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(a) A healthcare payor doing business in this state, when determining any gain-sharing or risk-sharing for a healthcare provider, shall not attribute to a healthcare provider any costs that are a result of variations in the healthcare payor’s freely negotiated contract pricing with other persons or entities outside the healthcare provider’s practice if including the costs reduces a healthcare provider’s gain-sharing amount or increases a healthcare provider’s risk-sharing amount.
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(b)
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(1) When determining any gain-sharing or risk-sharing for a healthcare provider based on the achievement of or failure to attain certain benchmarks, a healthcare payor doing business in this state shall use clearly expressed and identifiable benchmarks.
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(2) At least ninety (90) days in advance of implementation, the healthcare payor shall explain to the healthcare provider the applicability of the identifiable benchmarks.
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(3) Any identifiable benchmarks shall be within the control of the healthcare provider to achieve or fail to attain.
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