HB 2160 -- Health Insurance Networks

Sponsor:  Diehl

This bill prohibits any person whose primary business is
contracting with providers for the delivery of health care
services, known as a contracting entity, from selling, renting,
or giving a third party the entity's rights to a contracted
participating provider's services unless:

(1)  The third party is an employer or other entity that provides
health care coverage to its employees or members and the employer
or entity has a contract with the contracting entity for
administrative or claims processing services by the provider who
has a health care contract with the contracting entity and is
entitled to reimbursement for contracted health care services,
known as a participating provider;

(2)  The third party accessing the participating provider's
contracted services is an affiliate of the contracting entity or
is providing administrative services to or receiving
administrative services from the contracting entity or an
affiliate of the contracting entity; or

(3)  The health care contract between a contracting entity and
the participating provider specifically specifies that it applies
to a network rental arrangement and that one purpose of the
contract is to sell, rent, or give the contracting entity's
rights to the services of the participating provider and the
third party accessing the participating provider's services is a
third-party administrator, a preferred provider organization or
network, or an entity that engages in the business of providing
electronic claims transport between the contracting entity and
the third-party administrator.

A contracting entity that sells, rents, or gives its rights to a
participating provider's contracted services with the
participating provider must:

(1)  Maintain a webpage, updated at least every six months, that
lists the third parties with whom a contracting entity contracts
to sell, rent, or give the contracting entity's rights to a
participating provider or maintain a toll-free telephone number
accessible to all participating providers to access the same
listing of third parties; and

(2)  Require third parties accessing participating provider's
contracted services to comply with all applicable terms and
conditions of the contract except that a payer receiving
administrative services from the contracting entity will be
solely responsible for payment to the participating provider.

Missouri House of Representatives
95th General Assembly, 2nd Regular Session
Last Updated September 14, 2010 at 3:13 pm