State Law

Nevada Admin. Code-Chapter 695C. HMOs; Provider-Sponsored Organizations-Providers of Medical Care

08/15/2023 Nevada Section 695C.195

Per capita payments

Risk—Physicians Taking

 1.  An agreement between a primary physician or delivery system intermediary and an organization may provide for per capita payments. If an agreement provides for per capita payments, such payments must be:

(a) Paid in advance without regard to the time services are rendered or the extent of those services; and

(b) Based upon an actuarial computation of the expected cost of those services.

2.  The per capita payment:

(a) May be reduced by the amount withheld pursuant to the agreement between the provider and organization as an incentive for the effective use of health care services.

(b) May not reflect any payment made by an enrollee to a physician in accordance with the schedule filed with and approved by the Division.

3.  This section does not prohibit the organization and physician or delivery system intermediary from agreeing to prospective or retroactive adjustments of the per capital payment which reflect an increase in the number of enrollees or additional services tendered by the physician or delivery system intermediary.