2018 Missouri Revised Statutes
Title XXIII - Corporations, Associations and Partnerships
Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans
Section 354.652 Designation as essential community provider, procedure, qualifications.

Universal Citation: MO Rev Stat § 354.652 (2018)

Effective 28 Aug 1998


Chapter 354

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 physician's practice is comprised of:

(a) Medicaid or uninsured patients, or both; or

(b) A combination of paragraph (a) and Medicare or underinsured patients, or both;

(3) Serve a medically underserved area or a health professional shortage area;

(4) Serve a medically underserved population;

(5) Spend at least twenty hours per week at a principal site;

(6) Be available to a medically underserved population on evenings and weekends at a principal site;

(7) Hold hospital staff privileges with a participating network hospital of the health care insurer;

(8) Not be a direct employee of a health care insurer, a for-profit or a not-for-profit hospital or health services corporation; and

(9) Meet the following quality standards in accordance with guidelines established by the National Committee for Quality Assurance:

(a) A current valid license to practice;

(b) Clinical privileges in good standing at the hospital designated by the physician as the primary admitting facility;

(c) A valid Drug Enforcement Agency or Controlled Dangerous Substances certificate, if applicable;

(d) Graduation from medical school, and completion of a residency or board certification if applicable;

(e) Work history;

(f) Current adequate malpractice insurance according to the managed care organization's policy; and

(g) Professional liability claims history.


(L. 1998 H.B. 1302 § 2)

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