20-1074. Contract termination; duty to report; provision for continued services during insolvency; definitions

283 words·~1 min read·/az/title-20/20-1074

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

A. A health care services organization shall submit quarterly to the director a list of all provider contracts that have been terminated during the prior three months. The list shall be in writing and shall include the name and address of each provider whose contract has been terminated but shall not include the reasons for termination.

B. A health care services organization shall include in its contracts with providers a statement that requires the provider to provide services to enrollees at the same rates and subject to the same terms and conditions established in the contract for the duration of the period after the health care services organization is declared insolvent, until the earliest of the following:

1. A determination by the court that the organization cannot provide adequate assurance it will be able to pay contract providers' claims for covered services that were rendered after the health care services organization is declared insolvent.

2. A determination by the court that the insolvent organization is unable to pay contract providers' claims for covered services that were rendered after the health care services organization is declared insolvent.

3. A determination by the court that continuation of the contract would constitute undue hardship to the provider.

4. A determination by the court that the health care services organization has satisfied its obligations to all enrollees under its health care plans.

C. Unless preempted under federal law or unless federal law imposes greater requirements than this section, this section applies to a provider sponsored health care services organization.

D. For the purposes of this section:

1. "Court" has the same meaning prescribed in section 20-611.

2. "Delinquency proceeding" has the same meaning prescribed in section 20-611.