reglab/housing_qa huggingface dataset:
KS Stat § 40-3221 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 32 - Health Maintenance Organizations And Medicare Provider Organizations|40-3221 Liability of officers.

40-3221. Liability of officers. Any person who is an officer or principal managing director of the affairs of a health maintenance organization or medicare provider organization shall be fully and personally liable and accountable for any willful and intentional violations of the provisions of this act, by such person or by persons under such person's control. It is not intended through this legislation to modify the existing law of Kansas regarding personal or corporate liability for negligence or malpractice.History: L. 1974, ch. 181, § 21; L. 1998, ch. 174, § 26; July 1.
KS Stat § 40-3222 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 32 - Health Maintenance Organizations And Medicare Provider Organizations|40-3222 Use of certain words and initials prohibited.

40-3222. Use of certain words and initials prohibited. No person shall use in its name, contracts or literature the phrase "health maintenance organization" or the initials HMO unless such person is certified under the provisions of this act.History: L. 1974, ch. 181, § 22; July 1.
KS Stat § 40-3223 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 32 - Health Maintenance Organizations And Medicare Provider Organizations|40-3223 Open enrollment.

40-3223. Open enrollment. (a) After a health maintenance organization has been in operation twenty-four (24) months, it may have an annual open enrollment period of at least one month during which it accepts enrollees up to the limits of its capacity, as determined by the health maintenance organization, in the order in which they apply for enrollment. A health maintenance organization shall apply to the commissioner for authorization to impose such underwriting restrictions upon enrollment as may be deemed necessary by the health maintenance organization and the commissioner to preserve its financial stability, to prevent excessive adverse selection by prospective enrollees, or to avoid unreasonably high charges for enrollee coverage for health care services. The commissioner shall approve or deny such application within thirty (30) days of the receipt thereof from the health maintenance organization.(b) Health maintenance organizations providing or arranging for services exclusively on a group contract basis may limit the open enrollment provided for in subsection (a) to all members of the group or groups covered by such contracts.History: L. 1974, ch. 181, § 23; July 1.
KS Stat § 40-3224 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 32 - Health Maintenance Organizations And Medicare Provider Organizations|40-3224 Investments.

40-3224. Investments. With the exception of investments made in accordance with other provisions of this act, the investable funds of a health maintenance organization shall be invested only in securities or other instruments permitted by article 2a of chapter 40 of the Kansas Statutes Annotated, or acts amendatory thereof of supplemental thereto, or such other securities or investments as the commissioner may permit.History: L. 1974, ch. 181, § 24; July 1.
KS Stat § 40-3225 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 32 - Health Maintenance Organizations And Medicare Provider Organizations|40-3225 Fiduciary responsibilities; fidelity bond or insurance.

40-3225. Fiduciary responsibilities; fidelity bond or insurance. (a) Any director, officer or partner of a health maintenance organization or medicare provider organization who receives, collects, disburses or invests funds in connection with the activities of such organization shall be responsible for such funds in a fiduciary relationship to the health maintenance organization or medicare provider organization.(b) A health maintenance organization shall maintain in force a fidelity bond or fidelity insurance on such employees and officers, directors and partners in the amount not less than $250,000 for each health maintenance organization or a maximum of $5,000,000 in aggregate maintained on behalf of health maintenance organizations owned by a common parent corporation, or such sum as may be prescribed by the commissioner.History: L. 1974, ch. 181, § 25; L. 1996, ch. 169, § 10; L. 1998, ch. 174, § 27; July 1.
KS Stat § 40-3226 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 32 - Health Maintenance Organizations And Medicare Provider Organizations|40-3226 Confidentiality of medical information.

40-3226. Confidentiality of medical information. (a) Notwithstanding the provisions of K.S.A. 40-3212, and amendments thereto, any data or information pertaining to the diagnosis, treatment or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except to the extent that it may be necessary to carry out the purposes of this act, or upon the express consent of the enrollee or applicant or as otherwise provided by law, except that in no case shall the name of an enrollee or applicant be disclosed in any data pertaining to the diagnosis, treatment or health of such enrollee or applicant in any medical review procedure or in any report required under the provisions of this act or the rules and regulations issued pursuant thereto unless such enrollee or applicant has expressly consented thereto. A health maintenance organization shall be entitled to claim any statutory privileges against such disclosure which the provider who furnished such information to the health maintenance organization is entitled to claim.(b) Upon the express request of the enrollee, a complete record of any data or information pertaining to the diagnosis, treatment or health of such enrollee obtained from such person or from any provider by any health maintenance organization shall be provided to another health care provider designated by such enrollee when such enrollee is no longer an enrollee of such health maintenance organization.History: L. 1974, ch. 181, § 26; L. 1994, ch. 81, § 2; July 1.
KS Stat § 40-3228 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 32 - Health Maintenance Organizations And Medicare Provider Organizations|40-3228 Grievance procedures; minimum requirements.

