26.1-49 Health Provider Cooperatives
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<![CDATA[CHAPTER 26.1-49HEALTH PROVIDER COOPERATIVES26.1-49-01. Definitions. As used in this chapter:1."Commissioner" means the insurance commissioner.2."Health care provider" means any person or institution licensed to provide health<br>care services in this state.3."Health provider cooperative" means a corporation organized under this chapter and<br>operated on a cooperative plan to provide health care services to purchasers of<br>those services.4."Member" means a licensed health care provider or an organization owned,<br>controlled, or affiliated with a health care provider, including without limitation, a<br>professional corporation, partnership, or other similar organization.26.1-49-02. Organization - Licensure. A health provider cooperative shall organizeunder chapter 10-15 unless otherwise provided in this chapter. After incorporation the health<br>provider cooperative is subject to chapter 10-15 unless otherwise provided in this chapter. If a<br>provision of this chapter conflicts with chapter 10-15, the provision of this chapter applies. A<br>health provider cooperative organized under this chapter is not an insurance company under<br>chapter 26.1-12, a health maintenance organization under chapter 26.1-18.1, or a nonprofit<br>health service corporation under chapter 26.1-17. A health provider cooperative does not violate<br>limitations on the corporate practice of medicine.26.1-49-03. Powers. In addition to the powers granted a cooperative under chapter10-15, a health provider cooperative has the powers granted a nonprofit corporation under<br>chapter 10-33. The power granted under chapter 10-15 controls over any inconsistent power<br>granted by chapter 10-33.26.1-49-04. Provider contracts. A health provider cooperative and its members mayexecute service contracts permitting the provider members to provide some or all of their health<br>care services through the health provider cooperative to the enrollees, members, subscribers, or<br>insureds of a nonprofit health service plan, health maintenance organization, accident and health<br>insurance company, or the state medical assistance program. Each purchaser may execute<br>contracts for the purchase of health services from a health provider cooperative in accordance<br>with this section.A contract between a health provider cooperative and a purchaser mustprovide for payment by the purchaser on a substantially capitated or similar risk-sharing basis.1.Every contract between a health provider cooperative and a purchaser must be in<br>writing and must provide that if the purchaser fails to pay for health care services as<br>set forth in the contract, the enrollee is not liable to the provider for any sums owed<br>by the purchaser.2.A member provider, agent, or trustee, or assignee thereof, may not maintain any<br>action at law against an enrollee to collect sums owed by the purchaser.26.1-49-05. Contract filing - Approval. The health provider cooperative shall file eachcontract between the cooperative and a purchaser with the commissioner. The commissioner<br>shall disapprove any contract:1.In which the consideration paid for health services is unreasonably high in<br>relationship to the services provided.Page No. 12.That fails to include evidence of the specific procedures used to inform prospective<br>enrollees of any limitations imposed on the enrollee's right to receive care from a<br>health provider of the enrollee's choice.3.Under which a health provider cooperative assumes a corridor of risk greater than<br>fifteen percent in its first year of operation, or greater than thirty percent in any year<br>thereafter.Any actuarial costs incurred by the department in review of that filing must be borne by the<br>cooperative. The commissioner may adopt rules implementing this section.26.1-49-06.Election of directors - Vote by mail.Directors of health providercooperatives are elected under procedures set forth in chapter 10-15. A member may vote by<br>mail for a director unless mail voting is prohibited for election of directors by the articles or bylaws<br>of the cooperative. The board of directors shall prescribe the form of the ballot. The members<br>shall mark the ballot for the candidate chosen and mail the ballot to the cooperative in a sealed<br>plain envelope inside another envelope bearing the member's name. If the ballot of the member<br>is received by the cooperative on or before the date of the regular members' meeting, the ballot<br>must be accepted and counted as the vote of the absent member.26.1-49-07.State and federal governmental participation.The state or federalgovernment, or any entity or political subdivision of the state or federal government, may be a<br>member of a health provider cooperative. Any state or federal governmental hospital may be a<br>member of a health provider cooperative. With respect to federal governmental participation:1.A health provider cooperative may limit its enrollment to those persons entitled to<br>care under the federal program responsible for the health provider cooperative.2.A health provider cooperative may request that the commissioner waive the eligibility<br>requirements for participation that are contrary to federal law or regulations.3.The commissioner shall consult with federal officials to develop procedures to allow<br>a health provider cooperative to use the federal government as a guaranteeing<br>organization.4.In developing and implementing initiatives to expand access to health care, the<br>commissioner must recognize the unique problems of veterans and consider<br>methods to reach underserved portions of the veteran population.26.1-49-08. Prohibited practices - Penalty.1.It is unlawful for any person, company, or corporation or any agent, officer, or<br>employee thereof, to coerce or require any person to agree, either in writing or<br>orally, not to join or become or remain a member of any health provider cooperative<br>as a condition of securing or retaining a contract for health care services with the<br>person, firm, or corporation.2.It is unlawful for any person, company, or corporation, or any combination of<br>persons, companies, or corporations, or any agents, officers, or employees thereof,<br>to engage in acts of coercion, intimidation, or boycott of, or any refusal to deal with,<br>any health care providing entity arising from that entity's actual or potential<br>participation in a health provider cooperative.3.It is unlawful for any health provider cooperative to engage in any acts of coercion,<br>intimidation, or boycott of, or any concerted refusal to deal with any health plan<br>company seeking to contract with the cooperative on a competitive, reasonable, and<br>nonexclusive basis.Page No. 24.It is unlawful for any health provider cooperative to refuse membership to any<br>licensed health care provider or organization that applies for membership and that<br>otherwise agrees to the membership requirements of the health provider<br>cooperative.5.Any person violating subsections 1 through 4 is deemed to have committed a<br>violation of chapter 51-08.1 and is subject to the provisions, procedures, and<br>penalties of that chapter.Page No. 3Document Outlinechapter 26.1-49 health provider cooperatives]]>