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215 Ill. Comp. Stat. § 130/1002. Definitions: Limited Health Service Organization Act – Illinois
Status: Enacted     Year Enacted: 1989
Statute includes definitions relevant to the Limited Health Service Organization Act including a definition of per capita prepayment for providers.
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215 Ill. Comp. Stat. § 5/368b. Contracting procedures: Accident and Health Insurance – Illinois
Status: Enacted     Year Enacted: 2004
The fee schedule, the capitation schedule, and the network provider administration manual constitute confidential, proprietary, and trade secret information and are subject to the provisions of the Illinois Trade Secrets Act.
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27 R.I. Gen. Laws § 27-18-51. Restricted annual rate payments prohibited: Accident and Sickness Insurance Policies – Rhode Island
Status: Enacted     Year Enacted: 1998
(a) No policy delivered or issued in this state shall contain a provision for compensating any provider of outpatient mental health and/or substance abuse treatment service by using the restricted annual rate method of payment. …
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27 R.I. Gen. Laws § 27-19-43. Restricted annual rate payments prohibited: Nonprofit Hospital Service Corporations – Rhode Island
Status: Enacted     Year Enacted: 1998
(a) No corporation organized under this chapter shall compensate any provider of outpatient service by using the restricted annual rate method of payment. (b) The “restricted annual rate method of payment” is defined as any …
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27 R.I. Gen. Laws § 27-20-38. Restricted annual rate payments prohibited: Nonprofit Medical Service Corporations – Rhode Island
Status: Enacted     Year Enacted: 1998
(a) No corporation organized under this chapter shall compensate any provider of outpatient service by using the restricted annual rate method of payment. (b) The “restricted annual rate method of payment” is defined as any …
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27 R.I. Gen. Laws § 27-41-52. Restricted annual rate payments prohibited: Health Maintenance Organization Act – Rhode Island
Status: Enacted     Year Enacted: 1998
(a) No corporation organized under this chapter shall compensate any provider of outpatient service by using the restricted annual rate method of payment. (b) The restricted annual rate method of payment is defined as any …
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27 R.I. Gen. Laws §§ 27-68-1 & 27-68-2: Pilot Primary Care Program for the Uninsured – Rhode Island
Status: Enacted     Year Enacted: 2004
To increase access to primary care for those state residents who do not have access to health insurance coverage or who are unable to afford health insurance coverage, the director of the state department of …
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305 Ill. Comp. Stat. § 5/5-16. Managed Care: Medical Assistance – Illinois
Status: Enacted     Year Enacted: 1990
he Illinois Department may develop and implement a Primary Care Sponsor System consistent with the provisions of this Section. The purpose of this managed care delivery system shall be to contain the costs of providing …
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305 Ill. Comp. Stat. § 5/5-30.1. Managed care protections: Medical Assistance – Illinois
Status: Enacted     Year Enacted: 2014
An MCO shall pay any provider of emergency services that does not have in effect a contract with the contracted Medicaid MCO. The default rate of reimbursement shall be the rate paid under Illinois Medicaid …
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305 Ill. Comp. Stat. § 5/5-30.8. Managed care organization rate transparency: Medical Assistance – Illinois
Status: Enacted     Year Enacted: 2018
Department of Healthcare and Family Services shall implement a capitation base rate setting process beginning on the effective date of this amendatory Act of the 100th General Assembly which shall include all of the following …
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305 Ill. Comp. Stat. §§ 5/5A-12.2 through 12.5: Hospital Provider Funding – Illinois
Status: Enacted     Year Enacted: 2008
To preserve and improve access to hospital services, for hospital services rendered on or after July 1, 2008, the Illinois Department shall, except for hospitals described in subsection (b) of Section 5A-3, make payments to …
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40 Pa. Cons. Stat. § 991.2112. Financial incentives prohibition: Managed Care Plan Requirements – Pennsylvania
Status: Enacted     Year Enacted: 1998
No managed care plan shall use any financial incentive that compensates a health care provider for providing less than medically necessary and appropriate care to an enrollee. Nothing in this section shall be deemed to …
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40 Pa. Stat. and Pa. Cons. Stat. Ann. §§ 991.2101 through 991.2194: Quality Health Care Accountability and Protection – Pennsylvania
Status: Enacted     Year Enacted: 1998
Provisions governing managed care plans to ensure quality health care including prohibitions on financial incentives and gag clauses, standards regarding utilization review, prompt paymen of claims, and general responsibilities of managed care plans. Requires the …
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40 R.I. Gen. Laws § 40-8.4-17. Pilot primary care program established: Health Care for Families Act – Rhode Island
Status: Enacted     Year Enacted: 2004
To increase primary care access for those state residents who do not have access to health insurance coverage or who are unable to afford health insurance coverage, the director of the state department of human …
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62 Pa. Stat. and Cons. Stat. Ann. § 443.1. Medical assistance payments for institutional care: Medical Assistance – Pennsylvania
Status: Enacted     Year Enacted: 1968
Determines rates and methods of payment on behalf of eligble persons for inpatient hospital services.
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62 Pa. Stat. and Cons. Stat. Ann. § 443.5. Prepayment for contracted medical services: Medical Assistance – Pennsylvania
Status: Enacted     Year Enacted: 1976
For categorically needy or medically needy persons eligible for medical assistance, prepaid capitation payments or insurance premiums for services under the medical assistance State plan may be made on behalf of eligible persons through competitive …
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