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).
Appears in 3 contracts
Sources: Ancillary Services Agreement, Physician Provider Agreement, Provider Services Agreement