Section 1348.6 Of Article 2. Administration From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 2.
1348.6
. (a) No contract between a health care service plan and a
physician, physician group, or other licensed health care
practitioner shall contain any incentive plan that includes specific
payment made directly, in any type or form, to a physician, physician
group, or other licensed health care practitioner as an inducement
to deny, reduce, limit, or delay specific, medically necessary, and
appropriate services provided with respect to a specific enrollee or
groups of enrollees with similar medical conditions.
(b) 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 specific enrollees
or groups of enrollees with similar medical conditions. The payments
rendered or to be rendered to physicians, physician groups, or other
licensed health care practitioners under these arrangements shall be
deemed confidential information in accordance with subdivision (d) of
Section 1351.