{"data":{"id":"us-mo/mo.-rev.-stat.-354.552","jurisdiction":"us-mo","citation":"Mo. Rev. Stat. § 354.552","heading":"Community-based health maintenance organizations, requirements.","body":"1. A community-based health maintenance organization shall have available and accessible a sufficient number and type of physicians, specialists, and other providers as needed to:\n(1) Provide the benefits covered by the plan;\n(2) Meet the medical needs of the health plan's enrolled population;\n(3) Provide members with a reasonable choice of primary care physicians and specialty physicians.\n2. If a community-based health maintenance organization does not employ or contract with a physician with the expertise necessary to provide medically necessary care covered by the health plan, then the health maintenance organization shall arrange for a referral to a physician with the necessary expertise and ensure that the members obtain the covered benefit at no greater cost to the member than if the benefit were obtained from participating physicians.\n3. A community-based health maintenance organization's physicians, physician specialists and facilities shall be reasonably available. Primary health care services shall be in reasonable proximity to a member's personal residence or business, with due consideration given to the availability of physicians within the community-based health maintenance organization's service area. This provision shall not preclude a community-based health maintenance organization from arranging for the provision of member care outside the service area for a higher level of skill or specialty care than is available within the service area.","path":["Title XXIII - CORPORATIONS, ASSOCIATIONS AND PARTNERSHIPS","Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans"],"source_url":"https://revisor.mo.gov/main/OneSection.aspx?section=354.552","current_through":"2026 legislative session (floor)","vintage":"","retrieved_at":"2026-09-03T22:23:27Z","sha256":"5f8b6e3a4b45c72c9848c17ddbf1dc923600e2db4a1a5387f4e4c97533390ebe","source_id":"us-mo","stale":false,"prev":"us-mo/mo.-rev.-stat.-354.551","next":"us-mo/mo.-rev.-stat.-354.554"},"notice":"GroundRules: Original legal text. Not legal advice."}