354.656. Inclusion of essential community providers in health care network, exceptions. - Missouri Statutes

Inclusion of essential community providers in health care network,exceptions.

354.656. 1. Any health care insurer offering or marketing a grouppolicy, plan or contract for health care services in an area designatedpursuant to subdivision (4) or (5) of section 354.650 shall allow eachessential community provider in such designated area to submit an applicationto such health care insurer and provide a copy of the letter of designation asprovided in section 354.654. No health care insurer shall be required tooffer a provider contract to an essential community provider. The departmentof health and senior services shall receive any application submitted andcertify, if qualified; except that the department shall only issue the firstone thousand certificates for application to health maintenance organizations.

2. The name of each essential community provider shall appear inpublications distributed to consumers or enrollees of the policy, plan orcontract of all network model managed care plans if the essential communityprovider is a participating primary care physician.

3. Nothing in this section shall be construed to limit the ability of ahealth care insurer to terminate the contract of any physician for cause.

4. The requirements of this section shall not apply to a health careinsurer that is a medical group/staff model health maintenance organizationthat provides services to its enrollees through facilities that are owned oroperated by the health maintenance organization.

(L. 1998 H.B. 1302 § 4)