§ 42-491 — Contracting entity and covered entity requirements. Remittance advices. Member identification cards.

(a) Any contracting entity that enters into or renews a contract with a health care provider on or after January 1, 2009, and that sells, leases, rents, assigns or grants access to such provider's health care services, discounted rates or fees shall include in such contract a provision specifically stating that such contracting entity may sell, lease, rent, assign or grant access to such provider's health care services, discounted rates or the fees established in such contract. (b) (1) Each such contracting entity that sells, leases, rents, assigns or grants access to any covered entity, a physician panel or a health care provider's health care services, discounted rates or fees shall: (A) Maintain an Internet web site or a toll-free telephone number through which a health care provider may obtain a listing of the covered entities to which such provider's services, discounted rates or fees have been sold, leased, rented, assigned or granted access. Such contracting entity shall update such listing on a routine basis not less than every ninety days; and (B) Upon request at the time of entering into such contract, provide a list to the health care provider of all known covered entities to which such contracting entity may sell, lease, rent, assign or grant access to such provider's health care services, discounted rates or fees. Such contracting entity shall update such list on a routine basis not less than every ninety days. (2) Each covered entity that subsequently sells, leases, rents, assigns or grants access to such provider's health care services, discounted rates or fees shall: (A) Maintain an Internet web site or a toll-free telephone number through which a health care provider may obtain a listing of the entities to which such provider's services, discounted rates or fees have been subsequently sold, leased, rented, assigned or granted access. Such covered entity shall update such listing on a routine basis not less than every ninety days; and (B) At the time of such subsequent selling, leasing, renting, assigning or granting of access, inform the contracting entity and the health care providers such contracting entity has directly contracted with of the Internet web site address or toll-free telephone number established under subparagraph (A) of this subdivision. (c) Each covered entity shall pay the health care provider's discounted rates or fees in accordance with the terms and conditions set forth in the contract between the contracting entity and such provider. (d) Subject to any applicable continuity of care requirements, agreements or contractual provisions with a health care provider, a covered entity's right to exercise a contracting entity's rights and responsibilities under a contract shall terminate on the date such contracting entity's contract with such provider is terminated. (e) On and after January 1, 2009, all remittance advices, whether written or electronic, shall clearly identify the following: (1) The name of the covered entity responsible for payment to the health care provider; and (2) The name of the contracting entity through which the payment rate and any discounts are claimed. (f) On and after January 1, 2009, any contracting entity or covered entity that issues a member identification card shall clearly mark on such card the address of the Internet web site or toll-free telephone number set forth in subdivision (1) of subsection (b) of this section.

Legislative History

(P.A. 08-126, S. 2; P.A. 09-74, S. 33; P.A. 10-59, S. 1.) History: P.A. 08-126 effective January 1, 2009; P.A. 09-74 made a technical change in Subsec. (b)(1), effective May 27, 2009; P.A. 10-59 amended Subsec. (b) to designate existing provisions as new Subdiv. (1), redesignate existing Subdivs. (1) and (2) as Subdiv. (1)(A) and (B) and amend same to require updating of listing not less than every 90 days, and add new Subdiv. (2) re duties of covered entity that subsequently sells, leases, rents, assigns or grants access to provider's health care services, discounted rates or fees.