Qualified Providers. A qualified provider must be a county or an individual or agency contracted with a county or DDA.
Qualified Providers. Provider shall exclude any physician or other provider from performing services in connection with this Agreement if such provider has been suspended or terminated from participation in Medicaid or Government Programs or any other government-sponsored program, including Medicare or the Medicaid program in any state. Provider is prohibited from using any individual or entity (“Offshore Entity”) (including, but not limited to, any employee, contractor, subcontractor, agent, representative or other individual or entity) to perform any services for Plans if the individual or entity is physically located outside of one of the fifty United States or one of the United States Territories (i.e., American Samoa, Guam, Northern Marianas, Puerto Rico, and Virgin Islands), unless Company, in its sole discretion and judgment, agrees in advance and in writing to the use of such Offshore Entity. Provider further agrees that Company has the right to audit any Offshore Entity prior to the provision of services for Plans.
Qualified Providers. The state demonstrates that it has designed and implemented an adequate system for assuring that all waiver services are provided by qualified providers. Sub Assurances CMS Expectations The state verifies that providers initially and continually meet required licensure and/or certification standards and adhere to other state standards prior to their furnishing waiver service. State provides documentation of periodic review by licensing/certification entity. The state monitors non-licensed/non- certified providers to assure adherence to waiver requirements. State provides documentation that non- licensed/non-certified providers are monitored on a periodic basis sufficient to provide protections to waiver participants. The state implements its policies and procedures for verifying that provider training is conducted in accordance with state requirements and the approved waiver. State provides documentation of monitoring of training and actions it has taken when providers have not met requirements (e.g., technical assistance, training)
Qualified Providers. Article II.12 (Subcontracting) applies to Qualified Providers.]
Qualified Providers i. The MCO provider credentialing requirement in 42 CFR §438.214 shall apply to all HCBS providers. If the state wishes to change provider qualification standards from those that exist under waivers #0136 and #4159, the state must reach agreement with CMS to do so and ensure that the new standards preserve health and welfare. The state is required to report any changes in provider qualification standards as a part of the quarterly monitoring calls and quarterly reports pursuant to STCs 67 and 68.
Qualified Providers. A qualified provider must be a Contractor or an individual or agency contracted with Contractor named in this Personal Service Agreement or DDA.
Qualified Providers. For the purposes of this subsection Qualified Providers include:
Qualified Providers. The State demonstrates it has designed and implemented an adequate system for assuring that all waiver services are provided by qualified providers. Sub Assurances CMS Expectations Types of Evidence The State verifies that providers initially and continually meet required licensure and/or certification standards and adhere to other state standards prior to their furnishing waiver services. State provides documentation of periodic review by licensing/certification entity. Summary reports based on a significant sample of any single or combined method or source of evidence as follows: Record Reviews, on-site Record reviews, off-site Training verification records On-site observation, interviews, monitoring Analyzed collected data (including surveys, focus group, interviews, etc.) Trends, remediation actions proposed/taken Provider performance monitoring Operating agency performance monitoring Staff observation/opinion Participant/family observation/opinion Critical events and incident reports Mortality reviews Program logs Medication administration data reports, logs Financial records (including expenditures) Financial audits Meeting minutes Reports to Stat Medicaid Agency on delegated administrative functions Presentation of policies or procedures Other The state monitors non-licensed/non- certified providers to assure adherence to waiver requirements. State provides documentation that non-licensed/non- certified providers are monitored on a periodic basis sufficient to provide protections to waiver participants. The state implements its policies and procedures for verifying that provider training is conducted in accordance with state requirements and the approved waiver. State provides documentation of monitoring of training and actions it has taken when providers have not met requirements (e.g., technical assistance, training).
Qualified Providers. The CHC-MCO must limit its PCP Network to appropriately Qualified Providers. The CHC-MCO’s PCP Network must meet the following: Seventy–five to one hundred percent (75-100%) of the Network consists of PCPs who have completed an approved Primary Care residency in family medicine, osteopathic general medicine, or internal medicine. No more than twenty-five percent (25%) of the Network consists of PCPs without appropriate residencies but who have, within the past seven (7) years, five (5) years of post-training clinical practice experience in family medicine, osteopathic general medicine, internal medicine. Post-training experience is defined as having practiced at least as a 0.5 full-time equivalent in the practice areas described.
Qualified Providers. Laboratory shall exclude any Physician or other provider from performing services in connection with this agreement if such provider has been suspended or terminated from participation in Government Programs or any other government-sponsored program, including Medicare or the Medicaid program in any state.
