Relationship of health care professional and patient; financial incentives; definition
See bold text below:
A. Nothing in this article alters the relationship of physician and patient, registered nurse practitioner and patient, dentist and patient or optometrist and patient.
B. The corporation shall not in any way influence the subscriber in the subscriber’s free choice of hospital, physician, registered nurse practitioner, dentist or optometrist other than to limit its benefits to participating hospitals, physicians, dentists and optometrists.
C. Nothing in this article abridges the right of any physician, hospital, dentist or optometrist to decline patients in accordance with the standards and practices of such physician, hospital, dentist or optometrist, and the corporation shall not be deemed to be engaged in the corporate practice of medicine, dentistry or optometry.
Prohibited Financial Incentives
D. A contract between the corporation and a health care professional shall not contain a financial incentive plan that includes a specific payment made to or withheld from the health care professional as an inducement to deny, reduce, limit or delay medically necessary care that is covered by the contract with a subscriber or group of subscribers for a specific disease or condition. This section does not prohibit per diem or per case payments, diagnostic related grouping payments, or financial incentive plans, including capitation payments or shared risk arrangements, that are not connected to specific medical decisions relating to a subscriber or a group of subscribers for a specific disease or condition. Each corporation shall file with its annual report a written statement with the director that certifies that the corporation is in compliance with this subsection.
E. For the purposes of this section, “health care professional” has the same meaning prescribed in § 20-3151.