§ 24-A §4333 — Requirements for downstream risk arrangements

1.
Permissible downstream risk arrangements.
Downstream entities that do not exceed the risk threshold described in section 4334 may enter into downstream risk arrangements only if:
2.
Prohibited downstream risk payments.
A specific payment of any kind may not be made directly or indirectly under the incentive plan to a downstream entity as an inducement to reduce or limit covered medically necessary services under the carrier's contract furnished to an enrollee. Indirect payments include offerings of monetary value such as stock options or waivers of debt measured in the present or future.
3.
Applicability.
This section applies to risk arrangements between carriers and downstream entities with which they contract to provide medical services to enrollees. This section also applies to subcontracting arrangements.

Legislative History

PL 1999, c. 609, §20 (NEW).