NAC695F.310. Per capita payments.

     1. An agreement between a provider and an organization for the provision of a limited health service to enrollees on a prepayment basis may provide for per capita payments if the payments are:

     (a) Paid in advance without regard to the time services are rendered or the extent of those services; and

     (b) Based upon an actuarial computation of the expected cost of those services.

     2. The per capita payment:

     (a) May be reduced by an amount withheld pursuant to the agreement between the provider and organization as an incentive for the effective use of health care services.

     (b) May not reflect any payment made by an enrollee to a provider in accordance with a schedule of copayments filed with and approved by the Commissioner.

     3. This section does not prohibit the organization and provider from agreeing to prospective or retroactive adjustments of the per capita payment which reflect an increase in the number of enrollees or additional services tendered by the provider.

     (Added to NAC by Comm’r of Insurance, eff. 2-3-97)