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Current as of January 01, 2025 | Updated by Findlaw Staff
1. A health maintenance organization shall disclose to the department of commerce and insurance all financial arrangements, financial interest in, or contractual provisions with utilization review companies or any other health care provider that would encourage or limit the type, amount, duration and scope of services offered, restrict or limit referral or treatment to patients, including but not limited to financial incentives to limit, restrict or deny access to or delivery of medical or other services prior to the delivery of such services. Capitation arrangements between health maintenance organizations and health care providers shall not be considered an inducement to limit, restrict or deny access to medical services. The director shall review all financial arrangements filed with the department of commerce and insurance to determine if such arrangements offer an inducement to a provider to provide less than medically necessary services to an enrollee.
2. The capitation rate to be paid from the health maintenance organization to the health care provider is not required to be included with the financial arrangements to be filed with the department of commerce and insurance pursuant to subsection 1 of this section.
Cite this article: FindLaw.com - Missouri Revised Statutes Title XXIII. Corporations, Associations and Partnerships § 354.443. Financial disclosures to the department required by health maintenance organizations, when - last updated January 01, 2025 | https://codes.findlaw.com/mo/title-xxiii-corporations-associations-and-partnerships/mo-rev-st-354-443/
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 before relying on it for your legal needs.
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