40-3228. Grievance procedures; minimum requirements. A health maintenance organization shall provide in its certificate of coverage the procedures for resolving enrollee grievances. At a minimum, the certificate of coverage shall include the following provisions:(a) The definition of a grievance;(b) how, where and to whom the enrollee should file such enrollee's grievance; and(c) that upon receiving notification of a grievance related for payment of a bill for medical services, the health maintenance organization shall:(1) Acknowledge receipt of the grievance in writing within 10 working days unless it is resolved within that period of time;(2) conduct a complete investigation of the grievance within 20 working days after receipt of a grievance, unless the investigation cannot be completed within this period of time. If the investigation cannot be completed within 20 working days after receipt of a grievance, the enrollee shall be notified in writing within 30 working days time, and every 30 working days after that, until the investigation is completed. The notice shall state the reasons for which additional time is needed for the investigation;(3) have within five working days after the investigation is completed, someone not involved in the circumstances giving rise to the grievance or its investigation decide upon the appropriate resolution of the grievance and notify the enrollee in writing of the decision of the health maintenance organization regarding the grievance and of any right to appeal. The notice shall explain the resolution of the grievance and any right to appeal. The notice shall explain the resolution of the grievance in terms which are clear and specific; and(4) notify, if the health maintenance organization has established a grievance advisory panel, the enrollee of the enrollee's right to request the grievance advisory panel to review the decision of the health maintenance organization. This notice shall indicate that the grievance advisory panel is not obligated to conduct the review. This provision shall also state how, where and when the enrollee should make such enrollee's request for this review.History: L. 1996, ch. 169, § 12; July 1.
KS Stat § 40-3229 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 32 - Health Maintenance Organizations And Medicare Provider Organizations|40-3229 Prior authorization requirements for emergency medical treatment; duties and responsibilities of organization, enrollees and participating providers; resolution of disputes.

40-3229. Prior authorization requirements for emergency medical treatment; duties and responsibilities of organization, enrollees and participating providers; resolution of disputes. (a) A health maintenance organization that requires prior authorization before making payment for the treatment of medical emergency conditions, as defined by the health maintenance organization, shall provide enrollees with a toll-free telephone number answered 24 hours per day, seven days a week. At least one person with medical training who is authorized to determine whether an emergency condition exists shall be available 24 hours per day, seven days a week to make these determinations.(b) A health maintenance organization shall not base its denial of payment for emergency medical services solely on the failure of the enrollee to receive authorization prior to receiving the emergency medical service. The enrollee must notify the health maintenance organization of receipt of medical services for emergency conditions within 24 hours or as soon after that as is reasonably possible. Nothing shall require the health maintenance organization to authorize payment for any services provided during that 24 hour period, regardless of medical necessity, if those services do not otherwise constitute benefits under the certificate of coverage approved by the commissioner.(c) If the participating provider is responsible for seeking prior authorization from the health maintenance organization before receiving payment for the treatment of emergency medical conditions and the enrollee is eligible at the time when covered services are provided, then the enrollee will not be held financially responsible for payment for covered services if the prior authorization for emergency medical services has not been sought and received, other than for what the enrollee would otherwise be responsible, such as copayments and deductibles.(d) All disputes between an enrollee and a health maintenance organization arising under the provisions of this section shall be resolved by means of the grievance procedures established by the health maintenance organization.History: L. 1996, ch. 169, § 13; July 1.
KS Stat § 40-3230 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 32 - Health Maintenance Organizations And Medicare Provider Organizations|40-3230 Continuity of treatment upon termination of provider from plan.

