reglab/housing_qa huggingface dataset:
MO Rev Stat § 376.1318 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1318 - Powers of mutual holding company, engaging in business of insurance, no authority, affiliation and merger agreements.

Effective - 28 Aug 1996   376.1318. Powers of mutual holding company, engaging in business of insurance, no authority, affiliation and merger agreements. — A mutual holding company shall have the same powers granted to domestic insurance companies pursuant to chapter 382 relating to insurance holding company systems, and shall be subject to the requirements and provisions of such chapter and shall have all the powers granted to corporations organized pursuant to chapter 351. Neither the mutual holding company nor any stock holding company created pursuant to sections 376.1300 to 376.1322 shall be an insurer or shall have the authority to engage in the business of insurance. A mutual holding company may enter into an affiliation agreement or a merger agreement either at the time of reorganization, or at some later time with the approval of the director, with any mutual life insurance company authorized to do business in this state. Any such merger agreement may authorize participating policyholders of the mutual life insurance company to become members of the mutual holding company. Any such affiliation agreement or merger agreement is subject to the insurance laws of this state relating to such transactions entered into by a domestic mutual life insurance company. ­­-------- (L. 1996 S.B. 759)
MO Rev Stat § 376.1322 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1322 - Mutual holding company subject to supervision of director, dissolution or liquidation — demutualization.

Effective - 28 Aug 1996   376.1322. Mutual holding company subject to supervision of director, dissolution or liquidation — demutualization. — 1. A mutual holding company is subject to the supervision of the director of the department of commerce and insurance in the same manner as an insurer subject to the provisions of this chapter and shall automatically be a party to any proceeding pursuant to the Missouri insurers supervision, rehabilitation and liquidation act, sections 375.1150 to 375.1246, involving a life insurance company which, as a result of a reorganization pursuant to section 376.1300, is a subsidiary of the mutual holding company or a stock holding company created pursuant to section 376.1307. In any proceeding pursuant to sections 375.1150 to 375.1246 involving the reorganized life insurance company, the assets of the mutual holding company are deemed to be assets of the estate of the reorganized life insurance company for purposes of satisfying the claims of the reorganized life insurance company's policyholders. A mutual holding company shall not dissolve or liquidate without the approval of the director of the department of commerce and insurance or as ordered by the court pursuant to sections 375.1150 to 375.1246.  2. Sections 375.201 to 375.226 shall apply to a demutualization of a mutual holding company the same as if such holding company was a mutual life insurance company. This section does not apply to those companies organized under chapter 354 or chapter 355 and does apply only to for-profit mutual life insurance companies. ­­-------- (L. 1996 S.B. 759)
MO Rev Stat § 376.1345 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1345 - Method of reimbursement not to require fee, discount, or remuneration — notification requirements — electronic funds transfer, when — overpayment, procedure — violation, penalty.

Effective - 28 Aug 2020, 2 histories   376.1345. Method of reimbursement not to require fee, discount, or remuneration — notification requirements — electronic funds transfer, when — overpayment, procedure — violation, penalty. — 1. As used in this section, unless the context clearly indicates otherwise, terms shall have the same meaning as ascribed to them in section 376.1350.  2. No health carrier, nor any entity acting on behalf of a health carrier, shall restrict methods of reimbursement to health care providers for health care services to a reimbursement method requiring the provider to pay a fee, discount the amount of their claim for reimbursement, or remit any other form of remuneration in order to redeem the amount of their claim for reimbursement.  3. If a health carrier initiates or changes the method used to reimburse a health care provider to a method of reimbursement that will require the health care provider to pay a fee, discount the amount of its claim for reimbursement, or remit any other form of remuneration to the health carrier or any entity acting on behalf of the health carrier in order to redeem the amount of its claim for reimbursement, the health carrier or an entity acting on its behalf shall:  (1) Notify such health care provider of the fee, discount, or other remuneration required to receive reimbursement through the new or different reimbursement method; and  (2) In such notice, provide clear instructions to the health care provider as to how to select an alternative payment method, and upon request such alternative payment method shall be used to reimburse the provider until the provider requests otherwise.  4. A health carrier shall allow the provider to select to be reimbursed by an electronic funds transfer through the Automated Clearing House Network as required pursuant to 45 C.F.R. Sections 162.925, 162.1601, and 162.1602, and if the provider makes such selection, the health carrier shall use such reimbursement method to reimburse the provider until the provider requests otherwise.  5. An amount a health carrier claims was overpaid to a provider may only be collected, withheld, or recouped from the provider, or third party that submitted the provider's claim under the third party's provider identification number, to whom the overpaid amount was originally paid. The notice of withholding or recoupment by a health carrier shall also inform the provider or third party of the health care service, date of service, and patient for which the recoupment is being made.  6. Violation of this section shall be deemed an unfair trade practice under sections 375.930 to 375.948. ­­-------- (L. 2019 S.B. 514, A.L. 2020 H.B. 1682)
MO Rev Stat § 376.1353 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1353 - Utilization review activities monitored.

