provider

shall not be prohibited from obtaining from a health care professional

supplementary credentialing materials, an original signature, or accepting an

electronic signature of the Form KAPER-1, Part B. (33 Ky.R. 2245; 3220; 3401;

eff. 6-1-2007.)
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