§ 354.652 — Designation as essential community provider, procedure, qualifications.

Missouri § 354.652

• Jurisdiction: Missouri
• Title XXIII: CORPORATIONS, ASSOCIATIONS AND PARTNERSHIPS
• Ch. 354: Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans

Text

Any physician seeking a designation as an essential community provider shall:

(1)  Apply to the director of the department;

(2)  Document to the department that at least forty percent of the physician's practice is comprised of:

(a)  Medicaid or uninsured patients, or both; or

(b)  A combination of paragraph (a) and Medicare or underinsured patients, or both;

(3)  Serve a medically underserved area or a health professional shortage area;

(4)  Serve a medically underserved population;

(5)  Spend at least twenty hours per week at a principal site;

(6)  Be available to a medically underserved population on evenings and weekends at a principal site;

(7)  Hold hospital staff privileges with a participating network hospital of the health care insurer;

(8)  Not be a direct employee of a health care insurer, a for-profit or a not-for-profit hospital or health services corporation; and

(9)  Meet the following quality standards in accordance with guidelines established by the National Committee for Quality Assurance:

(a)  A current valid license to practice;

(b)  Clinical privileges in good standing at the hospital designated by the physician as the primary admitting facility;

(c)  A valid Drug Enforcement Agency or Controlled Dangerous Substances certificate, if applicable;

(d)  Graduation from medical school, and completion of a residency or board certification if applicable;

(e)  Work history;

(f)  Current adequate malpractice insurance according to the managed care organization's policy; and

(g)  Professional liability claims history.

Legislative History

(L. 1998 H.B. 1302 § 2)