Section 11: Exclusion of health care provider from participation; new participants; request for arbitration by aggrieved
282 words·~1 min read·
/ma/part-i/title-xxii/chapter-175f/11·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 11. No fund shall exclude a health care provider from participation except as provided in this section if the health care provider has complied with all necessary and required application procedures. A fund may exclude a health care provider from participation if:
(1)the applicant health care provider is not situated in a geographical location which is reasonably contiguous to the initial participants;
(2)the applicant health care provider does not meet standards of risk and claims management and financial management promulgated by a fund in its trust instrument;
(3)the applicant is not a nonprofit health care provider, if that fund's present participants are nonprofit; or
(4)the applicant is not a member of the classification of health care providers to which the fund's present participants belong. Each type of health care provider set forth in section 1 shall be considered to be a separate classification of health care providers.
No fund shall be required to provide insurance to a new participant except beginning at the start of the next policy year after the new participant's application is accepted, and no fund shall be required to accept more than one applicant health care provider during any policy year; provided, however, that a fund at its option may accept more than one such applicant during any policy year.
If any applicant health care provider is aggrieved by a decision to exclude him from participation in a fund, he may request arbitration by a board consisting of a member designated by the health care provider, a member chosen by the fund, and a member designated by the commissioner. Such board shall hold a hearing and render a decision on the issues presented.