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Current as of January 01, 2023 | Updated by FindLaw Staff
A. No health maintenance organization, health insurance organization, managed care organization, or other entity may contract with the state to provide a qualified plan to an enrollee unless so certified by the department.
B. No health maintenance organization, health insurance organization, managed care organization, or other entity shall be certified to provide a qualified plan unless that plan meets minimum standards established by the department by the adoption and promulgation of rules and regulations in accordance with the Administrative Procedure Act. Such standards shall include, but not be limited to:
(1) Access to routine, urgent, and emergency care by enrollees.
(2) Primary care including location, hours, waiting times, and access to care when needed.
(3) Availability of specialty care.
(4) Technical competence of health care providers.
(5) Implementation of a peer review program.
(6) Health and medical standards.
C. Any qualified plan provider that fails to maintain the minimum standards as determined by the department shall be subject to penalties, including revocation of any authority to participate in the state program or a prohibition on enrolling any new member.
Cite this article: FindLaw.com - Louisiana Revised Statutes Tit. 40, § 2222. Certification of organizations providing qualified plans - last updated January 01, 2023 | https://codes.findlaw.com/la/revised-statutes/la-rev-stat-tit-40-sect-2222/
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.
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