Kansas Statutes 40-3234. Health maintenance organization; financial condition; hearing; commissioner’s powers
Terms Used In Kansas Statutes 40-3234
- Commissioner: means the commissioner of insurance of the state of Kansas. See Kansas Statutes 40-3202
- Health maintenance organization: means an organization which:
(1) Provides or otherwise makes available to enrollees health care services, including at a minimum those basic health care services which are determined by the commissioner to be generally available on an insured or prepaid basis in the geographic area served;
(2) is compensated, except for reasonable copayments, for the provision of basic health care services to enrollees solely on a predetermined periodic rate basis;
(3) provides physician services directly through physicians who are either employees or partners of such organization or under arrangements with a physician or any group of physicians or under arrangements as an independent contractor with a physician or any group of physicians;
(4) is responsible for the availability, accessibility and quality of the health care services provided or made available. See Kansas Statutes 40-3202
(a) Whenever the commissioner determines that the financial condition of a health maintenance organization is such that its continued operation might be hazardous to its enrollees, creditors or the general public, or that such health maintenance organization has violated any provisions of this act, the commissioner, after notice and hearing, may order such health maintenance organization to take action reasonably necessary to rectify the condition or violation. Such action may include, but not limited to one or more of the following:
(1) Reduce the total amount of present and potential liability for benefits by reinsurance or other method acceptable to the commissioner;
(2) reduce the volume of any new business being accepted;
(3) reduce expenses by specified methods acceptable to the commissioner;
(4) suspend or limit the writing of any new business for a period of time;
(5) increase the health maintenance organization’s capital and surplus by contribution; or
(6) take such other steps the commissioner may deem appropriate under the circumstances.
(b) The commissioner may adopt rules and regulations which set uniform standards and criteria for early warning that the continued operation of any health maintenance organization might be hazardous to its enrollees, creditors or the general public and set standards for evaluating the financial condition of any health maintenance organization.