State Codes and Statutes
Statutes > Missouri > T23 > C354 > 354_552Community-based health maintenance organizations, requirements.
354.552. 1. A community-based health maintenance organization shallhave available and accessible a sufficient number and type of physicians,specialists, and other providers as needed to:
(1) Provide the benefits covered by the plan;
(2) Meet the medical needs of the health plan's enrolled population;
(3) Provide members with a reasonable choice of primary carephysicians and specialty physicians.
2. If a community-based health maintenance organization does notemploy or contract with a physician with the expertise necessary to providemedically necessary care covered by the health plan, then the healthmaintenance organization shall arrange for a referral to a physician withthe necessary expertise and ensure that the members obtain the coveredbenefit at no greater cost to the member than if the benefit were obtainedfrom participating physicians.
3. A community-based health maintenance organization's physicians,physician specialists and facilities shall be reasonably available.Primary health care services shall be in reasonable proximity to a member'spersonal residence or business, with due consideration given to theavailability of physicians within the community-based health maintenanceorganization's service area. This provision shall not preclude acommunity-based health maintenance organization from arranging for theprovision of member care outside the service area for a higher level ofskill or specialty care than is available within the service area.
(L. 1997 H.B. 335 § 1)
