218-1956-35 - CHAPTER 35 HEALTH MAINTENANCE ORGANIZATIONS (500.3501...500.3580)
- Section 500.3501 - Definitions.
- Section 500.3503 - Applicability of provisions to health maintenance organization.
- Section 500.3505 - Certificate of authority; use of descriptive words; restrictions.
- Section 500.3507 - Authorizing and regulating health maintenance organization; establishment of system by commissioner.
- Section 500.3508 - Quality assessment program; quality improvement program.
- Section 500.3509 - Certificate of authority; application; form; limitation; change of service area.
- Section 500.3511 - Governing body; election of enrollee board members; terms; vacancy; meetings.
- Section 500.3513 - Health delivery and business and financial operations; regulation by commissioner.
- Section 500.3515 - Additional health maintenance services; copayments; limitation; report on increase of employer and employee numbers; "preventive health care services" defined; partial payment from
- Section 500.3517 - Healthy lifestyle programs; emergency or out-of-area service; payment of expenses or fees.
- Section 500.3519 - Contract and contract rates; fairness; rate differential; basic health services required.
- Section 500.3521 - Prepayment rates; filing and approval of methodology; schedule.
- Section 500.3523 - Health maintenance contract; provisions.
- Section 500.3525 - Proposal to revise contract; approval of commissioner; approval with modifications; hearing; disposition; exception; notice.
- Section 500.3527 - Health maintenance contract; performance; violation of terms.
- Section 500.3528 - Health maintenance organization; duties.
- Section 500.3529 - Affiliated provider contracts; collection of payments from enrollees; contract provisions; waiver of requirement under subsection (2); contract format; evidence of sufficient number
- Section 500.3530 - Availability of covered services; assurance; establishment and maintenance of proximity.
- Section 500.3531 - Contracts with health care providers to become affiliated providers; requirements; standards; filing; duplicative standards; notice procedures; provider application period; approval
- Section 500.3533 - Prudent purchaser contracts; reimbursement for unauthorized services or services by nonaffiliated providers; rate and operating requirements; maintenance of financial records by hea
- Section 500.3535 - Solicitation or advertising.
- Section 500.3537 - Open enrollment period; acceptance of group members; rating nongroup membership.
- Section 500.3539 - Nongroup contract; exclusion or limitation; preexisting condition; renewal or continuation of nongroup contract or group contract; guaranteed renewal; healthy lifestyle program; "gr
- Section 500.3541 - Advocation by health professional.
- Section 500.3542 - Inducement to health professional prohibited; exception.
- Section 500.3543 - Third party administrator.
- Section 500.3545 - Acquisition of obligations from another managed care entity.
- Section 500.3547 - Health care service operations; visitation or examination by commissioner; consultation with enrollees; additional authority.
- Section 500.3548 - Maintenance of books, records, and files; funds and assets.
- Section 500.3549 - Disciplinary action; notice to board.
- Section 500.3551 - Health maintenance organization; net worth.
- Section 500.3553 - Minimum deposit requirements.
- Section 500.3555 - Financial plan.
- Section 500.3557 - Notice of changes in operations.
- Section 500.3559 - Reinsurance contract or plan; purpose; filing; approval; coverage.
- Section 500.3561 - Insolvency; continuation of benefits.
- Section 500.3563 - Insolvency; allocation of group coverage to health maintenance organizations and insurers participating in enrollment process; allocation of group coverage to health maintenance org
- Section 500.3565 - Cancellation of contract by nongroup subscriber.
- Section 500.3567 - Cancellation of contract with nongroup enrollee by health maintenance organization.
- Section 500.3569 - Assumption of financial risk; “requiring an affiliated provider to assume financial risk” defined.
- Section 500.3571 - State and federal health programs.
- Section 500.3573 - Operation of health care delivery system not meeting requirements of act; permitted conduct; limitations.
- Section 500.3580 - Consumer guide to health maintenance organizations; publication; contents; data; writing, presentation, promotion, and distribution of guide; access through internet.