| (a) An HMO may not, as a condition of a contract with
a physician or provider, or in any other manner, prohibit, attempt
to prohibit, or discourage a physician or provider from discussing
with or communicating to a current, prospective, or former patient,
or a party designated by a patient, with respect to:
(1) information or opinions regarding the patient's
health care, including the patient's medical condition or treatment
options, or the availability of facilities both in-network and out-of-network
for the treatment of a patient's medical condition;
(2) information or opinions regarding the provisions,
terms, requirements, or services of the health care plan as they relate
to the medical needs of the patient;
(3) the fact that the physician's or provider's contract
with the HMO has terminated or that the physician or provider will
otherwise no longer be providing medical care or health care services
under the health care plan; or
(4) the fact that, if medically necessary covered services
are not available through network physicians or providers, the HMO
must, on the request of a network physician or provider and within
time appropriate to the circumstances relating to the delivery of
the services and the condition of the patient, but in no event to
exceed five business days after receipt of reasonably requested documentation,
allow referral to a non-network physician or provider.
(b) An HMO may not in any way penalize, terminate,
or refuse to compensate for covered services, a physician or provider
for communicating with a current, prospective, or former patient,
or a party designated by a patient, in any way protected by this section.
(c) An HMO may not require a physician or provider
to provide a notification form stating that the physician or provider
is an out-of-network provider to a current, prospective, or former
patient, or a party designated by a patient, if the form contains
additional information that is intended, or is otherwise required
to be presented in a manner that is intended, to intimidate the patient.
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