Enforcement.

Checkout our iOS App for a better way to browser and research.

§431:26-107 Enforcement. (a) If the commissioner determines that:

(1) A health carrier has not contracted with a sufficient number of participating providers to ensure that covered persons have accessible health care services in a geographic area;

(2) A health carrier's network access plan does not ensure reasonable access to covered benefits;

(3) A health carrier has entered into a contract that does not comply with this article; or

(4) A health carrier has not complied with this article,

then the commissioner shall require a modification to the access plan, institute a corrective action plan that shall be followed by the health carrier, or use any of the commissioner's other enforcement powers to obtain the health carrier's compliance with this article.

(b) The commissioner shall not arbitrate, mediate, or settle disputes regarding a decision not to include a provider in a network plan or provider network or regarding any other dispute between a health carrier, its intermediaries, or one or more providers arising under a provider contract or its termination. [L 2017, c 191, pt of §1]


Download our app to see the most-to-date content.