Coverage offered through plan that provides for restricted network: Contracts with certain federally qualified health centers.
1. An individual carrier that offers a health benefit plan that includes a provision for a restricted network shall use its best efforts to contract with at least one health center in each established geographic service area to provide health care services to persons covered by the plan if the health center:
(a) Meets all conditions imposed by the carrier on similarly situated providers of health care with which the carrier contracts, including, without limitation:
(1) Certification for participation in the Medicaid or Medicare program; and
(2) Requirements relating to the appropriate credentials for providers of health care; and
(b) Agrees to reasonable reimbursement rates that are generally consistent with those offered by the carrier to similarly situated providers of health care with which the carrier contracts.
2. As used in this section, “health center” has the meaning ascribed to it in 42 U.S.C. § 254b.
Last modified: February 27, 2006