reglab/housing_qa huggingface dataset:
MO Rev Stat § 354.551 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.551 - Health maintenance organizations may offer point of service (POS) riders, when.

Effective - 28 Aug 1997   354.551. Health maintenance organizations may offer point of service (POS) riders, when. — 1. Missouri licensed health maintenance organizations shall be permitted to offer point of service riders (POS) to their approved health plan products, without being required to obtain a separate license as a health insurer pursuant to chapter 376, so long as medical and hospital expenses incurred under the POS rider do* not exceed ten percent of total medical and hospital expenses incurred for all health plan products sold.  2. Health maintenance organizations which have been licensed for at least one calendar year, who choose to insure the POS rider, shall maintain a net worth of the greater of:  (1) One million two hundred thousand dollars; or  (2) Two percent of total premium revenue for the immediately preceding twelve months plus fifty percent of uncovered liabilities as reported in the immediately preceding calendar quarter.  3. Health maintenance organizations which have been licensed for less than one calendar year, who choose to insure the POS rider, shall maintain a net worth of the greater of:  (1) One million two hundred thousand dollars; or  (2) Ten percent of the yearly average of the three-year annual premium plus fifty percent of its average annual uncovered liabilities as projected in its application for a certificate of authority.  4. The department of commerce and insurance may modify the net worth requirements for a health maintenance organization which has been licensed for less than one calendar year if its actual results deviate materially from its projections. In addition to any other deposit required of a licensed health maintenance organization pursuant to section 354.410, any health maintenance organization which chooses to issue a POS rider shall deposit an additional six hundred thousand dollars** with the director of the department of commerce and insurance. Any health maintenance organization which issues a POS rider whose medical and hospital expenses incurred under the POS rider exceed*** ten percent of total medical and hospital expenses incurred for all health plan products sold shall either cease insuring new POS riders until it comes into compliance with the ten percent limitation of this section or meet the minimum net worth requirements and all other statutory and regulatory requirements of a Missouri domestic life insurance company. ­­-------- (L. 1997 H.B. 335 § 11)  *Word "does" appears in original rolls.  **Word "dollars" does not appear in original rolls.  ***Word "exceeds" appears in original rolls.
MO Rev Stat § 354.552 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.552 - Community-based health maintenance organizations, requirements.

Effective - 28 Aug 1997   354.552. Community-based health maintenance organizations, requirements. — 1. A community-based health maintenance organization shall have 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 care physicians and specialty physicians.  2. If a community-based health maintenance organization does not employ or contract with a physician with the expertise necessary to provide medically necessary care covered by the health plan, then the health maintenance organization shall arrange for a referral to a physician with the necessary expertise and ensure that the members obtain the covered benefit at no greater cost to the member than if the benefit were obtained from 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's personal residence or business, with due consideration given to the availability of physicians within the community-based health maintenance organization's service area. This provision shall not preclude a community-based health maintenance organization from arranging for the provision of member care outside the service area for a higher level of skill or specialty care than is available within the service area. ­­-------- (L. 1997 H.B. 335 § 1)
MO Rev Stat § 354.554 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.554 - Standing referrals for certain members of community-based health maintenance organizations, when.

Effective - 28 Aug 1997   354.554. Standing referrals for certain members of community-based health maintenance organizations, when. — Each community-based health maintenance organization shall offer coverage that allows an enrollee who suffers from a life-threatening condition or a degenerative, disabling condition requiring a regimen of specialized medical treatment lasting for six months or more to receive a standing referral for specialty care case management by a physician or specialty care center with expertise in treating the condition. Under such specialty care case management, the provider shall coordinate primary and specialty care for the enrollee under a treatment plan approved by the health maintenance organization in consultation with the enrollee's primary care provider and the specialist physician or specialty care center. ­­-------- (L. 1997 H.B. 335 § 2)
MO Rev Stat § 354.556 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.556 - Trustees, vacancies, elections.

