376.1514. Written agreement required, contents.

324 words·~1 min read·/mo/chapter-376/376-1514

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376.1514. Written agreement required, contents. — 1. All providers offering medical services to members under a discount medical plan shall provide such services pursuant to a written agreement. The agreement may be entered into directly by the health care provider or by a health care provider network to which the provider belongs if the provider network has contracts with the health care provider that allow the provider network to contract on behalf of the health care provider.

2. A health care provider agreement shall provide the following:

(1)A description of the services and products to be provided at a discount;

(2)The amount or amounts of the discounts or, alternatively, a fee schedule which reflects the health care provider's discounted rates; and

(3)A provision that the health care provider will not charge members more than the discounted rates.

3. A health care provider agreement with a health care provider network shall require that the health care provider network have written agreements with its health care providers that:

(1)Contain the terms described in this subsection;

(2)Authorize the health care provider network to contract with the discount medical plan organization on behalf of the provider; and

(3)Require the network to maintain an up-to-date list of its contracted health care providers and to provide that list on a quarterly basis to the discount medical plan organization.

4. A health care provider agreement between a discount medical plan organization and an entity that contracts with a health care provider network shall require that the entity, in its contract with the health care provider network, require the health care provider network to have written agreements with its providers that comply with subsection 3 of this section.

5. The discount medical plan organization shall maintain a copy of each active health care provider agreement into which it has entered.

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(L. 2007 H.B. 818 merged with S.B. 66)

Effective 8-28-07 (S.B. 66); 1-01-08 (H.B. 818)