40-3230. Continuity of treatment upon termination of provider from plan. A health maintenance organization shall establish reasonable procedures for assuring a transition of enrollees to physicians or health care providers and for continuity of treatment, including providing immediate notice to the enrollee and making available to the enrollee a current listing of preferred providers, in the event a provider's participation in the plan is terminated for any reason. The plan shall include provisions for the continuation of care to enrollees for a period up to 90 days by a provider who is terminated from a network in those cases where the continuation of such care is medically necessary and in accordance with the dictates of medical prudence and where the enrollee has special circumstances such as a disability, a life threatening illness or is in the third trimester of pregnancy. The provisions for the continuation of care shall include guarantees that the enrollee will not be liable to the provider for any amounts owed for medical care other than any deductibles or copayment amounts specified in the certificate of coverage or other contract between the enrollee and the health maintenance organization. In the event the terminated provider is authorized to continue treating the enrollee pursuant to this subsection, the health maintenance organization shall have an obligation to pay the terminated provider at the previously contracted rate for services provided to the enrollee.History: L. 1996, ch. 169, § 14; July 1.
KS Stat § 40-3232 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 32 - Health Maintenance Organizations And Medicare Provider Organizations|40-3232 Insolvent health maintenance organization; allocation of insureds to other health maintenance organizations, when; eligibility for Kansas uninsurable health insurance plan act, when.

40-3232. Insolvent health maintenance organization; allocation of insureds to other health maintenance organizations, when; eligibility for Kansas uninsurable health insurance plan act, when. (a) In the event of an insolvency of a health maintenance organization, the commissioner may order that all other carriers that participated in the enrollment process with the insolvent health maintenance organization at a group's last regular enrollment period shall offer the group's enrollees of the insolvent health maintenance organization a 30-day enrollment period commencing upon the date of insolvency. Under such order each carrier shall offer to each enrollee of the insolvent health maintenance organization the same coverages that such insolvent health maintenance organization had offered to each enrollee of the group at such group's last regular enrollment period at rates determined in accordance with the successor health maintenance organization's existing rating methodology.(b) Any individual or enrollee who has health insurance coverage involuntarily terminated because of the insolvency of such individual's or enrollee's health maintenance organization shall be treated as the equivalent of a federally defined eligible individual for the purposes of the Kansas uninsurable health insurance plan act, K.S.A. 40-2117 et seq. and amendments thereto.History: L. 2000, ch. 147, § 33; July 1.
KS Stat § 40-3233 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 32 - Health Maintenance Organizations And Medicare Provider Organizations|40-3233 Rehabilitation, liquidation or conservation of health maintenance organization; commissioner's powers; priority of enrollee; distribution of assets.

40-3233. Rehabilitation, liquidation or conservation of health maintenance organization; commissioner's powers; priority of enrollee; distribution of assets. (a) A rehabilitation liquidation or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation or conservation of an insurance company and shall be conducted under the supervision of the commissioner pursuant to the law governing the rehabilitation, liquidation or conservation of insurance companies. The commissioner may apply for an order directing the commissioner to rehabilitate, liquidate or conserve a health maintenance organization upon any one or more grounds set out in the insurers supervision, rehabilitation and liquidation act, K.S.A. 40-3605 et seq., and amendments thereto, or when in the commissioner's discretion the continued operation of such health maintenance organization would be hazardous either to the enrollees of such health maintenance organization or to the people of this state. Each enrollee of such health maintenance organization shall have the same priority in the event of liquidation or rehabilitation as the law provides to policy holders of an health organization.(b) For purpose of determining the priority of distribution of general assets, any claim of any enrollee or enrollees' beneficiary shall have the same priority as established by K.S.A. 40-3641, and amendments thereto, for policyholders and beneficiaries of insureds of insurance companies. If an enrollee is liable to a nonparticipating provider for services provided pursuant to and covered by the health maintenance organization, such liability shall have the status of such enrollee's claim for distribution of general assets. A provider who is obligated by statute or agreement to hold any enrollee harmless from liability for services provided pursuant to and covered by a health maintenance organization shall have a priority of distribution of the general assets immediately following that of enrollees and enrollees' beneficiaries as described herein, and immediately preceding the priority of distribution described in subsection (d) of K.S.A. 40-3641 and amendments thereto.History: L. 2000, ch. 147, § 34; July 1.
KS Stat § 40-3234 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 32 - Health Maintenance Organizations And Medicare Provider Organizations|40-3234 Health maintenance organization; financial condition; hearing; commissioner's powers.

