Effective 28 Aug 1998

354.656. Inclusion of essential community providers in health care network, exceptions. — 1. Any health care insurer offering or marketing a group policy, plan or contract for health care services in an area designated pursuant to subdivision (4) or (5) of section 354.650 shall allow each essential community provider in such designated area to submit an application to such health care insurer and provide a copy of the letter of designation as provided in section 354.654. No health care insurer shall be required to offer a provider contract to an essential community provider. The department of health and senior services shall receive any application submitted and certify, if qualified; except that the department shall only issue the first one thousand certificates for application to health maintenance organizations.

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

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

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

­­--------

(L. 1998 H.B. 1302 § 4)