Common use of Provider Incentive Programs Clause in Contracts

Provider Incentive Programs. Contractors shall establish a performance-based incentive system for its providers for the Contractor’s Hoosier Healthwise providers. The Contractor will determine its own methodology for incentivizing providers. The Contractor must obtain OMPP-approval prior to implementing its provider incentive program and before making any changes thereto. The State encourages creativity in designing pay for performance programs. If the Contractor offers financial incentives to providers, these payments shall be above and beyond the standard Medicaid fee-for-service fee schedule. Section 1876(i)(8) of the Social Security Act and federal regulations 42 CFR 438.6(h), 42 CFR 422.208 and 42 CFR 422.210 provide information regarding physician incentive plans. The Contractor shall comply with all federal regulations regarding the physician incentive plan and supply to OMPP information on its plan as required in the regulations and with sufficient detail to permit OMPP to determine whether the incentive plan complies with the federal requirements. The Contractor shall provide information concerning its physician incentive plan, upon request, to its members and in any marketing materials in accordance with the disclosure requirements stipulated in the federal regulations. Similar requirements apply to subcontracting arrangements with physician groups and intermediate entities. Physician incentive plans shall comply with the following requirements: The Contractor will make no specific payment directly or indirectly to a physician or physician group as an inducement to reduce or limit medically necessary services furnished to an individual member; and The Contractor meets requirements for stop-loss protection, member survey and disclosure requirements under 42 CFR 438.6(h).

Provider Incentive Programs. Contractors shall establish a performance-based incentive system for its providers for the Contractor’s Hoosier Healthwise HIP providers. Different provider incentives may be established for the different Medicaid lines of business. The Contractor will determine its own methodology for incentivizing providers. The Contractor must shall obtain OMPP-approval prior to implementing its provider incentive program and before making any changes thereto. The State encourages creativity in designing pay for performance programs. If the Contractor offers financial incentives to providers, these payments shall be above and beyond the standard Medicaid Medicare fee-for-service fee schedule. Section 1876(i)(8) of the Social Security Act and federal regulations 42 CFR 438.6(h), 42 CFR 422.208 and 42 CFR 422.210 provide information regarding physician incentive plans. The Contractor shall comply with all federal regulations regarding the physician incentive plan and supply to OMPP information on its plan as required in the regulations and with sufficient detail to permit OMPP to determine whether the incentive plan complies with the federal requirements. The Contractor shall provide information concerning its physician incentive plan, upon request, to its members and in any marketing materials in accordance with the disclosure requirements stipulated in the federal regulations. Similar requirements apply to subcontracting arrangements with physician groups and intermediate entities. Physician incentive plans shall comply with the following requirements:  The Contractor will make no specific payment directly or indirectly to a physician or physician group as an inducement to reduce or limit medically necessary services furnished to an individual member; and  The Contractor meets requirements for stop-loss protection, member survey and disclosure requirements under 42 CFR 438.6(h).