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

      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.)

Notation

      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.