La. Rev. Stat. Ann. § 22:263. Requirements of provider contracts; prohibited incentives; definitions: Health Maintenance Organization Act – Louisiana
Status: EnactedYear Enacted: 1986
Year Amended: 2008
File: Download
Contracts between a health maintenance organization and a provider of health care services will include language exempting the enrollee from owing money that the HMO is responsible for covering. Providers who do not contract with the HMO can pursue collection from the HMO for services rendered. Nothing in this Section shall be construed to prohibit contracts that contain incentive plans that involve general payments, such as capitation payments, or shared-risk arrangements that are not tied to specific medical decisions involving a specific insured or groups of insureds with similar medical conditions.
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