Article 32.--HEALTH MAINTENANCE ORGANIZATIONS AND MEDICARE PROVIDER ORGANIZATIONS
40-3208.Powers.(a) The powers of a health maintenance organization or medicare providerorganization shall include but notbe limited to the following:
(1) The purchase, lease, construction, renovation, operation, ormaintenance of hospitals, medical facilities, or both, and their ancillaryequipment, and such property as may reasonably be required for itsprincipal office or for such other purposes as are necessary inthetransaction of the business of the organization;
(2) the furnishing of health care services through providers which areunder contract with or employed by the health maintenance organization;
(3) the contracting with any person for the performance on its behalf ofcertain functions such as marketing, enrollment and administration;
(4) the contracting with an insurance company licensed in this state, orwith a hospital or medical service corporation or dental servicecorporation authorized to do business in this state, for the provision ofinsurance, indemnity or reimbursement against the cost of health careservices provided by the health maintenance organization;
(5) the offering, in addition to health care services, of indemnitybenefits covering out-of-area or emergency services; and
(6) receiving and accepting from governmental or private agenciespayments covering all or part of the cost of the services provided orarranged for by the organization.
(b) Health maintenance organizations shall provide in their arrangementswith all contracting parties and providers that if there be valid medicaidcoverage, providing benefits for the same loss or condition, the medicaidcoverage shall be the source of last resort of any provider payment.
History: L. 1974, ch. 181, § 8;L. 1993, ch. 132, § 8;L. 1998, ch. 174, § 17; July 1.
Article 32.--HEALTH MAINTENANCE ORGANIZATIONS AND MEDICARE PROVIDER ORGANIZATIONS
40-3208.Powers.(a) The powers of a health maintenance organization or medicare providerorganization shall include but notbe limited to the following:
(1) The purchase, lease, construction, renovation, operation, ormaintenance of hospitals, medical facilities, or both, and their ancillaryequipment, and such property as may reasonably be required for itsprincipal office or for such other purposes as are necessary inthetransaction of the business of the organization;
(2) the furnishing of health care services through providers which areunder contract with or employed by the health maintenance organization;
(3) the contracting with any person for the performance on its behalf ofcertain functions such as marketing, enrollment and administration;
(4) the contracting with an insurance company licensed in this state, orwith a hospital or medical service corporation or dental servicecorporation authorized to do business in this state, for the provision ofinsurance, indemnity or reimbursement against the cost of health careservices provided by the health maintenance organization;
(5) the offering, in addition to health care services, of indemnitybenefits covering out-of-area or emergency services; and
(6) receiving and accepting from governmental or private agenciespayments covering all or part of the cost of the services provided orarranged for by the organization.
(b) Health maintenance organizations shall provide in their arrangementswith all contracting parties and providers that if there be valid medicaidcoverage, providing benefits for the same loss or condition, the medicaidcoverage shall be the source of last resort of any provider payment.
History: L. 1974, ch. 181, § 8;L. 1993, ch. 132, § 8;L. 1998, ch. 174, § 17; July 1.
Article 32.--HEALTH MAINTENANCE ORGANIZATIONS AND MEDICARE PROVIDER ORGANIZATIONS
40-3208.Powers.(a) The powers of a health maintenance organization or medicare providerorganization shall include but notbe limited to the following:
(1) The purchase, lease, construction, renovation, operation, ormaintenance of hospitals, medical facilities, or both, and their ancillaryequipment, and such property as may reasonably be required for itsprincipal office or for such other purposes as are necessary inthetransaction of the business of the organization;
(2) the furnishing of health care services through providers which areunder contract with or employed by the health maintenance organization;
(3) the contracting with any person for the performance on its behalf ofcertain functions such as marketing, enrollment and administration;
(4) the contracting with an insurance company licensed in this state, orwith a hospital or medical service corporation or dental servicecorporation authorized to do business in this state, for the provision ofinsurance, indemnity or reimbursement against the cost of health careservices provided by the health maintenance organization;
(5) the offering, in addition to health care services, of indemnitybenefits covering out-of-area or emergency services; and
(6) receiving and accepting from governmental or private agenciespayments covering all or part of the cost of the services provided orarranged for by the organization.
(b) Health maintenance organizations shall provide in their arrangementswith all contracting parties and providers that if there be valid medicaidcoverage, providing benefits for the same loss or condition, the medicaidcoverage shall be the source of last resort of any provider payment.
History: L. 1974, ch. 181, § 8;L. 1993, ch. 132, § 8;L. 1998, ch. 174, § 17; July 1.
