§ 40:2242 — Participation in state health care delivery system required

§2242. Participation in state health care delivery system required
A. Any health care delivery system established by the state pursuant to
a federal Medicaid waiver to provide health care to persons otherwise eligible
for Medicaid and to indigent, uninsured, or underinsured persons shall
recognize and include essential community providers as available and required
in the health care delivery systems and networks including but not limited to
referrals to specialists and health extenders.
B. Any basic benefits plan that may be established under a health
maintenance organization, health insurance organization, or managed care
organization that contracts with the state to provide or coordinate the provision
of health care services to persons otherwise eligible for Medicaid and to
indigent, uninsured, or underinsured persons shall include essential community
providers as available and required as active medical and health professionals.
However, the essential community provider shall agree to provide services that
meet all the terms and requirements, including the same administrative,
financial, licensure, and professional conditions which apply to health care
providers which have been designated as providers in a network established
by the basic benefits plan.
C. The secretary of the Louisiana Department of Health shall
promulgate rules and regulations in accordance with the Administrative
Procedure Act for the implementation of this Part which shall include but not
be limited to the establishment of minimum levels of participation of essential
community providers in such plans. Any plan provider that does not maintain
the minimum level of participation as determined by the secretary shall be
subject to penalties, including revocation of any authority to participate in the
state program or a prohibition on enrolling new members as determined by the
secretary.

Legislative History

Acts 1995, No. 1187, §1, eff. June 29, 1995.