To amend chapter 354, RSMo, by adding four new sections relating to health care provider joint ventures.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF MISSOURI, AS FOLLOWS:

     Section A. Chapter 354, RSMo, is amended by adding thereto four new sections to be known as sections 354.792, 354.794, 354.796 and 354.798, to read as follows:

     354.792. As used in sections 354.792 to 354.798, the following terms mean:

     (1) "Antitrust law" shall mean as follows:

     (a) The meaning given it in the Clayton Act (15 U.S.C. section 12(a)) and in paragraph 5 of subsection (2) of the Federal Trade Commission Act (15 U.S.C. section 45) to the extent such section applies to unfair methods of competition; and

     (b) The provisions of chapter 416, RSMo;

     (2) "Committee", the Missouri health facilities review committee established in chapter 197, RSMo;

     (3) "Enrollee", any individual for whom a health care provider joint venture is responsible for providing health care services;

     (4) "Health care provider joint venture", an agreement between two or more providers that is entered into solely for the purpose of sharing in the provision of health care services and that involves substantial operational integration or financial risk sharing between the parties as specified in section 354.796;

     (5) "Health care services", services which an enrolled population might reasonably require to maintain good health, including, at a minimum, emergency care, inpatient hospital, physician care, outpatient medical services, dental care as well as other services for preventing illness, injury, or physical disability;

     (6) "Person", any individual, partnership, association, or corporation, or limited liability company or similar organization;

     (7) "Provider", any physician, hospital, or other person which is required to be licensed or otherwise authorized in this state to furnish health care services;

     (8) "Relevant geographic market", the geographic area in which a health care provider joint venture is offering health care services to its enrollees;

     (9) "Utilization review", a system for reviewing the appropriate and efficient allocation of health care services given or proposed to be given to a patient or group of patients by a provider.

     354.794. 1. Persons seeking to form health care provider joint venture shall file a written application with the committee and a determination whether their activities are authorized by sections 354.792 to 354.798. The committee shall determine the form and content of the application.

     2. Upon receipt of a completed application, the committee shall forward a copy of the application to the attorney general.

The attorney general shall review any application filed pursuant to sections 354.792 to 354.798 and may recommend approval of the application if the attorney general determines that the application is, taken as a whole, more likely to result in lower costs, increased access, or improved quality of health care than otherwise would occur under existing market conditions or conditions likely to develop without an exemption from antitrust law. In making a determination, the attorney general may consider, to the extent relevant:

     (1) Existing market structure;

     (2) Actual and potential sellers and buyers, or providers and purchasers;

     (3) Geographic market area;

     (4) Entry conditions;

     (5) Current market conditions;

     (6) Historical market behavior;

     (7) Whether the joint venture would unnecessarily restrain competition or restrains competition in ways not reasonably related to the purpose in sections 354.792 to 354.798 of this act;

     (8) Consistency with the applicable guidelines of the U.S. Department of Justice and the U.S. Federal Trade Commission; and

     (9) Any additional factors relating to state and federal antitrust law determined to be relevant to the application as promulgated by the committee, in consultation with the attorney general, pursuant to chapter 536, RSMo.

     3. The attorney general shall review any application and issue a written decision within ninety days recommending approval or disapproval of the application. If the attorney general determines that an applicant does not meet the qualifications for antitrust relief under sections 354.792 to 354.798, the committee shall inform the applicant in writing of the specific reasons why the applicant does not comply with these sections. If the attorney general determines that an applicant meets the requirements of sections 354.792 to 354.798, the committee shall review the application pursuant to subsection 4 of this section. The determination of the attorney general is final and is not appealable.

     4. No application for the formation of a health care provider joint venture shall be approved by the committee unless the health care joint venture has been approved by the attorney general and is:

     (1) A nonexclusive network in which the participating providers are permitted to create or join other competing networks;

     (2) Comprised of no more than fifty percent of any given provider profession in the relevant geographic market; and

     (3) Comprised of no more than fifty percent of the specialist providers in the relevant geographic market, with no less than two members of any specialty permitted to participate.

     354.796. 1. The committee shall supervise the activities of any health care provider joint venture authorized under sections 354.792 to 354.798. The committee shall provide for periodic review through, at a minimum, annual reports, audits prepared by certified public accountants, and periodic review by the committee. Upon evidence that a health care provider joint venture may not meet the requirements of sections 354.792 to 354.798, the committee, after a hearing thereon, may provisionally suspend or revoke an approval or may stipulate conditions for continuing approval. Decisions of the committee may be appealed by the applicant pursuant to section 197.335, RSMo. If the committee provisionally suspends or revokes approval of a joint venture for its failure to meet the requirements of subsection 3 of section 354.794, it shall request the attorney general to review the joint venture to determine whether it is in compliance with said subsection. The attorney general shall determine within ninety days whether the joint venture is in compliance with subsection 3 of section 354.974 and shall recommend whether the exemption granted under the provisions of sections 354.792 to 354.798 be terminated, maintained, or maintained only if the joint venture meets a specified set of conditions. Any recommendations of the attorney general shall be incorporated in the committee's final decision. Any final decision of the committee is appealable by the joint venture as provided in section 197.335, RSMo.

     2. Providers who form a health care provider joint venture shall:

     (1) Accept capitation contracts;

     (2) Accept contracts with fee withholding mechanisms relating to the ability of the health care provider to meet established goals of the joint venture for utilization review and management;

     (3) Contribute capital to fund the operational costs of the joint venture; and

     (4) Develop and operate comprehensive programs for utilization review and quality assurance that include controls over the use of institutional, specialized and ancillary medical services.

     354.798. 1. No provider in a health care provider joint venture, or the joint venture itself, that engages in activities approved by the committee and the attorney general pursuant to sections 354.752 to 354.798 shall be subject to civil or criminal liability under the antitrust laws of this state.

     2. The provisions of sections 354.792 to 354.798 shall not apply to health care providers who enter into other agreements or otherwise exchange information.

     3. When the committee withdraws its approval of any joint venture, such withdrawal becomes effective at the end of the next quarter of the joint venture's tax year.