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 physician 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 by a healthcare payor to a physician as a result of patient care costs that fall below cost thresholds of any form;
(3) (A) "Healthcare payor" means an entity that reimburses a physician for the delivery of healthcare services that are covered by the healthcare payor.
(B) "Healthcare payor" does not include a provider-based network or system that utilizes risk-sharing including an accountable care organization or a clinically integrated network; and
(4) "Risk-sharing payment" means a reduction in a payment to or refund of a payment already made to a physician as a result of patient care costs that exceed cost thresholds of any form.
Section: 23-99-902 23-99-903 NextLast modified: November 15, 2016