Financial Incentive Programs Prohibited; Capitated Payment Arrangement Allowed

1. Law
2. Georgia Code
3. Insurance
4. Managed Health Care Plans
5. Patient Protection
6. Financial Incentive Programs Prohibited; Capitated Payment Arrangement Allowed

1. A managed care plan may not use a financial incentive or disincentive program that directly or indirectly compensates a health care provider or hospital for ordering or providing less than medically necessary and appropriate care to his or her patients or for denying, reducing, limiting, or delaying such care. Nothing in this Code section shall be deemed to prohibit a managed care entity from using a capitated payment arrangement consistent with the intent of this Code section.
2. A managed care plan shall make full and timely payment or reimbursement to any health care provider or hospital in the same manner and subject to the same penalties as required of insurers for group accident and sickness insurance policies under paragraph (5) of subsection (b) of Code Section 33-30-6.

(Code 1981, §33-20A-6, enacted by Ga. L. 1996, p. 485, § 1; Ga. L. 1999, p. 342, § 2; Ga. L. 1999, p. 350, § 2; Ga. L. 2000, p. 136, § 33.)

Editor's notes.

- Ga. L. 1999, p. 342, § 7, not codified by the General Assembly, provides that: "This Act shall become effective on July 1, 1999, for purposes of preparing for implementation of the consumer choice option and shall be applicable to any contract, policy, or other agreement of a managed care plan or health maintenance organization if such contract, policy, or agreement provides for health care services or reimbursement therefor and is issued, issued for delivery, delivered, or renewed on or after January 1, 2000."

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