Oklahoma § 63-2550.3 - Termination of participating providers – Procedures and

§ 63-2550.3. Termination of participating providers – Procedures and

conditions.

A. Every managed care plan shall establish procedures

governing termination of a participating provider who is terminated

for reasons other than cause. The procedures shall include

assurance of continued coverage of services, at the contract terms

and price by a terminated provider for up to ninety (90) calendar

days from the date of notice to the covered person, for a covered

person who:

1. Has a degenerative and disabling condition or disease;

2. Has entered the third trimester of pregnancy. Additional

coverage of services by the terminated provider shall continue

through at least six (6) weeks of postpartum evaluation; or

3. Is terminally ill.

Oklahoma Statutes - Title 63. Public Health and Safety

B. 1. If a participating provider voluntarily chooses to

discontinue participation as a network provider in a managed care

plan, the managed care plan shall permit a covered person to

continue an ongoing course of treatment with the disaffiliated

provider during a transitional period:

a.

of up to ninety (90) days from the date of notice to

the managed care plan of the provider’s disaffiliation

from the managed care plan’s network, or

b.

that includes delivery and postpartum care if the

covered person has entered the third trimester of

pregnancy at the time of the provider’s

disaffiliation.

2. If a provider voluntarily chooses to discontinue

participation as a network provider participating in a managed care

plan, such provider shall give at least a ninety-day notice of the

disaffiliation to the managed care plan. The managed care plan

shall immediately notify the disaffiliated provider’s patients of

that fact.

3. Notwithstanding the provisions of paragraph 1 of this

subsection, continuing care shall be authorized by the managed care

plan during the transitional period only if the disaffiliated

provider agrees to:

a.

continue to accept reimbursement from the managed

care plan at the rates applicable prior to the start

of the transitional period as payment in full,

b.

adhere to the managed care plan’s quality assurance

requirements and to provide to the managed care plan

necessary medical information related to such care,

and

c.

otherwise adhere to the managed care plan’s policies

and procedures, including, but not limited to,

policies and procedures regarding referrals, and

obtaining preauthorization and treatment plan

approval from the managed care plan.

Added by Laws 1999, c. 361, § 3, eff. Nov. 1, 1999.