376.1514. Written agreement required, contents.

MISSOURI STATUTES AND CODES

376.1514. Written agreement required, contents.

Written agreement required, contents.

376.1514. 1. All providers offering medical services to membersunder a discount medical plan shall provide such services pursuant to awritten agreement. The agreement may be entered into directly by thehealth care provider or by a health care provider network to which theprovider belongs if the provider network has contracts with the health careprovider that allow the provider network to contract on behalf of thehealth care provider.

2. A health care provider agreement shall provide the following:

(1) A description of the services and products to be provided at adiscount;

(2) The amount or amounts of the discounts or, alternatively, a feeschedule which reflects the health care provider's discounted rates; and

(3) A provision that the health care provider will not charge membersmore than the discounted rates.

3. A health care provider agreement with a health care providernetwork shall require that the health care provider network have writtenagreements with its health care providers that:

(1) Contain the terms described in this subsection;

(2) Authorize the health care provider network to contract with thediscount medical plan organization on behalf of the provider; and

(3) Require the network to maintain an up-to-date list of itscontracted health care providers and to provide that list on a quarterlybasis to the discount medical plan organization.

4. A health care provider agreement between a discount medical planorganization and an entity that contracts with a health care providernetwork shall require that the entity, in its contract with the health careprovider network, require the health care provider network to have writtenagreements with its providers that comply with subsection 3 of thissection.

5. The discount medical plan organization shall maintain a copy ofeach active health care provider agreement into which it has entered.