(a) Every managed care organization shall allow every nursing home in its service
area an opportunity to be a network contracted facility at the plan's standard terms,
conditions, and rates. Either party may opt to limit the contract to existing residents only.
(b) With the exception of subsection (c) of this Section, a managed care organization
shall only terminate or refuse to renew a contract with a nursing home if the nursing
home fails to meet quality standards if the following conditions are met:
(1) the quality standards are made known to the nursing home;
(2) the quality standards can be objectively measured through data;
(3) the nursing home is measured on at least a year's worth of performance;
(4) a nursing home that the MCO has determined did not meet a quality standard has
the opportunity to contest that determination by challenging the accuracy or the measurement
of the data through an arbitration process agreed to by contract; and
(5) the Department may attempt to mediate a dispute prior to arbitration.
(c) A managed care organization may terminate or refuse to renew a contract with a
nursing home for a material breach of the contract, including, but not limited to,
failure to grant reasonable and timely access to the MCO's care coordinators, SNFists
and other providers, termination from the Medicare or Medicaid program, or revocation
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature or via Westlaw before relying on it for your legal needs.
Was this helpful?
Response sent, thank you
Welcome to FindLaw's Cases & Codes
A free source of state and federal court opinions, state laws, and the United States Code. For more information about the legal concepts addressed by these cases and statutes, visit FindLaw's Learn About the Law.