Minnesota Administrative Rules

4688.0050 REQUIREMENTS FOR CONTRACTS WITH HEALTH PLAN COMPANIES.

A health plan company that contracts with providers shall offer a provider contract to all designated ECPs located within the health plan company's approved service area. An ECP shall agree to serve, with or without a contract, all health plan companies within whose approved service area the ECP is located. The provider contract shall be the same or substantially similar to those offered to health plan providers who provide the same type or category of services, unless the parties mutually agree to a different contract. The provider contract shall include all of the services designated by the commissioner to the extent the services are covered under any health plan company certificate of coverage. Every provider contract between a designated ECP and a health maintenance organization or community integrated service network shall contain the provisions of Minnesota Statutes, section 62D.123. Designation of an applicant as an ECP shall not directly or indirectly require a health plan company to contract with a related organization that is affiliated with the designated ECP but is neither designated nor eligible for designation as an ECP. For the purposes of parts 4688.0001 to 4688.0160, "related organization" has the meaning given in Minnesota Statutes, section 317A.011, subdivision 18.

Statutory Authority:

MS s 62Q.19

History:

21 SR 6; L 1997 c 225 art 2 s 62

Published Electronically:

September 26, 1997