354.652. Designation as essential community provider, procedure, qualifications. - Missouri Statutes

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Statutes > Missouri > T23 > C354 > 354_652

Designation as essential community provider, procedure,qualifications.

354.652. Any physician seeking a designation as an essential communityprovider shall:

(1) Apply to the director of the department;

(2) Document to the department that at least forty percent of thephysician's practice is comprised of:

(a) Medicaid or uninsured patients, or both; or

(b) A combination of paragraph (a) and Medicare or underinsuredpatients, or both;

(3) Serve a medically underserved area or a health professional shortagearea;

(4) Serve a medically underserved population;

(5) Spend at least twenty hours per week at a principal site;

(6) Be available to a medically underserved population on evenings andweekends at a principal site;

(7) Hold hospital staff privileges with a participating network hospitalof the health care insurer;

(8) Not be a direct employee of a health care insurer, a for profit or anot-for-profit hospital or health services corporation; and

(9) Meet the following quality standards in accordance with guidelinesestablished by the National Committee for Quality Assurance:

(a) A current valid license to practice;

(b) Clinical privileges in good standing at the hospital designated bythe physician as the primary admitting facility;

(c) A valid Drug Enforcement Agency or Controlled Dangerous Substancescertificate, if applicable;

(d) Graduation from medical school, and completion of a residency orboard certification if applicable;

(e) Work history;

(f) Current adequate malpractice insurance according to the managed careorganization's policy; and

(g) Professional liability claims history.

(L. 1998 H.B. 1302 § 2)

State Codes and Statutes

Statutes > Missouri > T23 > C354 > 354_652

Designation as essential community provider, procedure,qualifications.

354.652. Any physician seeking a designation as an essential communityprovider shall:

(1) Apply to the director of the department;

(2) Document to the department that at least forty percent of thephysician's practice is comprised of:

(a) Medicaid or uninsured patients, or both; or

(b) A combination of paragraph (a) and Medicare or underinsuredpatients, or both;

(3) Serve a medically underserved area or a health professional shortagearea;

(4) Serve a medically underserved population;

(5) Spend at least twenty hours per week at a principal site;

(6) Be available to a medically underserved population on evenings andweekends at a principal site;

(7) Hold hospital staff privileges with a participating network hospitalof the health care insurer;

(8) Not be a direct employee of a health care insurer, a for profit or anot-for-profit hospital or health services corporation; and

(9) Meet the following quality standards in accordance with guidelinesestablished by the National Committee for Quality Assurance:

(a) A current valid license to practice;

(b) Clinical privileges in good standing at the hospital designated bythe physician as the primary admitting facility;

(c) A valid Drug Enforcement Agency or Controlled Dangerous Substancescertificate, if applicable;

(d) Graduation from medical school, and completion of a residency orboard certification if applicable;

(e) Work history;

(f) Current adequate malpractice insurance according to the managed careorganization's policy; and

(g) Professional liability claims history.

(L. 1998 H.B. 1302 § 2)

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State Codes and Statutes

Statutes > Missouri > T23 > C354 > 354_652

Designation as essential community provider, procedure,qualifications.

354.652. Any physician seeking a designation as an essential communityprovider shall:

(1) Apply to the director of the department;

(2) Document to the department that at least forty percent of thephysician's practice is comprised of:

(a) Medicaid or uninsured patients, or both; or

(b) A combination of paragraph (a) and Medicare or underinsuredpatients, or both;

(3) Serve a medically underserved area or a health professional shortagearea;

(4) Serve a medically underserved population;

(5) Spend at least twenty hours per week at a principal site;

(6) Be available to a medically underserved population on evenings andweekends at a principal site;

(7) Hold hospital staff privileges with a participating network hospitalof the health care insurer;

(8) Not be a direct employee of a health care insurer, a for profit or anot-for-profit hospital or health services corporation; and

(9) Meet the following quality standards in accordance with guidelinesestablished by the National Committee for Quality Assurance:

(a) A current valid license to practice;

(b) Clinical privileges in good standing at the hospital designated bythe physician as the primary admitting facility;

(c) A valid Drug Enforcement Agency or Controlled Dangerous Substancescertificate, if applicable;

(d) Graduation from medical school, and completion of a residency orboard certification if applicable;

(e) Work history;

(f) Current adequate malpractice insurance according to the managed careorganization's policy; and

(g) Professional liability claims history.

(L. 1998 H.B. 1302 § 2)