40-3211. Examination of organizations and providers.
40-3211
40-3211. Examination oforganizations and providers.(a) The commissioner may make an examination of the affairs of anyhealth maintenance organization or medicare provider organization andproviders with whom suchorganization has contracts, agreements orother arrangements as often asthe commissioner deems it necessary for the protection of the interestsof the people of this state but not less frequently than once everythree years.
(b) At least once every three years and atsuch other times as the commissioner may require, a health maintenanceorganization or medicare provider organization shall obtain an on-sitequality of care assessment by anindependent quality review organization acceptable to the commissioner forthe purpose of evaluating levels of health care delivery according toindustry standards as prevailing from time to time. The findings of saidindependent quality review organization shall be expressed by it in awritten opinion relating to the general quality of care providedby the health maintenance organization or medicare provider organizationand its related contractors ofhealth care services. Failure to obtain such quality of care assessment orthe rendering of an unfavorable opinion by the independent quality revieworganization shall give the commissioner cause to institute action inaccordance with K.S.A. 40-3205, 40-3206 or 40-3207, and amendments thereto.
(c) Every health maintenance organization or medicareprovider organization and any of the medicare provider organization providersshall submitits books and records relating its operation to such examinations.Medical records of individuals and records of providers under a contractto the health maintenance organization or medicare provider organizationshall be subject to suchexamination, but the identity of patients shall not be disclosed in anyreport to the commissioner or the commissioner's agents orrepresentatives. For the purpose of examinations, the commissioner mayadminister oaths to, and examine the officers and agents of the healthmaintenance organization or medicare provider organization and theprincipals of such providers.
(d) The fees and expenses of examinations under this section shallbe assessed against the organization being examined and remitted to thecommissioner. The fees and expenses of the commissioner shall be inaccordance with K.S.A. 40-223, and amendments thereto.
(e) In lieu of such examination, the commissioner may accept thereport of an examination made by the appropriate examining agency orofficial of another state or agency of the federal government.
History: L. 1974, ch. 181, § 11;L. 1975, ch. 462, § 52;L. 1987, ch. 175, § 1;L. 1998, ch. 174, § 20; July 1.