§2222. Certification of organizations providing qualified plans
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.
Acts 1995, No. 1211, §1, eff. June 29, 1995.
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