26:2H-12.81 Applicability of plan.

3. a. Except for plans limited to specific clinical specialties or diagnosis related groups, a hospital and physician incentive plan shall apply to all admissions and all inpatient costs related to those admissions in a given program. Plans shall be open to all surgeons and attending physicians of record and may, at the discretion of a participating hospital, include other physicians involved in the provision of inpatient care. A physician shall not be eligible to participate in a plan unless the physician has been on the medical staff of the hospital for at least one year, except that these restrictions shall not apply to hospitalists and physicians who are new to the participating hospital's geographic area. Each plan shall include a mechanism to limit incentives attributable to year-to-year increases in patient volume for physicians on staff with multiple admitting privileges.

b. (1) A hospital and physician incentive plan shall be filed with the Department of Health by the hospital or facilitator-convener prior to the anticipated start date of the plan. The plan shall set forth the physician incentive methodology, institutional and specialty-specific goals, quality and cost performance standards, and any standards, programs, or protocols designed to ensure the plan meets the requirements of this act. Hospitals that have implemented a hospital and physician incentive plan shall submit an annual report to the department setting forth the distributions made to physicians, quality and cost performance standards, proposed revisions to the plan, if any, and such other information as the department may require.

(2) The department shall review plans submitted pursuant to paragraph (1) of this subsection, and shall notify the hospital if its plan does not meet the requirements of this act. The department shall provide the hospital with a reasonable opportunity to remedy any deficiencies in the plan, and may terminate a plan that continues to fail to meet the requirements of this act.

c. (1) A participating physician may withdraw from a plan upon reasonable notice to the hospital.

(2) A hospital may terminate a plan upon reasonable notice to the department and to physicians participating in the plan.

d. Patients shall be notified of the hospital and physician incentive plan in advance of admission to the hospital.

L.2017, c.46, s.3.