Common use of PHYSICIAN INCENTIVE PLAN Clause in Contracts

PHYSICIAN INCENTIVE PLAN. 8.5.1 The Contractor may establish physician incentive plans pursuant to federal and State regulations, including 42 CFR 422.208 and 422.210, and 42 CFR 438.6. 8.5.2 The Contractor shall disclose any and all such arrangements to DCH, and upon request, to Members. Such disclosure shall include: · Whether services not furnished by the physician or group are covered by the incentive plan; · The type of Incentive Arrangement; · The percent of Withhold or bonus; and, · The panel size and if patients are pooled, the method used. 8.5.3 Upon request, the Contractor shall report adequate information specified by the regulations to DCH in order that DCH will adequately monitor the CMO plan. 8.5.4 If the Contractor’s physician incentive plan includes services not furnished by the physician/group, the Contractor shall: (1) ensure adequate stop loss protection to individual physicians, and must provide to DCH proof of such stop loss coverage, including the amount and type of stop loss; and (2) conduct annual Member surveys, with results disclosed to DCH, and to Members, upon request. 8.5.5 Such physician incentive plans may not provide for payment, directly or indirectly, to either a physician or physician group as an inducement to reduce or limit medically necessary services furnished to an individual.

PHYSICIAN INCENTIVE PLAN. 8.5.1 The Contractor may establish physician incentive plans pursuant to federal and State regulations, including 42 CFR 422.208 and 422.210, and 42 CFR 438.6. 8.5.2 The Contractor shall disclose any and all such arrangements to DCH, and upon request, to Members. Such disclosure shall include: · • Whether services not furnished by the physician or group are covered by the incentive plan; · • The type of Incentive Arrangement; · • The percent of Withhold or bonus; and, · • The panel size and if patients are pooled, the method used. 8.5.3 Upon request, the Contractor shall report adequate information specified by the regulations to DCH in order that DCH will adequately monitor the CMO plan. 8.5.4 If the Contractor’s physician incentive plan includes services not furnished by the physician/group, the Contractor shall: (1) ensure adequate stop loss protection to individual physicians, and must provide to DCH proof of such stop loss coverage, including the amount and type of stop loss; and (2) conduct annual Member surveys, with results disclosed to DCH, and to Members, upon request. 8.5.5 Such physician incentive plans may not provide for payment, directly or indirectly, to either a physician or physician group as an inducement to reduce or limit medically necessary services furnished to an individual.

PHYSICIAN INCENTIVE PLAN. 8.5.1 The Contractor may establish physician incentive plans pursuant to federal and State regulations, including 42 CFR 422.208 and 422.210, and 42 CFR 438.6. 8.5.2 The Contractor shall disclose any and all such arrangements to DCH, and upon request, to Members. Such disclosure shall include: · : 8.5.2.1 Whether services not furnished by the physician or group are covered by the incentive plan; · ; 8.5.2.2 The type of Incentive Arrangement; · ; 8.5.2.3 The percent of Withhold or bonus; and, · , 8.5.2.4 The panel size and if patients are pooled, the method used. 8.5.3 Upon request, the Contractor shall report adequate information specified by the regulations to DCH in order that DCH will adequately monitor the CMO plan. 8.5.4 If the Contractor’s physician incentive plan includes services not furnished by the physician/group, the Contractor shall: (1) ensure adequate stop loss protection to individual physicians, and must provide to DCH proof of such stop loss coverage, including the amount and type of stop loss; and (2) conduct annual Member surveys, with results disclosed to DCH, and to Members, upon request. 8.5.5 Such physician incentive plans may not provide for payment, either directly or indirectly, to either a physician or physician group as an inducement to reduce or limit medically necessary services furnished to an individual.

PHYSICIAN INCENTIVE PLAN. 8.5.1 The Contractor may establish physician incentive plans pursuant to federal and State regulations, including 42 CFR 422.208 and 422.210, and 42 CFR 438.6. 8.5.2 The Contractor shall disclose any and all such arrangements to DCH, and upon request, to Members. Such disclosure shall include: · : 8.5.2.1 Whether services not furnished by the physician or group are covered by the incentive plan; · ; 8.5.2.2 The type of Incentive Arrangement; · ; 8.5.2.3 The percent of Withhold or bonus; and, · , 8.5.2.4 The panel size and if patients are pooled, the method used. 8.5.3 Upon request, the Contractor shall report adequate information specified by the regulations to DCH in order that DCH will adequately monitor the CMO plan. 8.5.4 If the Contractor’s physician incentive plan includes services not furnished by the physician/group, the Contractor shall: (1) ensure adequate stop loss protection to individual physicians, and must provide to DCH proof of such stop loss coverage, including the amount and type of stop loss; and (2) conduct annual Member surveys, with results disclosed to DCH, and to Members, upon request. 8.5.5 Such physician incentive plans may not provide for payment, directly or indirectly, to either a physician or physician group as an inducement to reduce or limit medically necessary services furnished to an individual.