Effective - 28 Aug 1997   354.556. Trustees, vacancies, elections. — 1. The terms of office of the trustees elected by the enrollees of the community-based health maintenance organization shall begin immediately upon their election.  2. If a vacancy occurs in the office of a trustee, the vacancy shall be filled for the unexpired term in the same manner as the office was previously filled, except that the board of trustees may appoint a qualified person to fill the vacancy in the office of an elected enrollee until the next regular election at which time an enrollee of the community-based health maintenance organization shall be elected for the unexpired term.  3. The elections of the enrollee members of the board of trustees shall be arranged for, managed and conducted by the board of trustees of the community-based health maintenance organization. ­­-------- (L. 1997 H.B. 335 § 3)
MO Rev Stat § 354.558 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.558 - Materials provided to prospective purchasers.

Effective - 28 Aug 1997   354.558. Materials provided to prospective purchasers. — A community-based health maintenance organization shall provide each prospective purchaser of its services with the following marketing materials prior to enrollment:  (1) A list of the health care providers who have a contractual agreement to provide services under the plan of coverage. It shall be a violation of the unfair trade practices act for a community-based health maintenance organization to falsely list that a provider has a contractual agreement to provide services under its plan of coverage;  (2) Information to describe how the community-based health maintenance organization will use utilization management to promote efficiency in the delivery of services in accordance with the terms of the contract for coverage. This information shall explain how the community-based health maintenance organization will encourage the use of treatment options that produce the most cost-effective results. The format and content of the descriptive information disclosed under this subdivision shall be approved by the department of commerce and insurance and shall include information regarding covered benefits available under the plan;  (3) Disclosure of grievance procedures established in accordance with regulations promulgated by the department of commerce and insurance for community-based health maintenance organizations. Included in this information shall be notification of how and when to contact the health plan and the department of commerce and insurance regarding a grievance; and  (4) Notice of the availability of coverage as described in section 354.554. ­­-------- (L. 1997 H.B. 335 § 4)
MO Rev Stat § 354.559 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.559 - Disclosure to members, restrictions and prohibitions.

Effective - 28 Aug 1997   354.559. Disclosure to members, restrictions and prohibitions. — No community-based health maintenance organization shall prohibit or restrict any provider from disclosing to any subscriber, enrollee or member any information that such provider deems appropriate regarding the nature of treatment, risks or alternatives thereto, the availability of other therapy, consultation or test, the decision of any plan to authorize or deny services, or to process the plan or any person to authorize or deny services, or to process the plan or any person contracting with the plan uses or proposes to use, to authorize or deny health care services or benefits. Any such prohibition or restriction contained in a contract with a provider entered into after August 28, 1997, shall be void and unenforceable. The standards used to determine if a community-based health maintenance organization has prohibited or restricted a provider's disclosure in violation of this section shall be those established by federal regulation of the Health Care Financing Administration for use in regulating managed care plans serving Medicare enrollees. ­­-------- (L. 1997 H.B. 335 § 5)
MO Rev Stat § 354.560 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.560 - Payment arrangements, department to adopt rules — disclosure of financial arrangements — confidentiality.

Effective - 28 Aug 1997   354.560. Payment arrangements, department to adopt rules — disclosure of financial arrangements — confidentiality. — 1. The director of the department of commerce and insurance shall adopt rules governing the use of payment arrangements by community-based health maintenance organizations which use payment withholding arrangements that place a physician at substantial financial risk. The standards for determining substantial financial risk and determining which payment arrangements are subject to rules shall be the same as provided for health maintenance organizations and competitive medical plans contracting with the Medicare program, as provided in 42 CFR 417.479, or its successor regulation.  2. The department of commerce and insurance may require that community-based health maintenance organizations disclose to the department financial arrangements or contractual provisions that place a physician at substantial financial risk. Such financial arrangements and contractual provisions which constitute substantial financial risk for the physician shall be reviewed by the department and shall be deemed approved if not disapproved by the director of the department within thirty days from the date that they are filed with the department.  3. The department of commerce and insurance shall promulgate rules governing the confidentiality of proprietary information disclosed to the department pursuant to this section. Proprietary information disclosed pursuant to this section shall not be construed to be a public record as defined in chapter 610. ­­-------- (L. 1997 H.B. 335 § 6)
MO Rev Stat § 354.562 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.562 - Grievance procedures, rulemaking authority.

