A person or entity that contracts with a health-care provider shall comply with this article and shall include the provisions required by this article in the contract. Source: L. 2010: Entire article amended with relocations, (HB 10-1332), ch. 300, p. 1413, § 1, effective May 26. L. 2016: Entire section amended, (SB 16-127), ch. 68, […]
As used in this article, unless the context otherwise requires: “Category of coverage” means one of the following types of coverage offered by a person or entity: Health maintenance organization plans; Any other commercial plan or contract that is not a health maintenance organization plan; Medicare; Medicaid; or Workers’ compensation. “CMS” means the federal centers […]
A person or entity shall provide, with each health-care contract, a summary disclosure form disclosing, in plain language, the following: The terms governing compensation and payment; Any category of coverage for which the health-care provider is to provide service; The duration of the contract and how the contract may be terminated; The identity of the […]
In each contract between a pharmacy benefit manager and a pharmacy, the pharmacy shall be given the right to obtain from the pharmacy benefit manager, within ten days after any request, a current list of the sources used to determine maximum allowable cost pricing. The pharmacy benefit manager shall update the pricing information at least […]
A material change to a contract shall occur only if the person or entity provides in writing to the health-care provider the proposed change and gives ninety days’ notice before the effective date of the change. The writing shall be conspicuously entitled “notice of material change to contract”. If the health-care provider objects in writing […]
Notwithstanding section 25-37-103 (3), a contract may be modified by operation of law as required by any applicable state or federal law or regulation, and the person or entity may disclose this change by any reasonable means. Source: L. 2010: Entire article amended with relocations, (HB 10-1332), ch. 300, p. 1418, § 1, effective May […]
Upon completion of processing of a claim, the person or entity shall provide information to the health-care provider stating how the claim was adjudicated and the responsibility for any outstanding balance of any party other than the person or entity. Source: L. 2010: Entire article amended with relocations, (HB 10-1332), ch. 300, p. 1423, § […]
A person or entity shall not assign, allow access to, sell, rent, or give the person’s or entity’s rights to the health-care provider’s services pursuant to the person’s or entity’s contract unless the person or entity complies with the requirements of this section. A person or entity may assign, allow access to, sell, rent, or […]
Except as permitted by this article, a person or entity shall not require, as a condition of contracting, that a health-care provider waive or forego any right or benefit to which the health-care provider may be entitled under state or federal law, rule, or regulation that provides legal protections to a person solely based on […]
Upon sixty days’ notice, a health-care provider may decline to provide service pursuant to a contract to new patients covered by the person or entity. The notice shall state the reason or reasons for this action. As used in this section, “new patients” means those patients who have not received services from the health-care provider […]
A term for compensation or payment shall not survive the termination of a contract, except for a continuation of coverage required by law or with the agreement of the health-care provider. In addition to the right to terminate a contract in accordance with section 25-37-104 (2) based on a material change to the contract, a […]
A contract shall not preclude its use or disclosure to a third party for the purpose of enforcing the provisions of this article or enforcing other state or federal law. The third party shall be bound by the confidentiality requirements set forth in the contract or otherwise. Source: L. 2010: Entire article amended with relocations, […]
This article shall not apply to: An exclusive contract with a single medical group in a specific geographic area to provide or arrange for health-care services; however, this article shall apply to contracts for health-care services between the medical group and other medical groups; A contract or agreement for the employment of a health-care provider […]
With respect to the enforcement of this article, including arbitration, there shall be available: Private rights of action at law and in equity; Equitable relief, including injunctive relief; Reasonable attorney fees when the health-care provider is the prevailing party in an action to enforce this article, except to the extent that the violation of this […]
No provision of this article shall be used to justify any act or omission by a health-care provider that is prohibited by any applicable professional code of ethics or state or federal law prohibiting discrimination against any person. Source: L. 2010: Entire article amended with relocations, (HB 10-1332), ch. 300, p. 1426, § 1, effective […]
Nothing in this article, including the designation of standards, code sets, rules, edits, or related specifications, divests copyright holders of their copyrights in any work referenced in this article. Source: L. 2010: Entire article amended with relocations, (HB 10-1332), ch. 300, p. 1426, § 1, effective May 26.
