56-7-3010 - Contractor requirements. [Effective until June 30, 2010. See the Compiler's Notes.]
56-7-3010. Contractor requirements. [Effective until June 30, 2010. See the Compiler's Notes.]
(a) Contractors shall ensure that health care providers providing services to plan enrollees:
(1) Do not charge enrollees or third parties for health care services covered by the plan in excess of the amount allowed by the plan, except for any applicable copayments, deductibles or coinsurance;
(2) Do not refuse to provide services to a plan enrollee on the basis of health status, medical condition, previous insurance status, race, color, creed, age, national origin, gender, sexual orientation, disability or marital status. This subdivision (a)(2) may not be construed to require a provider to furnish medical services that are not within the scope of that provider's license; and
(3) Are reimbursed at the negotiated reimbursement rates between the contractor and its provider network.
(b) Health care providers shall not be required to provide services to enrollees who refuse or fail to meet their cost sharing responsibilities.
(c) Contractors shall ensure that the state, through the department, and the enrollees benefit financially from any contracts maintained between the contractor and health care providers providing services to plan enrollees. All special pricing considerations, financial incentives and discounts incorporated into the contracts shall accrue to the state and the enrollees.
[Acts 2006, ch. 867, §§ 5, 14(a).]