§ 23-99-1205. Contracting process

1. (a)

   1. (1) A material amendment to a healthcare contract is allowed if a contracting entity provides to a participating healthcare provider the material amendment at least ninety (90) days before the effective date of the material amendment and in writing.

   2. (2) The notice required under subdivision (a)(1) of this section shall specify the precise healthcare contract or healthcare contracts to which the material amendment applies and be conspicuously labeled as follows:

   3. (3) The notice shall contain sufficient information about the amendment to allow a healthcare provider to assess the financial impact, if any, of the amendment.

2. (b) A notice described under subdivision (a)(1) of this section is not required for a material amendment resulting solely from a change in a fee schedule or code set if:

   1. (1) The fee schedule or code set is published by the United States Government or another third party; and

   2. (2) The terms of the healthcare contract expressly state that the healthcare provider’s compensation or claims submission is based on the fee schedule or code set.

3. (c)

   1. (1) Within ten (10) business days of a healthcare provider’s request, a contracting entity shall provide to the healthcare provider a full and complete copy of each healthcare contract between the contracting entity and the healthcare provider.

   2. (2) A full and complete copy of the healthcare contract shall include any amendments to the healthcare contract.

4. (d)

   1. (1)

      1. (A) A healthcare contract shall open for renegotiation and revision at least one (1) time every three (3) years.

      2. (B) Under subdivision (d)(1)(A) of this section, a party to the healthcare contract is not required to terminate the healthcare contract in order to open the healthcare contract for renegotiation of the terms.

   2. (2) This section does not prohibit a renegotiation of a healthcare contract at any time during the term of the healthcare contract.

5. (e)

   1. (1) A violation of this section is:

      1. (A) An unfair trade practice under § 23-66-206; and

      2. (B) Subject to the Trade Practices Act, § 23-66-201 et seq.

   2. (2) If a healthcare contract contains a provision that violates this section, the healthcare contract is void.

“Notice of Material Amendment to Healthcare Contract”.