Starting this year, plans that sign or renew a contract must disclose details of physician incentive arrangements and certify that their physicians comply with stop-loss coverage requirements
By April 1 each year, plans must report to HCFA what portions of capitation payments went to primary care, specialty, hospital and other services during the previous calendar year.
Plans must tell beneficiaries whether physicians operate under incentives, and if so what type (capitation, withhold, bonus), whether the incentives cover referrals to specialists and whether there is stop-loss insurance. They also must provide a summary of patient satisfaction survey results.
If incentive plans put physicians at substantial financial risk, a plan must conduct a beneficiary survey during 1997 or the first year of the incentive plan. Thereafter, the survey must be conducted every two years. Beginning in 1998, plans may satisfy the requirement by using a survey being developed for HCFA's broader Consumer Assessment of Health Plans Study.