PROHIBITION OF EXCLUSIVE ARRANGEMENTS WITH MANAGED CARE INSURERS
In this chapter:
I. An "affiliate" of a specific person means any person directly or indirectly controlling, controlled by or under common control with such specific person.
II. "Exclusive arrangement" means any agreement, contract, combination or conspiracy, including, without limitation, acquisition, purchase, affiliation or consulting agreements with medical practitioners or group practices and contracts of employment, between a managed care insurer and any person or persons which has the purposes or effect of:
(a) Committing any person providing physician services to accept and treat as patients the subscribers to or participants in a managed care plan to the exclusion of persons who have coverage from any or all other managed care insurers;
(b) Providing reimbursement on sliding scales, capitation rates, payment schedules or other payment arrangements as a financial incentive for persons providing physician services to restrict treatment of persons who have coverage from some or all other managed care insurers; or
(c) Providing reimbursement on sliding scales, capitation rates, payment schedules or other payment arrangements which contain a financial disincentive for failing to restrict treatment of persons who have coverage through any or all other managed care insurers.
" means any arrangement for the provision of physician services which is characterized by some measure of risk-sharing through capitated or other shared-risk compensation formulae, and which are characterized by the establishment and maintenance of a provider network available to subscribers or participants, and which provides incentives for subscribers or participants to use that network for covered services, and which ordinarily limit coverage or the extent of such coverage to physician services provided by that network. "
" shall include any managed care products or services or similar products including but not limited to those governed by RSA 415, RSA 419, RSA 420, RSA 420-A, RSA 420-B, and RSA 420-C. "Managed care" shall not include direct primary care services which meet the requirements of RSA 329:1-e.
IV. "Managed care insurer" means a person offering or underwriting managed care and any affiliate thereof.
V. "Managed care plan" means any medical insurance plan offering or underwriting managed care.
VI. "Person" includes natural persons, trusts, corporations, limited liability companies, partnerships, limited partnerships, proprietorships, incorporated or unincorporated associations, and any other legal entity, and any and all of their affiliates.
Source. 1996, 134:2, eff. May 21, 1996. 2019, 330:4, eff. Oct. 15, 2019.