Common use of Denial of Capitation Payments Clause in Contracts

Denial of Capitation Payments. If the Centers for Medicare and Medicaid Services denies payment for new Enrollees, as authorized by Social Security Act (SSA) Section 1903(m)(5) and 42 CFR Section 434.67, or such other applicable federal statutes or regulations, based upon a determination that Contractor failed substantially to provide medically necessary items and services, imposed premium amounts or charges in excess of permitted payments, engaged in discriminatory practices as described in SSA Section 1932(e)(1)(A)(iii), misrepresented or falsified information submitted to CMS, SDOH, LDSS, the Enrollment Broker, or an Enrollee, potential Enrollee, or health care provider, or failed to comply with federal requirements (i.e. 42 CFR Section 417.479 and 42 CFR Section 434.70) relating to the Physician Incentive Plans, SDOH and LDSS will deny capitation payments to the Contractor for the same Enrollees for the period of time for which CMS denies such payment.

Denial of Capitation Payments. If the Centers for Medicare and Medicaid Services denies payment for new Enrollees, as authorized by Social Security Act (SSA) Section 1903(m)(5) and 42 CFR Section 434.67, or such other applicable federal statutes or regulations, based upon a determination that Contractor failed substantially to provide medically necessary items and services, imposed premium amounts or charges in excess of permitted payments, engaged in discriminatory practices as described in SSA Section 1932(e)(1)(A)(iii1932(e)(l)(A)(iii), misrepresented or falsified information submitted to CMS, SDOH, LDSS, the Enrollment Broker, or an Enrollee, potential Enrollee, or health care provider, or failed to comply with federal requirements (i.e. 42 CFR Section 417.479 and 42 CFR Section 434.70) relating to the Physician Incentive Plans, SDOH and LDSS will deny capitation payments to the Contractor for the same Enrollees for the period of time for which CMS denies such payment.

Denial of Capitation Payments. If the US Centers for Medicare and Medicaid Services (CMS) denies payment for new Enrollees, as authorized by Social Security Act (SSA) Section SSA § 1903(m)(5) and 42 CFR Section 434.67§ 438.730 (e), or such other applicable federal statutes or regulations, based upon a determination that Contractor failed substantially to provide medically necessary items and services, imposed premium amounts or charges in excess of permitted payments, engaged in discriminatory practices as described in SSA Section § 1932(e)(1)(A)(iii), misrepresented or falsified information submitted to CMS, SDOH, LDSS, the Enrollment Broker, or an Enrollee, potential Prospective Enrollee, or health care provider, or failed to comply with federal requirements (i.e. 42 CFR Section 417.479 § 422.208 and 42 CFR Section 434.70§ 438.6 (h) relating to the Physician Incentive Plans), SDOH and LDSS will deny capitation payments to the Contractor for the same Enrollees for the period of time for which CMS denies such payment.

Denial of Capitation Payments. If the US Centers for Medicare and Medicaid Services (CMS) denies payment for new Enrollees, as authorized by Social Security Act (SSA) SSA Section 1903(m)(5) and 42 CFR Section 434.67438.730 (e), or such other applicable federal statutes or regulations, based upon a determination that Contractor failed substantially to provide medically necessary items and services, imposed premium amounts or charges in excess of permitted payments, engaged in discriminatory practices as described in SSA Section 1932(e)(1)(A)(iii), misrepresented or falsified information submitted to CMS, SDOH, LDSS, the Enrollment Broker, or an Enrollee, potential Prospective Enrollee, or health care provider, or failed to comply with federal requirements (i.e. i.e., 42 CFR Section 417.479 422.208 and 42 CFR Section 434.70438.6 (h) relating to the Physician Incentive Plans), SDOH and LDSS will deny capitation payments to the Contractor for the same Enrollees for the period of time for which CMS denies such payment.

Denial of Capitation Payments. If the Centers for Medicare and Medicaid Services (CMS) denies payment for new Enrollees, as authorized by Social Security Act (SSA) Section SSA § 1903(m)(5) and 42 CFR Section 434.67§ 438.730 (e), or such other applicable federal statutes or regulations, based upon a determination that Contractor failed substantially to provide medically necessary items and services, imposed premium amounts or charges in excess of permitted payments, engaged in discriminatory practices as described in SSA Section 1932(e)(1)(A)(iii§ 1932(e)(l)(A)(iii), misrepresented or falsified information submitted to CMS, SDOH, LDSS, the Enrollment Broker, or an Enrollee, potential Prospective Enrollee, or health care provider, or failed to comply with federal requirements (i.e. 42 CFR Section 417.479 § 422.208 and 42 CFR Section 434.70§ 438.6 (h)) relating to the Physician Incentive Plans, SDOH and LDSS will deny capitation payments to the Contractor for the same Enrollees for the period of time for which CMS denies such payment.