Effective - 28 Aug 1997   354.562. Grievance procedures, rulemaking authority. — The director of the department of commerce and insurance shall promulgate rules governing grievance procedures for enrollees of a community-based health maintenance organization. Such regulations shall be consistent with and not less or more stringent than federal regulations governing grievance procedures promulgated by the Health Care Financing Administration of the United States Department of Health and Human Services for Medicare enrollees in managed care plans. ­­-------- (L. 1997 H.B. 335 § 7)
MO Rev Stat § 354.563 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.563 - Medicare rules to apply to community-based health maintenance organizations, when.

Effective - 28 Aug 1997   354.563. Medicare rules to apply to community-based health maintenance organizations, when. — If the Health Care Financing Administration of the United States Department of Health and Human Services promulgates regulations governing the practice of utilization review in health maintenance organizations serving enrollees in the Medicare program, the director of the department of commerce and insurance may issue rules to apply those standards to community-based health maintenance organizations as defined in subdivision (3) of section 354.400. ­­-------- (L. 1997 H.B. 335 § 8)
MO Rev Stat § 354.565 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.565 - Community-based health maintenance organization designation given, when — revocation.

Effective - 28 Aug 1997   354.565. Community-based health maintenance organization designation given, when — revocation. — The director of the department of commerce and insurance shall designate those health maintenance organizations which meet the criteria established in subdivision (3) of section 354.400 as community-based health maintenance organizations. After a community-based health maintenance organization has been so designated for two years, the director may revoke such designation at any time thereafter upon finding that the health maintenance organization has ceased to meet the established criteria for community-based health maintenance organizations. ­­-------- (L. 1997 H.B. 335 § 9)
MO Rev Stat § 354.567 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.567 - Community-based health maintenance organizations subject to other laws regarding health maintenance organizations.

Effective - 28 Aug 1997   354.567. Community-based health maintenance organizations subject to other laws regarding health maintenance organizations. — Community-based health maintenance organizations shall be subject to the same provisions of law as other health maintenance organizations to the extent they are not inconsistent with the provisions of sections 354.552 to 354.567. ­­-------- (L. 1997 H.B. 335 § 10)
MO Rev Stat § 354.570 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.570 - Rulemaking — procedure.

Effective - 28 Aug 1997   354.570. Rulemaking — procedure. — No rule or portion of a rule promulgated pursuant to sections 192.068, 354.603, 376.423, 376.1353, 376.1356, 376.1378, 376.1387, * 354.560, 354.562 and 354.563 shall become effective unless it has been promulgated in accordance with the provisions of chapter 536. ­­-------- (L. 1997 H.B. 335 § 14)   *Section number "376.1390" appears in original rolls, but was not enacted by H.B. 335, 1997.
MO Rev Stat § 354.600 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.600 - Definitions.

