Section 354.443

Title XXIII CORPORATIONS, ASSOCIATIONS AND PARTNERSHIPS

Chapter 354

Effective - 28 Aug 1997   

  354.443.  Financial disclosures to the department required by health maintenance organizations, when. — 1.  A health maintenance organization shall disclose to the department of commerce and insurance all financial arrangements, financial interest in, or contractual provisions with utilization review companies or any other health care provider that would encourage or limit the type, amount, duration and scope of services offered, restrict or limit referral or treatment to patients, including but not limited to financial incentives to limit, restrict or deny access to or delivery of medical or other services prior to the delivery of such services.  Capitation arrangements between health maintenance organizations and health care providers shall not be considered an inducement to limit, restrict or deny access to medical services.  The director shall review all financial arrangements filed with the department of commerce and insurance to determine if such arrangements offer an inducement to a provider to provide less than medically necessary services to an enrollee.

  2.  The capitation rate to be paid from the health maintenance organization to the health care provider is not required to be included with the financial arrangements to be filed with the department of commerce and insurance pursuant to subsection 1 of this section.

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(L. 1997 H.B. 335)