Title XXIII, CORPORATIONS, ASSOCIATIONS AND PARTNERSHIPS

354.551. Health maintenance organizations may offer point of service (POS) riders, when. — 1. Missouri licensed health maintenance organizations shall be permitted to offer point of service riders (POS) to their approved health plan products, without being required to obtain a se…

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 …

354.554. Standing referrals for certain members of community-based health maintenance organizations, when. — Each community-based health maintenance organization shall offer coverage that allows an enrollee who suffers from a life-threatening condition or a degenerative, disablin…

354.556. Trustees, vacancies, elections. — 1. The terms of office of the trustees elected by the enrollees of the community-based health maintenance organization shall begin immediately upon their election. 2. If a vacancy occurs in the office of a trustee, the vacancy shall be f…

354.558. Materials provided to prospective purchasers. — A community-based health maintenance organization shall provide each prospective purchaser of its services with the following marketing materials prior to enrollment: (1) A list of the health care providers who have a contr…

354.559. Disclosure to members, restrictions and prohibitions. — No community-based health maintenance organization shall prohibit or restrict any provider from disclosing to any subscriber, enrollee or member any information that such provider deems appropriate regarding the nat…

354.560. Payment arrangements, department to adopt rules — disclosure of financial arrangements — confidentiality. — 1. The director of the department of commerce and insurance shall adopt rules governing the use of payment arrangements by community-based health maintenance organ…

354.562. Grievance procedures, rulemaking authority. — The director of the department of commerce and insurance shall promulgate rules governing grievance procedures for enrollees of a community-based health maintenance organization. Such regulations shall be consistent with and …

354.563. Medicare rules to apply to community-based health maintenance organizations, when. — If the Health Care Financing Administration of the United States Department of Health and Human Services promulgates regulations governing the practice of utilization review in health ma…

354.565. Community-based health maintenance organization designation given, when — revocation. — The director of the department of commerce and insurance shall designate those health maintenance organizations which meet the criteria established in subdivision (3) of section 354.4…

354.567. Community-based health maintenance organizations subject to other laws regarding health maintenance organizations. — Community-based health maintenance organizations shall be subject to the same provisions of law as other health maintenance organizations to the extent th…

354.570. Rulemaking — procedure. — No rule or portion of a rule promulgated pursuant to sections 192.068, 354.603, 376.423, 376.1353, 376.1356, 376.1378, 376.1387, * 354.560, 354.562 and 354.563 shall become effective unless it has been promulgated in accordance with the provisio…

354.600. Definitions. — For purposes of sections 354.600 to 354.636 the following terms shall mean: (1) "Facility", an institution providing health care services or a health care setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surg…

354.603. Sufficiency of health carrier network, requirements, criteria — access plan filed with the department, when. — 1. A health carrier shall maintain a network that is sufficient in number and types of providers to assure that all services to enrollees shall be accessible wi…

354.606. Providers notified of specific covered services, when — hold harmless provision — cessation of operations procedure — selection standards for health care professionals, filing with the department. — 1. A health carrier shall establish a mechanism by which the participati…

354.609. Termination of a contract, procedure. — 1. A health carrier and a participating provider shall provide at least sixty days written notice to each other before terminating the contract without cause. The written notice shall include an explanation of why the contract is b…

354.612. Continuation of care after provider termination, when. — 1. Contracts between health plans and providers shall include a provision for the continuation of care to enrollees for a period of up to ninety days by a provider who terminates or is terminated from a network whe…

354.615. Referrals to appropriate providers, when. — 1. If a health carrier determines that it does not have a health care provider with appropriate training and experience in its panel or network to meet the particular health care needs of an enrollee, the health carrier shall m…

354.618. Open referral health plans offered, when — definitions — obstetrician/ gynecologist services to be offered, when — eye care providers, discrimination against, prohibited — exemptions. — 1. A health carrier shall be required to offer as an additional health plan, an open …

354.621. Intermediary and participating provider requirements. — 1. Intermediaries and participating providers with whom they contract shall comply with all the applicable requirements of sections 354.600 to 354.636. 2. A health carrier's statutory responsibility to monitor the o…

354.624. Proposed provider contract forms filed with the director — contracts maintained at place of business, available for review, when. — 1. A health carrier shall file with the director all contract forms proposed for use with its participating providers and intermediaries. T…

354.627. Liability of a health carrier, when. — 1. The executing of a contract by a health carrier shall not relieve the health carrier of its liability to any person with whom it has contracted for the provision of services, or of its responsibility for compliance with the law o…