Effective - 28 Aug 1997   376.1353. Utilization review activities monitored. — A health carrier shall be responsible for monitoring all utilization review activities carried out by, or on behalf of, the health carrier and for ensuring that all requirements of sections 376.1350 to 376.1390 and applicable rules and regulations are met. The health carrier shall also ensure that appropriate personnel have operational responsibility for the conduct of the health carrier's utilization review program. ­­-------- (L. 1997 H.B. 335)
MO Rev Stat § 376.1356 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1356 - Utilization review entity monitored, when.

Effective - 28 Aug 2019, 2 histories   376.1356. Utilization review entity monitored, when. — Whenever a health carrier contracts to have a utilization review entity perform the utilization review functions required by sections 376.1350 to 376.1390* or applicable rules and regulations, the health carrier shall be responsible for monitoring the activities of the utilization review entity with which the health carrier contracts and for ensuring that the requirements of sections 376.1350 to 376.1390* and applicable rules and regulations are met. ­­-------- (L. 1997 H.B. 335, A.L. 2019 S.B. 514)  *Section 376.1390 does not exist.
MO Rev Stat § 376.1359 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1359 - Written utilization program implemented, filed with the director.

Effective - 28 Aug 1997   376.1359. Written utilization program implemented, filed with the director. — 1. A health carrier that conducts utilization review shall implement a written utilization review program that describes all review activities, both delegated and nondelegated, for covered services provided. The program document shall describe information as required by the director.  2. A health carrier shall file an annual report of its utilization review program activities with the director. ­­-------- (L. 1997 H.B. 335)
MO Rev Stat § 376.1364 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1364 - Unique confirmation number required, prior authorization review — secure electronic transmission for prior authorizations — single cover page, contents.

Effective - 28 Aug 2019   376.1364. Unique confirmation number required, prior authorization review — secure electronic transmission for prior authorizations — single cover page, contents. — 1. Any utilization review entity performing prior authorization review shall provide a unique confirmation number to a provider upon receipt from that provider of a request for prior authorization. Except as otherwise requested by the provider in writing, unique confirmation numbers shall be transmitted or otherwise communicated through the same medium through which the requests for prior authorization were made.  2. No later than January 1, 2021, utilization review entities shall accept and respond to requests for prior authorization of drug benefits through a secure electronic transmission using the National Council for Prescription Drugs SCRIPT Standard Version 2017071 or a backwards-compatible successor adopted by the United States Department of Health and Human Services. For purposes of this subsection, facsimile, proprietary payer portals, and electronic forms shall not be considered electronic transmission.  3. No later than January 1, 2021, utilization review entities shall accept and respond to requests for prior authorization of health care services and mental health services electronically. For purposes of this subsection, facsimile, proprietary payer portals, and electronic forms shall not be considered electronic transmission.  4. No later than January 1, 2021, each health carrier utilizing prior authorization review shall develop a single secure electronic prior authorization cover page for all of its health benefit plans utilizing prior authorization review, which the carrier or its utilization review entity shall use to accept and respond to, and which providers shall use to submit, requests for prior authorization. Such cover page shall include, but not be limited to, fields for patient or enrollee information, referring or requesting provider information, rendering or attending provider information, and required clinical information, and shall be supplemented by additional clinical information as required by the health carrier or utilization review entity. ­­-------- (L. 2019 S.B. 514)
MO Rev Stat § 376.1365 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1365 - Reconsideration of an adverse determination, when.

