§ 23-99-1201. Title

This subchapter shall be known and may be cited as the “Healthcare Contracting Simplification Act”.

§ 23-99-1202. Definitions

As used in this subchapter: (1) “All-products clause” means a provision in a healthcare contract that requires a healthcare provider, as a condition of participation or continuation in a provider network or a health benefit plan, to: (A) Serve in another provider network utilized by the contracting entity or a healthcare insurer affiliated with the […]

§ 23-99-1203. All-products clause — Prohibition

(a) Except as provided in subsections (b) and (d) of this section, a contracting entity shall not: (1) Offer to a healthcare provider a healthcare contract that includes an all-products clause; (2) Enter into a healthcare contract with a healthcare provider that includes an all-products clause; or (3) Amend or renew an existing healthcare contract […]

§ 23-99-1204. Prohibition — Most favored nation clause

(a) A contracting entity shall not: (1) Offer to a healthcare provider a healthcare contract that includes a most favored nation clause; (2) Enter into a healthcare contract with a healthcare provider that includes a most favored nation clause; or (3) Amend or renew an existing healthcare contract previously entered into with a healthcare provider […]

§ 23-99-1205. Contracting process

(a) (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) The notice required under subdivision (a)(1) of this section shall specify the precise healthcare […]

§ 23-99-1206. Freedom of contract

(a) A contracting entity shall not, directly or indirectly, offer or enter into a healthcare contract that: (1) Prohibits a participating healthcare provider from entering into a healthcare contract with another contracting entity; or (2) Prohibits a contracting entity from entering into a healthcare contract with another healthcare provider. (b) (1) A violation of this […]

§ 23-99-1207. Enforcement

(a) A contracting entity is subject to the Trade Practices Act, § 23-66-201 et seq. (b) The State Insurance Department shall enforce this subchapter.

§ 23-99-1208. Rules

(a) The Insurance Commissioner shall promulgate rules necessary to ensure compliance with this subchapter. (b) (1) When adopting the initial rules to ensure compliance with this subchapter, the final rule shall be filed with the Secretary of State for adoption under § 25-15-204(f): (A) On or before March 1, 2020; or (B) If approval under […]

§ 23-99-1209. Effective date

(a) This subchapter applies to the activities of risk-based provider organizations on and after January 1, 2021. (b) Except as provided in subsection (a) of this section, this subchapter is effective on and after September 1, 2019.