354.443. Financial disclosures to the department required by health maintenance organizations, when. - Missouri Statutes

Financial disclosures to the department required by healthmaintenance organizations, when.

354.443. 1. A health maintenance organization shall disclose to thedepartment of insurance, financial institutions and professional registrationall financial arrangements, financial interest in, or contractual provisionswith utilization review companies or any other health care provider that wouldencourage or limit the type, amount, duration and scope of services offered,restrict or limit referral or treatment to patients, including but not limitedto financial incentives to limit, restrict or deny access to or delivery ofmedical or other services prior to the delivery of such services. Capitationarrangements between health maintenance organizations and health careproviders shall not be considered an inducement to limit, restrict or denyaccess to medical services. The director shall review all financialarrangements filed with the department of insurance, financial institutionsand professional registration to determine if such arrangements offer aninducement to a provider to provide less than medically necessary services toan enrollee.

2. The capitation rate to be paid from the health maintenanceorganization to the health care provider is not required to be included withthe financial arrangements to be filed with the department of insurance,financial institutions and professional registration pursuant to subsection 1of this section.

(L. 1997 H.B. 335)