Common use of Denial of Capitation Payments Clause in Contracts

Denial of Capitation Payments. If the US Centers for Medicare and Medicaid Services (CMS) denies payment for new Enrollees, as authorized by SSA.§.1903(m)(5) and 42 CFR §.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 §.1932(e)(1)(A)(iii), misrepresented or falsified information submitted to CMS, SDOH, LDSS, the Enrollment Broker, or an Enrollee, Prospective Enrollee, or health care provider, or failed to comply with federal requirements (i.e., 42 CFR §.422.208 and 42 CFR §.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 SSA.§.1903(m)(5Social Security Act (SSA) ss. 1903(m)(5) and 42 CFR §.438.730 (e)ss. 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 §.1932(e)(1)(A)(iiiss. 1932(e)(l)(A)(iii), misrepresented or falsified information submitted to CMS, SDOH, LDSS, the Enrollment Broker, or an Enrollee, Prospective potential Enrollee, or health care provider, or failed to comply with federal requirements (i.e., i.e. 42 CFR §.422.208 ss. 417.479 and 42 CFR §.438.6 (hss. 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 SSA.§.1903(m)(5Social Security Act (SSA) § 1903(m)(5) and 42 CFR §.438.730 § 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 §.1932(e)(1)(A)(iii§ 1932(e)(1)(A)(iii), misrepresented or falsified information submitted to CMS, SDOH, LDSS, the Enrollment Broker, or an Enrollee, Prospective Enrollee, or health care provider, or failed to comply with federal requirements (i.e., i.e. 42 CFR §.422.208 ' 422.208 and 42 CFR §.438.6 ' 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.