Provider Discrimination Prohibited Sample Clauses
Provider Discrimination Prohibited. The Contractor shall not discriminate for the participation, reimbursement, or indemnification of any provider who is acting within the scope of his or her license or certification under applicable State law, solely on the basis of the license or certification. The Contractor shall not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. If the Contractor declines to include individual or groups of providers in its network, it must give the affected providers written notice of the reason for its decision. Nothing in this provision, however, shall require the Contractor to contract with providers beyond the number necessary to meet the needs of Enrollees or preclude the Contractor from using different reimbursement amounts for different specialties or for different practitioners in the same specialty, or preclude the Contractor from establishing measures that are designed to maintain quality of services and control costs and are consistent with its responsibilities to Enrollees. The Contractor shall not employ or contract with providers excluded from participation in federal health care programs under either Section 1128 or Section 1128A of the Social Security Act.
Provider Discrimination Prohibited. ACOH may not, with respect to Provider participation, compensation or indemnification under this Agreement, discriminate against Provider to the extent that the Provider is acting within the scope of his, her or its license or certification under applicable State law, solely on the basis of that license or certification. Without limiting the foregoing, ACOH shall not discriminate against Provider for serving high-risk populations or specializing in conditions that require costly treatment. Nothing herein shall be construed to: (i) require ACOH to contract with Provider if not necessary to meet the needs of Members; (ii) preclude ACOH from using different reimbursement amounts for different specialties or for different practitioners in the same specialty; or (iii) preclude ACOH from establishing measures that are designed to maintain quality of services and control costs and are consistent with ACOH’s responsibilities to Members. 42 CFR §§438.12, 438.214(c).
Provider Discrimination Prohibited. ACDE may not, with respect to Provider participation, compensation or indemnification under this Agreement, discriminate against Provider to the extent that the Provider is acting within the scope of his, her or its license or certification under applicable State law, solely on the basis of that license or certification. Without limiting the foregoing, ACDE shall not discriminate against Provider for serving high-risk populations or specializing in conditions that require costly treatment. Nothing herein shall be construed to: (i) require ACDE to contract with Provider if not necessary to meet the needs of Members; (ii) preclude ACDE from using different reimbursement amounts for different specialties or for different practitioners in the same specialty; or
Provider Discrimination Prohibited. ACDE may not, with respect to Hospital participation, compensation or indemnification under this Agreement, discriminate against Hospital to the extent that the Hospital is acting within the scope of his, her or its license or certification under applicable State law, solely on the basis of that license or certification. Without limiting the foregoing, ACDE shall not discriminate against Hospital for serving high-risk populations or specializing in conditions that require costly treatment. Nothing herein shall be construed to: (i) require ACDE to contract with Hospital if not necessary to meet the needs of Members; (ii) preclude ACDE from using different reimbursement amounts for different specialties or for different practitioners in the same specialty; or
Provider Discrimination Prohibited. ACOH may not, with respect to Hospital participation, compensation or indemnification under this Agreement, discriminate against Hospital to the extent that the Hospital is acting within the scope of his, her or its license or certification under applicable State law, solely on the basis of that license or certification. Without limiting the foregoing, ACOH shall not discriminate against Hospital for serving high-risk populations or specializing in conditions that require costly treatment. Nothing herein shall be construed to: (i) require ACOH to contract with Hospital if not necessary to meet the needs of Members; (ii) preclude ACOH from using different reimbursement amounts for different specialties or for different practitioners in the same specialty; or (iii) preclude ACOH from establishing measures that are designed to maintain quality of services and control costs and are consistent with ACOH’s responsibilities to Members. 42 CFR §§438.12, 438.214(c).
Provider Discrimination Prohibited. AmeriHealth Caritas D.C. may not, with respect to Provider participation, compensation or indemnification under this Agreement, discriminate against Provider to the extent that the Provider is acting within the scope of his, her or its license or certification under applicable State law, solely on the basis of that license or certification. Without limiting the foregoing, AmeriHealth Caritas D.C. shall not discriminate against Provider for serving high-risk populations or specializing in conditions that require costly treatment. Nothing herein shall be construed to: (i) require AmeriHealth Caritas D.C. to contract with Provider if not necessary to meet the needs of Members; (ii) preclude AmeriHealth Caritas D.C. from using different reimbursement amounts for different specialties or for different practitioners in the same specialty; or (iii) preclude AmeriHealth Caritas D.C. from establishing measures that are designed to maintain quality of services and control costs and are consistent with AmeriHealth Caritas D.C.’s responsibilities to Members. 42 CFR §§438.12, 438.214(c).