20-1074

20-1074. Contract termination; duty to report;
provision for continued services during insolvency;
definitions

A. Each month a health care services organization shall submit to the director a
list of all written provider contracts that have been terminated during the prior
month. The list shall be in writing and shall include the name and address of each
provider whose contract has been terminated but shall not include the reasons for
termination.

B. A health care services organization shall include in its contracts with
providers a statement that requires the provider to provide services to enrollees at the
same rates and subject to the same terms and conditions established in the contract for
the duration of the period after the health care services organization is declared
insolvent, until the earliest of the following:

1. The expiration of the period during which the health care services organization
is required to continue benefits as described in section 20-1069, subsection A.

2. A notification from the receiver pursuant to section 20-1069, subsection F or a
determination by the court that the organization cannot provide adequate assurance it
will be able to pay contract providers' claims for covered services that were rendered
after the health care services organization is declared insolvent.

3. A determination by the court that the insolvent organization is unable to pay
contract providers' claims for covered services that were rendered after the health care
services organization is declared insolvent.

4. A determination by the court that continuation of the contract would constitute
undue hardship to the provider.

5. A determination by the court that the health care services organization has
satisfied its obligations to all enrollees under its health care plans.

C. Unless preempted under federal law or unless federal law imposes greater
requirements than this section, this section applies to a provider sponsored health care
services organization.

D. For the purposes of this section:

1. "Court" has the same meaning prescribed in section 20-611.

2. "Delinquency proceeding" has the same meaning prescribed in section 20-611.