Common use of PHYSICIAN INCENTIVE PLAN Clause in Contracts

PHYSICIAN INCENTIVE PLAN. The Contractor may operate a physician incentive plan (PIP) only if no specific payment can be made directly or indirectly under a PIP to a physician or physician group as an inducement to reduce or limit medically necessary services furnished to an Enrollee. Contracts must be in compliance with the requirements set forth in 42 CFR §§ 422.208 and 422.210. The Contractor shall provide to the Division of Medicaid the following disclosure: a. Whether services not furnished by physician/group is covered by incentive plan. If the PIP does not cover services furnished by physician/group, no further disclosure is required. b. The type of incentive arrangement, e.g. withhold, bonus, capitation. c. Percentage of withhold or bonus, if applicable. d. Panel size, and if patients are pooled, the approved method used. e. If the physician/group is at substantial financial risk, the Contractor must report proof the physician/group has adequate stop-loss coverage, including amount and type of stop-loss.