LD 34
pg. 2
Page 1 of 2 An Act to Protect the Choice of Hospital Care for HMO Enrollees LD 34 Title Page
Download Bill Text
LR 153
Item 1

 
2. Terms and conditions.__Before entering into any agreements
under subsection 1, a carrier shall establish terms and
conditions that must be met by providers wishing to enter into an
agreement with the carrier.__The carrier shall make available to
the provider a written statement of the terms and conditions that
must be met by providers wishing to enter into an agreement with
the carrier.

 
3.__No denial of right to enter into agreement.__Any provider,
including a hospital, willing to meet the terms and conditions of
agreements established by carriers under subsection 2 may not be
denied the right to enter into an agreement with a carrier.__When
a carrier denies a provider the right to enter into an agreement
with the carrier on the grounds that the provider does not meet
the terms and conditions established by the carrier under
subsection 2, the carrier shall provide the provider with a
written notice that explains the basis of the denial and states
the specific terms and conditions that the provider, in the
opinion of the carrier, does not satisfy.

 
SUMMARY

 
This bill prohibits nonprofit hospital and medical service
organizations, preferred provider organizations, health insurers
and health maintenance organizations from denying a provider,
including a hospital, the right to participate in a managed care
plan if the provider is willing to meet the terms and conditions
of the agreement established by the managed care plan.


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