40-3234. Health maintenance organization; financial condition; hearing; commissioner's powers. (a) Whenever the commissioner determines that the financial condition of a health maintenance organization is such that its continued operation might be hazardous to its enrollees, creditors or the general public, or that such health maintenance organization has violated any provisions of this act, the commissioner, after notice and hearing, may order such health maintenance organization to take action reasonably necessary to rectify the condition or violation. Such action may include, but not limited to one or more of the following:(1) Reduce the total amount of present and potential liability for benefits by reinsurance or other method acceptable to the commissioner;(2) reduce the volume of any new business being accepted;(3) reduce expenses by specified methods acceptable to the commissioner;(4) suspend or limit the writing of any new business for a period of time;(5) increase the health maintenance organization's capital and surplus by contribution; or(6) take such other steps the commissioner may deem appropriate under the circumstances.(b) The commissioner may adopt rules and regulations which set uniform standards and criteria for early warning that the continued operation of any health maintenance organization might be hazardous to its enrollees, creditors or the general public and set standards for evaluating the financial condition of any health maintenance organization.History: L. 2000, ch. 147, § 35; July 1.
KS Stat § 40-3235 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 32 - Health Maintenance Organizations And Medicare Provider Organizations|40-3235 Health maintenance organization act; provisions supplemental to.

40-3235. Health maintenance organization act; provisions supplemental to. K.S.A. 40-3231 through 40-3234, and amendments thereto, shall be part of and supplemental to the health maintenance organization act cited at K.S.A. 40-3201 et seq., and amendments thereto.History: L. 2000, ch. 147, § 36; July 1.
KS Stat § 40-3301 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 33 - Insurance Holding Companies|40-3301 Declaration of public interest and policy.

40-3301. Declaration of public interest and policy. (a) It is hereby found and declared that it may not be inconsistent with the public interest and the interest of policyholders to permit insurers to:(1) Engage in activities which would enable them to make better use of management skills and facilities;(2) diversify into new lines of business through acquisition or organization of subsidiaries;(3) have free access to capital markets which could provide funds for insurers to use in diversification programs;(4) implement sound tax planning conclusions; and(5) serve the changing needs of the public and adapt to changing conditions of the social, economic and political environment, so that insurers are able to compete effectively and to meet the growing public demand for institutions capable of providing a comprehensive range of financial services.(b) It is further found and declared that the public interest and the interests of policyholders are or may be adversely affected when:(1) Control of an insurer is sought by persons who would utilize such control adversely to the interests of policyholders;(2) acquisition of control of an insurer would substantially lessen competition or create a monopoly in the insurance business in this state;(3) an insurer which is part of a holding company system is caused to enter into transactions or relationships with affiliated companies on terms which are not fair and reasonable; or(4) an insurer pays dividends which jeopardize the financial condition of such insurer.(c) It is hereby declared that the policies and purposes of this act are to promote the public interest by:(1) Facilitating the achievement of the objectives enumerated in subsection (a) of this section;(2) requiring disclosure of pertinent information relating to changes in control of an insurer;(3) requiring disclosure by an insurer of material transactions and relationships between the insurer and its affiliates, including certain dividends paid by the insurer; and(4) providing standards governing material transactions between the insurer and its affiliates.(d) It is further declared that it is desirable to prevent unnecessary multiple and conflicting regulation of insurers. Therefore, this state shall exercise regulatory authority over domestic insurers and, unless otherwise provided in this act, not over nondomestic insurers, with respect to the matters contained herein.History: L. 1974, ch. 183, § 1; L. 1990, ch. 173, § 1; April 12.
KS Stat § 40-3309 (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 33 - Insurance Holding Companies|40-3309 Rules, regulations and orders of commissioner; hearings.

40-3309. Rules, regulations and orders of commissioner; hearings. The commissioner of insurance, upon notice and opportunity for all interested persons to be heard, may issue such rules and regulations and orders as shall be necessary to carry out the provisions of this act. Hearings on orders, as defined in subsection (d) of K.S.A. 77-502, and amendments thereto, shall be conducted in accordance with the provisions of the Kansas administrative procedure act.History: L. 1974, ch. 183, § 9; L. 1988, ch. 356, § 122; L. 2013, ch. 15, § 9; July 1.
KS Stat § 40-3311a (2021)
2021 Kansas Statutes|Chapter 40 - Insurance|Article 33 - Insurance Holding Companies|40-3311a Same; suspension, revocation or refusal to renew certificate of authority.

40-3311a. Same; suspension, revocation or refusal to renew certificate of authority. On and after July 1, 1993, when it appears to the commissioner of insurance that any person has committed a violation of this act which makes the continued operation of an insurer contrary to the interests of policyholders or the public, the commissioner of insurance may, after giving notice and an opportunity to be heard, determine to suspend, revoke or refuse to renew such insurer's license or authority to do business in this state for such period as the commissioner of insurance finds is required for the protection of policyholders or the public. Any such determination shall be accompanied by specific findings of fact and conclusions of law.History: L. 1992, ch. 288, § 8; L. 2013, ch. 15, § 11; July 1.