PHYSICIAN INCENTIVE PLAN. If CONTRACTOR wants to institute a Physician Incentive Plan, CONTRACTOR shall submit the proposed plan to the COUNTY which will in turn submit the Plan to the State for approval, in accordance with the provisions of 42 C.F.R. § 438.6(c).
PHYSICIAN INCENTIVE PLAN. 8.5.1 The Contractor may establish physician incentive plans pursuant to federal and State regulations, including 42 CFR 422.208 and 422.210, and 42 CFR 438.6.
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:
PHYSICIAN INCENTIVE PLAN. If Contractor wants to institute a Physician Incentive Plan, Contractor shall submit the proposed plan to County which will in turn submit the Plan to the State for approval, in accordance with the provisions of Title 42, CFR section 438.6(h).
PHYSICIAN INCENTIVE PLAN. 10.7.1 The Contractor will design and implement a plan that evaluates the quality of care delivered by PCPs and provides financial incentives to promote PCPs’ commitment to Preventive Services (the “Physician Incentive Plan”). The Contractor will submit such plan to ASES for approval at on or before December 1, 2011, and ASES shall approve it no later than thirty (30) Calendar Days after its submission. The Provider Incentive Plan will include, at a minimum, the following components:
PHYSICIAN INCENTIVE PLAN. The Contractor may, at its discretion, operate a Physician Incentive Plan (PIP) only if: • No single physician is put at financial risk for the costs of treating a Member that are outside the physician’s direct control; • No specific payment is made directly or indirectly to a physician or physician group as an inducement to reduce or limit medically appropriate services furnished to an individual Member; and, • The applicable stop/loss protection, Member survey, and disclosure requirements of 42 C.F.R. § 417 are met. The Contractor shall comply with all applicable requirements governing physician incentive plans, including but not limited to such requirements appearing at 42 C.F.R.§§ 422.208 and 422.210. In accordance with 42 C.F.R. § 438.6 (b), all incentive and withhold arrangements are necessary for the specified activities, targets, performance measures, or quality-based outcomes that support program initiatives as specified in the Department’s quality strategy. Performance for all incentive and withhold arrangements is measured during the rating period under which the incentive or withhold arrangement is applied. Further, all incentive and withhold arrangements must: • Be for a fixed amount of time; • Not be renewed automatically; • Be made available to both public and private contractors under the same terms of performance. • Does not condition MCO participation in the withhold arrangement on the MCO entering into or adhering to intergovernmental transfer agreements Additionally, the Contractor shall submit the Physician Incentive Plan annually to the Department. The Contractor shall be liable for any and all loss of Federal Financial Participation (FFP) incurred by the Department that results from the Contractor’s or any of its subcontractors’ failure to comply with the requirements governing physician incentive plans at 42 C.F.R.§§ 417, 434 and 1003; however, the Contractor shall not be liable for any loss of FFP under this provision that exceeds the total FFP reduction attributable to Members in the Contractor’s plan, and the Contractor shall not be liable if it can demonstrate, to the satisfaction of the Department, that it has made a good faith effort to comply with the cited requirements. The Contractor shall report biannually, or upon request, whether services not furnished by physician/group are covered by Physician Incentive Plan or incentive arrangement that includes withhold, bonus, capitation, and percent of withhold or bonus, if applica...
PHYSICIAN INCENTIVE PLAN. If Contractor elects t o operate a Physician Incentive Plan, Contractor agrees that no specific payment will be made directly or indirectly under the plan to a physician or physician group as an inducement to reduce or limit medically necessary services furnished to an Enrollee. Contractor agrees to submit to SDOH annual reports containing the information on its physician incentive plan in accordance with 42 CFR Section 434.70. The contents of such reports shall comply with the requirements of 42 CFR Section 417.479 and be in a format to be provided by SDOH. The Contractor must ensure that any agreements for contracted services covered by this Agreement, such as agreements between the Contractor and other entities or between the Contractor's subcontracted entities and their contractors, at all levels including the physician level, include language requiring that the physician incentive plan information be provided by the sub-contractor in an accurate and timely manner to the Contractor, in the format requested by SDOH. In the event that the incentive arrangements place the physician or physician group at risk for services beyond those provided directly by the physician or physician group for an amount beyond the risk threshold of 25% of potential payments for covered services (substantial financial risk), the Contractor must comply with all additional requirements listed in regulation, such as: conduct enrollee/disenrollee satisfaction surveys; disclose the requirements for the physician incentive plans to its beneficiaries upon request; and ensure that all physicians and physician groups at substantial financial risk have adequate stop-loss protection. Any of these additional requirements that are passed on to the subcontractors must be clearly stated in their Agreement.
PHYSICIAN INCENTIVE PLAN. First Medical may, upon prior written approval from ASES, design and implement a Physician Incentive Plan. First Medical shall submit a written request to ASES before implementing any such incentive program by providing a summary of the program for ASES review and approval at least sixty (60) Calendar Days before the projected implementation date for the program. XXXX has the absolute right to approve or disapprove the Physician Incentive program, and the program may be implemented only upon receipt of prior written approval from ASES. Once the Physician Incentive Plan is approved by ASES, First Medical shall notify applicable Physicians as established under section 7.1 of this Agreement.
PHYSICIAN INCENTIVE PLAN. A. If Contractor elects to operate a Physician Incentive Plan, Contractor agrees that no specific payment will be made directly or indirectly under the plan to a physician or physician group as an inducement to reduce or limit medically necessary services furnished to an Enrollee. Contractor agrees to submit to DHS annual reports containing the information on its physician incentive plan in accordance with 42 CFR § 438.6 (h). The contents of such reports shall comply with the requirements of 42 CFR §§ 422.208 and 422.210.
PHYSICIAN INCENTIVE PLAN. The parties to this Agreement shall, to the extent applicable, comply with the Physician Inventive Plan (PW) regulations, 42 C.F.R. 4 17.479 and 42 C.F.R. 434.70 and shall incorporate the requirements of such regulations into any agreement between a party and any other person or entity for the provision of services under this Agreement. The parties acknowledge that no specific payment will be made, directly or indirectly, as an inducement to reduce or limit medically necessary services furnished to a Member.
