33-20B-3. Qualifications for participating providers; reasonable consideration.

Any essential rural health care provider shall have the opportunity to become a participating provider of health care services in a health benefit plan if such provider meets all of the following conditions:#

1. (1)

   Participates in the medicare and Medicaid programs;#

2. (2)

   Adopts and complies with a policy for the provision of health care services to indigent and charity patients;#

3. (3)

   Is licensed, where required under law, and qualified to render the services provided by the plan;#

4. (4)

   Agrees to payment terms which are either:#

   1. (A)

      The same payment terms applicable to other similar participating providers in the plan; or#

   2. (B)

      Such payment terms as may be mutually agreed upon by such provider and a health care insurer; and#

5. (5)

   Meets the reasonable and nondiscriminatory qualifications and standards established by the plan. Plan standards must comply with all applicable laws and regulations, but such qualifications and standards may not discriminate against essential rural health care providers on the basis of geographic proximity to other participating providers or corporate status.#

All essential rural health care providers within a defined service area who meet the conditions established in subsection (a) of this Code section shall be given the opportunity to apply to become a participating provider in a plan. Provisions within a health benefit plan applicable to providers in such plan shall be applied by the health care insurer in a uniform and consistent manner to similarly situated providers. In the event an essential rural health care provider requests the opportunity to become a participating provider in any health benefit plan, the health care insurer shall conduct reasonable and good faith negotiations with such essential rural health care provider to determine whether it meets the applicable qualifications and standards established by the plan in accordance with all applicable laws, rules, and regulations as promulgated by the Commissioner of Insurance.#

Health benefit plans shall include sufficient and reasonable numbers of physicians located in rural areas.#