As used in this article:(a) 'Department' means the Mississippi Department of Insurance.(b) 'Managed care plan' means a plan operated by a managed care entity as described in paragraph (c) of this section that provides for the financing and delivery of health care services to persons enrolled in such plan through: (i) Arrangements with selected providers to furnish health care services;(ii) Explicit standards for the selection of participating providers;(iii) Organizational arrangements for ongoing quality assurance, utilization review programs and dispute resolution; and(iv) Financial incentives for persons enrolled in the plan to use the participating providers, products and procedures provided for by the plan.(c) 'Managed care entity' includes a licensed insurance company, hospital or medical service plan, health maintenance organization (HMO), an employer or employee organization, or a managed care contractor as described in paragraph (d) of this section that operates a managed care plan.(d) 'Managed care contractor' means a person or corporation that: (i) Establishes, operates or maintains a network of participating providers;(ii) Conducts or arranges for utilization review are plan.(d) 'Managed care contractor' means a person or corporation that: (i) Establishes, operates or maintains a network of participating providers;(ii) Conducts or arranges for utilization review activities; and(iii) Contracts with an insurance company, a hospital or medical service plan, an employer or employee organization, or any other entity providing coverage for health care services to operate a managed care plan.(e) 'Participating provider' means a physician, hospital, pharmacy, pharmacist, dentist, nurse, chiropractor, optometrist, or other provider of health care services licensed or certified by the state, that has entered into an agreement with a managed care entity to provide services, products or supplies to a patient enrolled in a managed care plan.Laws, 1995, ch. 613, § 37, eff. 7/1/1995.
Mississippi Legal Code