58-41-121Documents provided to risk bearing entity by health maintenance organization.

In entering into, amending, or renewing a contract with a risk bearing entity, a health maintenance organization shall, unless already specified in the contract, provide the following, upon request, to a risk bearing entity:

(1)    At the time the contract is entered into, a written statement describing the amount or method of remuneration to be paid to the risk bearing entity. If any part of the remuneration is a calculated amount based on variable factors, the payment methodology upon which the calculated amount will be determined. The statement shall specify the services and expenses for which the risk bearing entity is financially liable in whole or part;

(2)    At the time payment is made, the basis of the calculation of that payment;

(3)    For health benefit plans in which the covered persons are assigned to the risk bearing entity under a capitated payment arrangement, a list of enrollees and payments due to the risk bearing entity, to be provided monthly if not already available to the risk bearing entity;

(4)    At the time the contract is entered into, a copy of the health maintenance organization's most recent annual statement filed with the NAIC; and

(5)    Once the contract is in effect, the quarterly or annual statement.

Source: SL 2013, ch 256, § 36.