Title 33, Chapter 20A, Section 6
( 33-20A-6)
(a) 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. (b) 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. |