354.636. Contract requirements after January 1, 1998. — All provider and intermediary contracts delivered, issued for delivery, continued or renewed on or after January 1, 1998, shall comply with sections 354.600 to 354.636 unless otherwise provided by sections 354.600 to 354.636…

354.650. Definitions. — As used in sections 354.650 to 354.658, the following terms mean: (1) "Department", the department of health and senior services; (2) "Essential community provider", an individual physician, licensed pursuant to the provisions of chapter 334, who meets the…

354.652. Designation as essential community provider, procedure, qualifications. — Any physician seeking a designation as an essential community provider shall: (1) Apply to the director of the department; (2) Document to the department that at least forty percent of the physicia…

354.654. Department of health and senior services, duties — rulemaking authority. — 1. The department of health and senior services shall issue a letter of designation as an essential community provider to any physician who makes a written request and application to the departmen…

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 a…

354.658. Designation nontransferable, site specific — annual affidavit required — notice of certain changes, required when. — 1. The designation of essential community provider shall not be transferable to another physician, health care provider or entity. 2. The designation of e…

354.700. Definitions. — As used in sections 354.700 to 354.723, the following terms mean: (1) "Dental care services", services included in the practice of dentistry as defined in section 332.071; (2) "Director", the director of the department of commerce and insurance; (3) "Enrol…

354.702. Prepaid dental plans, who may offer — certificate of authority required — certain state laws not to apply. — 1. A prepaid dental plan may not be established or operated in this state, nor may membership be solicited in such a plan unless the plan is offered by a prepaid …

354.703. Director may order violators to cease and desist, hearing — noncompliance, director's remedies. — 1. The director of the department of commerce and insurance may issue an order directing any person or entity to cease and desist from engaging in any act or practice in vio…

354.704. Application for certificate of authority, content. — An application for a certificate of authority to operate a prepaid dental plan corporation in this state shall be filed with the director on a form prescribed by the director. Such application shall be verified by an o…

354.705. Certificate of authority granted, when. — 1. Issuance of a certificate of authority shall be granted by the director if the director is satisfied that the following conditions are met: (1) The financial requirements of sections 354.700 to 354.723 have been fulfilled; (2)…

354.707. Capital, surplus, security required — cash, securities, bond to be deposited or filed with director, director to return deposit, when — security subject to final judgments — security not required for prepaid dental plans funded by government — director may waive capital,…

354.710. Reserve requirements — reserve not required for prepaid dental plans funded by government — surplus requirement for prepaid dental plans in existence January 1, 1987, additional time. — 1. Every prepaid dental plan organization shall, not later than January 1, 1994, have…

354.712. Contract or contract certificate to be issued to enrollees, content, copy to be filed with director — newborn child to be covered, when, extent of coverage, notification of birth and additional premium, when, effect of. — 1. Every enrollee in a prepaid dental plan corpor…

354.715. Providers of dental care, written contract with prepaid dental plan corporations, review and mediation procedures for enrollees required. — 1. Any provider of dental health care services who agrees with a prepaid dental plan corporation to provide dental care services to…

354.717. Director, powers — financial examinations, when, by whom made and paid. — 1. The director, or any person authorized by him, may examine the financial condition and the affairs and management of any prepaid dental plan corporation whenever the director deems necessary. 2.…

354.720. Annual report, required, content. — 1. Every prepaid dental plan corporation shall file with the director annually, on or before March first, a report verified by at least two principal officers covering the preceding calendar year. 2. Such report shall be on forms presc…

354.721. Agents, registration required — rules and regulations authorized. — 1. A prepaid dental plan corporation shall register the names of all persons acting as agents, for the solicitation of contracts, with the director within thirty days after September 28, 1987. 2. The dir…

354.722. Revocation or suspension of certificate of authority, when — notice, civil suit authorized — suspension, revocation, activity permitted. — 1. The director may suspend or revoke any certificate of authority issued to a prepaid dental plan corporation pursuant to sections …

354.723. Rulemaking authorized. — The director may, after notice and hearing, promulgate such reasonable rules and regulations as are necessary or proper to carry out the provisions of sections 354.700 to 354.723. ­­-------- (L. 1987 S.B. 272 § 13)

354.725. Exclusion, labor organization's health plans. — The provisions of sections 354.700 to 354.725 shall not apply to any labor organization's health plan existing on September 28, 1987, providing services on its premises established and maintained primarily for its members a…