US Laws, Codes, Statutes & Cases

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 39
                             MANAGED CARE REFORM
    41-3928.  INCENTIVES TO WITHHOLD CARE PROHIBITED. (1) No managed care
organization shall offer a provider and no contract between a managed care
organization and a provider shall contain any incentive plan that includes a
specific payment made, in any type or form, to the provider as an inducement
to deny, reduce, limit, or delay specific, medically necessary, and
appropriate services covered by the health care contract and provided with
respect to a specific member or group of members with similar medical
conditions.
    (2)  Nothing in this section shall be construed to prohibit contracts that
contain incentive plans that involve general payments such as capitation
payments or shared risk agreements that are not tied to specific medical
decisions involving specific members or groups of members with similar medical
conditions.