Compensation for utilization management activities. a. Consistent with 42 CFR §438.3(i) and 42 CFR §422.208, compensation to individuals or entities that conduct utilization management activities shall not be structured so as to provide incentives for the individual or entity to deny, limit, or discontinue medically necessary services to any beneficiary.
Appears in 12 contracts
Samples: Intergovernmental Agreement, Intergovernmental Agreement, Intergovernmental Agreement
Compensation for utilization management activities. a. Consistent with 42 CFR §438.3(i) and 42 CFR §422.208, compensation to individuals or entities that conduct utilization management activities shall not be Exhibit A, Attachment I Program Specifications structured so as to provide incentives for the individual or entity to deny, limit, or discontinue medically necessary services to any beneficiary.
Appears in 3 contracts
Samples: Intergovernmental Agreement, Intergovernmental Agreement, Intergovernmental Agreement
Compensation for utilization management activities. a. Consistent with 42 CFR §438.3(i) and 42 CFR §422.208, compensation to individuals or entities that conduct utilization management activities shall not be structured so as to provide incentives for the individual or entity to deny, limit, or discontinue medically necessary services to any beneficiary.beneficiary.
Appears in 1 contract
Samples: Intergovernmental Agreement