Denial of Capitation Payments. If the US Centers for Medicare and Medicaid Services (CMS) denies payment for new Enrollees, as authorized by Social Security Act (SSA) Section SSA§ 1903(m)(5) and 42 CFR Section 434.67§ 438.730 (e), or such other applicable federal statutes or regulations, based upon a determination that Contractor failed substantially to provide medically necessary items and services, imposed premium amounts or charges in excess of permitted payments, engaged in discriminatory practices as described in SSA Section 1932(e)(1)(A)(iii§ 1932(e)(l)(A)(iii), misrepresented or falsified information submitted to CMS, SDOH, LDSS, the Enrollment Broker, or an Enrollee, potential Prospective Enrollee, or health care provider, or failed to comply with federal requirements (i.e. 42 CFR Section 417.479 § 422.208 and 42 CFR Section 434.70§ 438.6 (h) relating to the Physician Incentive Plans, SDOH and LDSS will deny capitation payments to the Contractor for the same Enrollees for the period of time for which CMS denies such payment.

Denial of Capitation Payments. If the Centers for Medicare and Medicaid Services denies payment for new Enrollees, as authorized by Social Security Act (SSA) Section section 1903(m)(5) and 42 CFR Section section 434.67, or such other applicable federal statutes or regulations, based upon a determination that Contractor failed substantially to provide medically necessary items and services, imposed premium amounts or charges in excess of permitted payments, engaged in discriminatory practices as described in SSA Section 1932(e)(1)(A)(iiisection 1932(e)(l)(A)(iii), misrepresented or falsified information submitted to CMS, SDOH, LDSS, the Enrollment Broker, or an Enrollee, potential Enrollee, or health care provider, or failed to comply with federal requirements (i.e. 42 CFR Section section 417.479 and 42 CFR Section section 434.70) relating to the Physician Incentive Plans, SDOH and LDSS will deny capitation payments to the Contractor for the same Enrollees for the period of time for which CMS denies such payment.

Denial of Capitation Payments. If the Centers for Medicare and Medicaid Services Health Care Financing Administration (HCFA) denies payment for new Enrollees, as authorized by Social Security Act (SSA) Section 1903(m)(5) and '1903(m)(5)and 42 CFR Section ' 434.67, or such other applicable federal statutes or regulations, based upon a determination that Contractor failed substantially to provide medically necessary items and services, imposed premium amounts or charges in excess of permitted payments, engaged in discriminatory practices as described in SSA Section ' 1932(e)(1)(A)(iii), misrepresented or falsified information submitted to CMSHCFA, SDOH, LDSS, the Enrollment Broker, or an Enrollee, potential Enrollee, or health care provider, or failed to comply with federal requirements (i.e. i. e. 42 CFR Section ' 417.479 and 42 CFR Section '434.70) relating to the Physician Incentive Plans, SDOH and LDSS will deny capitation payments to the Contractor for the same Enrollees for the period of time for which CMS HCFA denies such payment.

Denial of Capitation Payments. If the Centers for Medicare and Medicaid Services denies payment for new Enrollees, as authorized by Social Security Act (SSA) Section 1903(m)(5) and 42 CFR Section 434.67, or such other applicable federal statutes or regulations, based upon a determination that Contractor failed substantially to provide medically necessary items and services, imposed premium amounts or charges in excess of permitted payments, engaged in discriminatory practices as described in DISCRIMINATORY PRACTICES AS DESCRIBED IN SSA Section 1932(e)(1)(A)(iii), misrepresented or falsified information submitted to CMS, SDOH, LDSS, the Enrollment Broker, or an Enrollee, potential Enrollee, or health care provider, or failed to comply with federal requirements (i.e. 42 CFR Section 417.479 and 42 CFR Section 434.70) relating to the Physician Incentive Plans, SDOH and LDSS will deny capitation payments to the Contractor for the same Enrollees for the period of time for which CMS denies such payment.