§ 23-99-903 — Physician penalties - Limitation

(a) A healthcare payor doing business in this state, when determining any gain-sharing or risk-sharing for a healthcare provider, shall not attribute to a healthcare provider any costs that are a result of variations in the healthcare payor's freely negotiated contract pricing with other persons or entities outside the healthcare provider's practice if including the costs reduces a healthcare provider's gain-sharing amount or increases a healthcare provider's risk-sharing amount. (b) (1) When determining any gain-sharing or risk-sharing for a healthcare provider based on the achievement of or failure to attain certain benchmarks, a healthcare payor doing business in this state shall use clearly expressed and identifiable benchmarks. (2) At least ninety (90) days in advance of implementation, the healthcare payor shall explain to the healthcare provider the applicability of the identifiable benchmarks. (3) Any identifiable benchmarks shall be within the control of the healthcare provider to achieve or fail to attain.

Legislative History

Amended by Act 2019, No. 862,§ 1, eff. 7/24/2019. Added by Act 2015, No. 902,§ 1, eff. 7/22/2015.