Effective - 28 Aug 1997   376.1365. Reconsideration of an adverse determination, when. — 1. In a case involving an initial determination or a concurrent review determination, a health carrier shall give the provider rendering the service an opportunity to request on behalf of the enrollee a reconsideration of an adverse determination by the reviewer making the adverse determination.  2. The reconsideration shall occur within one working day of the receipt of the request and shall be conducted between the provider rendering the service and the reviewer who made the adverse determination or a clinical peer designated by the reviewer if the reviewer who made the adverse determination is not available within one working day.  3. If the reconsideration process does not resolve the difference of opinion, the adverse determination may be appealed by the enrollee or the provider on behalf of the enrollee. Reconsideration is not a prerequisite to a standard appeal or an expedited appeal of an adverse determination. ­­-------- (L. 1997 H.B. 335)
MO Rev Stat § 376.1367 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1367 - Emergency services benefit determination, coverage required, when.

Effective - 28 Aug 2018, 2 histories   376.1367. Emergency services benefit determination, coverage required, when. — When conducting utilization review or making a benefit determination for emergency services:  (1) A health carrier shall cover emergency services necessary to screen and stabilize an enrollee, as determined by the treating emergency department health care provider, and shall not require prior authorization of such services;  (2) Coverage of emergency services shall be subject to applicable co-payments, coinsurance and deductibles;  (3) Before a health carrier denies payment for an emergency medical service based on the absence of an emergency medical condition, it shall review the enrollee's medical record regarding the emergency medical condition at issue. If a health carrier requests records for a potential denial where emergency services were rendered, the health care provider shall submit the record of the emergency services to the carrier within forty-five processing days, or the claim shall be subject to section 376.383. The health carrier's review of emergency services shall be completed by a board-certified physician licensed under chapter 334 to practice medicine in this state;  (4) When an enrollee receives an emergency service that requires immediate post evaluation or post stabilization services, a health carrier shall provide an authorization decision within sixty minutes of receiving a request; if the authorization decision is not made within sixty minutes, such services shall be deemed approved;  (5) When a patient's health benefit plan does not include or require payment to out-of-network health care providers for emergency services including but not limited to health maintenance organization plans, as defined in section 354.400, or a health benefit plan offered by a health carrier consistent with subdivision (19) of section 376.426, payment for all emergency services as defined in section 376.1350 necessary to screen and stabilize an enrollee shall be paid directly to the health care provider by the health carrier. Additionally, any services authorized by the health carrier for the enrollee once the enrollee is stabilized shall also be paid by the health carrier directly to the health care provider. ­­-------- (L. 1997 H.B. 335, A.L. 2018 S.B. 982)
MO Rev Stat § 376.1369 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1369 - Certification of compliance, when.

Effective - 28 Aug 1997   376.1369. Certification of compliance, when. — A health carrier shall annually provide a written certification to the director that the utilization review program of the health carrier or its designee complies with all applicable state and federal laws establishing confidentiality and reporting requirements. ­­-------- (L. 1997 H.B. 335)
MO Rev Stat § 376.1372 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1372 - Certification and member handbook to include utilization review procedures — website or provider portal, prior authorization requirements available on.

Effective - 28 Aug 2019, 2 histories   376.1372. Certification and member handbook to include utilization review procedures — website or provider portal, prior authorization requirements available on. — 1. In the certificate of coverage and the member handbook provided to enrollees, a health carrier shall include a clear and comprehensive description of its utilization review procedures, including the procedures for obtaining review of adverse determinations, and a statement of rights and responsibilities of enrollees with respect to those procedures.  2. A health carrier shall include a summary of its utilization review procedures in material intended for prospective enrollees.  3. A health carrier shall print on its membership cards a toll-free telephone number to call for utilization review decisions.  4. (1) A health carrier or utilization review entity shall make any current prior authorization requirements or restrictions, including written clinical review criteria, readily accessible on its website or provider portal. Requirements and restrictions, including step therapy protocols as such term is defined in section 376.2030, shall be described in detail.  (2) No health carrier or utilization review entity shall amend or implement a new prior authorization requirement or restriction prior to the change being reflected on the carrier or utilization review entity's website or provider portal as specified in subdivision (1) of this subsection.  (3) Health carriers and utilization review entities shall provide participating providers with written or electronic notice of the new or amended requirement not less than sixty days prior to implementing the requirement or restriction. ­­-------- (L. 1997 H.B. 335, A.L. 2019 S.B. 514)
MO Rev Stat § 376.1375 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1375 - Registry of grievances maintained, procedures — definitions.

