2018 Missouri Revised Statutes
Title XXIII - Corporations, Associations and Partnerships
Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans
Section 354.552 Community-based health maintenance organizations, requirements.
Effective 28 Aug 1997
Title XXIII CORPORATIONS, ASSOCIATIONS AND PARTNERSHIPSChapter 354
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)