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Cal. Health & Safety Code § 1348.6

Administration

Known as the Knox-Keene Health Care Service Plan Act

The act spans §§ 1340–1399 (617 sections).

Applied in 1 court decision — leading case Centinela Freeman Emergency Medical Associates v. Health Net of California, Inc. (2016)

Most recently applied in Centinela Freeman Emergency Medical Associates v. Health Net of California, Inc. (November 2016)

Added by Stats. 1996, Ch. 1014, Sec. 2

(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.

Official source: California Legislative Information. Reproduced from public-domain California statutes; confirm against the official source for the current text. Not legal advice.