The General Assembly finds that: (1) Under an alternative payment system, a healthcare payor, when determining a healthcare provider’s patient care costs, may use factors that are not under the control of the healthcare provider; (2) A healthcare provider may not receive an appropriate share of savings or reduction in recoupment under an alternative payment […]
As used in this subchapter: (1) “Alternative payment system” means a payment methodology used by a healthcare payor that includes a risk-sharing or gain-sharing component for a healthcare provider that participates in a plan, program, or network offered by the healthcare payor; (2) “Gain-sharing payment” means an increase in a payment or additional payments made […]
(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 […]
(a) The provisions of this subchapter shall not be waived by contract. (b) Contractual arrangements or actions taken in conflict with this subchapter or that purport to waive any requirements of this subchapter are void.
(a) The State Insurance Department shall develop and promulgate rules for the implementation and enforcement of this subchapter. (b) In addition to or as an alternative to any enforcement action by the department, a healthcare provider or an organization that represents healthcare providers may enforce this subchapter by filing suit against a healthcare payor in: […]