Effective - 28 Aug 1997   376.1375. Registry of grievances maintained, procedures — definitions. — 1. A health carrier shall maintain a written register of all grievances in a manner consistent with the requirements for maintaining complaint records pursuant to section 354.445. The grievance register shall contain the total number, type, nature and result of all grievances and such other information as may be prescribed by the director. A health carrier shall furnish the director with any records regarding a grievance upon request.  2. All grievances shall be date stamped when received by the health carrier. The date shall be legible and easily identified.  3. Upon receipt of any inquiry from the department of commerce and insurance regarding a grievance, a health carrier shall mail to the department an adequate response to the inquiry within twenty days from the date the department mails the inquiry. An envelope's postmark shall determine the date of mailing. When the requested response is not produced by the health carrier within twenty days, this nonproduction shall be deemed a violation of law, unless the person can demonstrate that there is reasonable justification for that delay. As used in this section:  (1) "Inquiry", each and every question or request for information submitted in writing to a health carrier by the department concerning a grievance;  (2) "Adequate response", a written response answering each inquiry with reasonable specificity. A health carrier's acknowledgment of the department's inquiry is not an adequate response. ­­-------- (L. 1997 H.B. 335)
MO Rev Stat § 376.1378 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1378 - Grievances and certificate of compliance filed with the director, when.

Effective - 28 Aug 1997   376.1378. Grievances and certificate of compliance filed with the director, when. — 1. A copy of the grievance procedures, including all forms used to process a grievance, shall be filed with the director. Any subsequent material modifications to the documents also shall be filed. In addition, a health carrier shall file annually with the director, as part of its annual report required by section 376.1375, a certificate of compliance stating that the health carrier has established and maintains, for each of its health benefit plans, grievance procedures that fully comply with the provisions of sections 376.1350 to 376.1390. The director has authority to disapprove a filing that fails to comply with sections 376.1350 to 376.1390 or applicable rules and regulations.  2. A description of the grievance procedure shall be set forth in or attached to the policy, certificate, membership booklet, outline of coverage or other evidence of coverage provided to enrollees.  3. The grievance procedure documents shall include a statement of an enrollee's right to contact the director's office for assistance at any time. The statement shall include the toll-free telephone number and address of the department of commerce and insurance.  4. No such grievance procedure shall act as a bar to any suit in a court of competent jurisdiction instituted by any such enrollee, or as a bar to any defense thereto by the health carrier.  5. In the event there is a conflict between the outcomes of the grievance procedure and any such suit, the outcome of the suit in a court of competent jurisdiction shall prevail. ­­-------- (L. 1997 H.B. 335)
MO Rev Stat § 376.1382 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1382 - First- and second-level grievance review for managed care plans, first-level procedures.

Effective - 28 Aug 1997   376.1382. First- and second-level grievance review for managed care plans, first-level procedures. — 1. A health carrier that offers managed care plans shall establish a first-level and second-level grievance review process for its managed care plans. A grievance may be submitted by an enrollee, an enrollee's representative or a provider acting on behalf of an enrollee.  2. Upon receipt of a request for first-level grievance review, a health carrier shall:  (1) Acknowledge receipt in writing of the grievance within ten working days;  (2) Conduct a complete investigation of the grievance within twenty working days after receipt of a grievance, unless the investigation cannot be completed within this time. If the investigation cannot be completed within twenty working days after receipt of a grievance, the enrollee shall be notified in writing on or before the twentieth working day and the investigation shall be completed within thirty working days thereafter. The notice shall set forth with specificity the reasons for which additional time is needed for the investigation;  (3) Within five working days after the investigation is completed, have someone not involved in the circumstances giving rise to the grievance or its investigation decide upon the appropriate resolution of the grievance and notify the enrollee in writing of the health carrier's decision regarding the grievance and of the right to file an appeal for a second-level review. The notice shall explain the resolution of the grievance and the right to appeal in terms which are clear and specific;  (4) Within fifteen working days after the investigation is completed, notify the person who submitted the grievance of the carrier's resolution of said grievance. ­­-------- (L. 1997 H.B. 335)