58-41-122.Documents provided to health maintenance organization by risk bearing entity.
A health maintenance organization shall include in any contract with a risk bearing entity a requirement that the risk bearing entity provide to the health maintenance organization at the time a contract is entered into and annually thereafter the following:
(1)Annual audited GAAP report in accordance with generally accepted accounting principles in the United States (U.S. GAAP);
(2)Documentation that satisfies the health maintenance organization that the risk bearing entity has sufficient ability to accept risk; and
(3)Documentation that satisfies the health maintenance organization that the risk bearing entity has appropriate management expertise and infrastructure.
The contract shall also require that the risk bearing entity on a quarterly basis provide status reports that include the following:
(1)Financial statements prepared in accordance with U. S. GAAP;
(2)An aging report of the percentage of claims that have been paid, pended, or denied, across all contracts with risk bearing entities; and
(3)On a monthly basis, a report of the estimated reported claims and incurred but not reported claims liability of the risk bearing entity.
Source: SL 2013, ch 256, §37.