New York Department Adopts Health Risk Transfer Regulation

The regulation also forbids carriers from using the default of a provider as an excuse for getting out of their commitments to health plan members. “Notwithstanding any agreement to the contrary, the insurer retains full financial risk on a prospective basis for the provision of health care services pursuant to any applicable policy or regulation, ” the regulation states.

A group practice or other company that wants to accept capitated payments must show that it has a net worth equal to at least 12.5% of its total annual in-network capitation revenue from all insurance companies, or cash and easily cashed assets with a value equal to at least 5% of its total capitation revenue.