Xxxxx Laws I and II Sample Clauses

Xxxxx Laws I and II. If the MCO implements a physician incentive plan, then the MCO must meet the Xxxxx Laws I & II, 42 C.F.R. § 422.208, 417.479, Social Security Act Physician Incentive Plan 1903(m)(2)(A)(viii) and Social Security Act1903(m)(4) that require: a. No specific payment of any kind be made directly or indirectly under the plan to a physician or physician group as an inducement to reduce or to limit medically necessary services. Indirect payments include offerings of monetary value (such as stock options or waivers of debt) measured in the present or future. b. If the MCO places a physician or physician group at substantial financial risk (as determined by the Secretary of the Department) for services not provided by the physician or physician group, the MCO shall provide stop-loss protection for the physician or physician group that is adequate and appropriate based on standards developed by the Secretary that take into account the number of physicians placed at such substantial financial risk in the group or under the plan and the number of individuals enrolled with the organization who receive services from the physician or the physician group.
Sample 1

Related to Xxxxx Laws I and II

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