Effective - 28 Aug 2007   354.600. Definitions. — For purposes of sections 354.600 to 354.636 the following terms shall mean:  (1) "Facility", an institution providing health care services or a health care setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing facilities, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings;  (2) "Health benefit plan", a policy, contract, certificate or agreement entered into, offered or issued by a health carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services;  (3) "Health care professional", a physician or other health care practitioner licensed, accredited or certified by the state of Missouri to perform specified health services;  (4) "Health care provider" or "provider", a health care professional or a facility;  (5) "Health carrier", a health maintenance organization established pursuant to sections 354.400 to 354.636;  (6) "Health indemnity plan", a health benefit plan that is not a managed care plan;  (7) "Intermediary", a person authorized to negotiate and execute provider contracts with health carriers on behalf of health care providers or on behalf of a network;  (8) "Managed care plan", a health benefit plan that either requires an enrollee to use, or creates incentives, including financial incentives, for an enrollee to use health care providers managed, owned, under contract with or employed by the health carrier;  (9) "Network", the group of participating providers providing services to a managed care plan;  (10) "Participating provider", a provider who, under a contract with the health carrier or with its contractor or subcontractor, has agreed to provide health care services to enrollees with an expectation of receiving payment, other than coinsurance, co-payments or deductibles, directly or indirectly from the health carrier;  (11) "Primary care professional" or "primary care provider", a participating health care professional designated by the health carrier to supervise, coordinate or provide initial care or continuing care to an enrollee, and who may be required by the health carrier to initiate a referral for specialty care and maintain supervision of health care services rendered to the enrollee. ­­-------- (L. 1997 H.B. 335, A.L. 2007 S.B. 66)
MO Rev Stat § 354.612 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.612 - Continuation of care after provider termination, when.

Effective - 28 Aug 1997   354.612. Continuation of care after provider termination, when. — 1. Contracts between health plans and providers shall include a provision for the continuation of care to enrollees for a period of up to ninety days by a provider who terminates or is terminated from a network where the continuation of care is medically necessary and in accordance with the dictates of medical prudence, including circumstances such as disability, pregnancy, or life-threatening illness.  2. Such provision for the continuation of care shall guarantee that the enrollee shall not be liable to the provider for any amounts owed for medical care other than deductibles or co-payment amounts specified in the certificate of coverage or other contract between the enrollee and the health plan.  3. In the event the terminated provider is authorized to continue treating the enrollee pursuant to this section, the health plan shall have an obligation to pay the terminated provider at the previously contracted rate for services provided to the enrollee. ­­-------- (L. 1997 H.B. 335)
MO Rev Stat § 354.621 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.621 - Intermediary and participating provider requirements.

Effective - 28 Aug 1997   354.621. Intermediary and participating provider requirements. — 1. Intermediaries and participating providers with whom they contract shall comply with all the applicable requirements of sections 354.600 to 354.636.  2. A health carrier's statutory responsibility to monitor the offering of covered benefits to enrollees shall not be delegated or assigned to the intermediary.  3. If applicable, an intermediary shall transmit utilization documentation and claims paid documentation to the health carrier. The carrier shall monitor the timeliness and appropriateness of payments made to providers and health care services received by enrollees.  4. If applicable, an intermediary shall maintain the books, records, financial information and documentation of services provided to enrollees at its principal place of business in the state and preserve them for five years in a manner that facilitates regulatory review.  5. An intermediary shall allow a health carrier or the director access to the intermediary's books, records, financial information and any documentation of services provided to enrollees, as necessary to determine compliance with sections 354.600 to 354.636.  6. A health carrier shall have the right, in the event of the intermediary's insolvency, to require the assignment to the health carrier of the provisions of a provider's contract addressing the provider's obligation to furnish covered services. ­­-------- (L. 1997 H.B. 335)
MO Rev Stat § 354.624 (2021)
2021 Missouri Revised Statutes|Title XXIII - Corporations, Associations and Partnerships|Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans|Section 354.624 - Proposed provider contract forms filed with the director — contracts maintained at place of business, available for review, when.

Effective - 28 Aug 1997   354.624. Proposed provider contract forms filed with the director — contracts maintained at place of business, available for review, when. — 1. A health carrier shall file with the director all contract forms proposed for use with its participating providers and intermediaries. The forms shall not contain any information on compensation terms, rates or other payments by the carrier to participating providers or intermediaries and shall contain information on any term involving risk-sharing arrangements between the parties.  2. The health carrier shall maintain provider and intermediary contracts at its principal place of business in the state, or the health carrier shall have access to all contracts and provide copies to facilitate regulatory review upon twenty days' prior written notice from the director or at the time of any examination. ­­-------- (L. 1997 H.B. 335)