354.560. Payment arrangements, department to adopt rules--disclosure of financial arrangements--confidentiality.

MISSOURI STATUTES AND CODES

354.560. Payment arrangements, department to adopt rules--disclosure of financial arrangements--confidentiality.

Payment arrangements, department to adopt rules--disclosure offinancial arrangements--confidentiality.

354.560. 1. The director of the department of insurance, financialinstitutions and professional registration shall adopt rules governing the useof payment arrangements by community-based health maintenance organizationswhich use payment withholding arrangements that place a physician atsubstantial financial risk. The standards for determining substantialfinancial risk and determining which payment arrangements are subject to rulesshall be the same as provided for health maintenance organizations andcompetitive medical plans contracting with the Medicare program, as providedin 42 CFR 417.479, or its successor regulation.

2. The department of insurance, financial institutions and professionalregistration may require that community-based health maintenance organizationsdisclose to the department financial arrangements or contractual provisionsthat place a physician at substantial financial risk. Such financialarrangements and contractual provisions which constitute substantial financialrisk for the physician shall be reviewed by the department and shall be deemedapproved if not disapproved by the director of the department within thirtydays from the date that they are filed with the department.

3. The department of insurance, financial institutions and professionalregistration shall promulgate rules governing the confidentiality ofproprietary information disclosed to the department pursuant to this section.Proprietary information disclosed pursuant to this section shall not beconstrued to be a public record as defined in chapter 610, RSMo.