☰ Revisor of Missouri


Chapter 354

< > Effective - 28 Aug 1997    bottom

  354.552.  Community-based health maintenance organizations, requirements. — 1.  A community-based health maintenance organization shall have available and accessible a sufficient number and type of physicians, specialists, and other providers as needed to:

  (1)  Provide the benefits covered by the plan;

  (2)  Meet the medical needs of the health plan's enrolled population;

  (3)  Provide members with a reasonable choice of primary care physicians and specialty physicians.

  2.  If a community-based health maintenance organization does not employ or contract with a physician with the expertise necessary to provide medically necessary care covered by the health plan, then the health maintenance organization shall arrange for a referral to a physician with the necessary expertise and ensure that the members obtain the covered benefit at no greater cost to the member than if the benefit were obtained from participating physicians.

  3.  A community-based health maintenance organization's physicians, physician specialists and facilities shall be reasonably available.  Primary health care services shall be in reasonable proximity to a member's personal residence or business, with due consideration given to the availability of physicians within the community-based health maintenance organization's service area.  This provision shall not preclude a community-based health maintenance organization from arranging for the provision of member care outside the service area for a higher level of skill or specialty care than is available within the service area.


(L. 1997 H.B. 335 § 1)

---- end of effective  28 Aug 1997 ----

use this link to bookmark section  354.552

Click here for the Reorganization Act of 1974 - or - Concurrent Resolutions Having Force & Effect of Law
In accordance with Section 3.090, the language of statutory sections enacted during a legislative session are updated and available on this website on the effective date of such enacted statutory section. Revisor Home    

Other Information
 Recent Sections Editorials May Be Cited As Tables & Forms Multiple Enact
Repeal & Transfer Definitions End Report

Site changes Pictures Contact

Other Links
Legislative Research Oversight MOLIS
Library MO WebMasters
Missouri Senate
State of Missouri
Missouri House