No Incentives to Limit Medically Necessary Services. Health Plan and Subcontractor shall not structure compensation provided to individuals or entities that conduct utilization management and concurrent review activities so as to provide incentives for the individual or entity to deny, limit, or discontinue Medically Necessary services to any Covered Person.
Appears in 9 contracts
Samples: Downstream Provider Medicaid Program Regulatory Requirements Appendix, Downstream Provider Medicaid Program Regulatory Requirements Appendix, Kansas Medicaid and Chip Regulatory Requirements Appendix
No Incentives to Limit Medically Necessary Services. Subcontractor and Health Plan and Subcontractor shall not structure compensation provided to individuals or entities that conduct utilization management and concurrent review activities so as to provide incentives for the individual or entity to deny, limit, or discontinue Medically Necessary services to any Covered Person.
Appears in 7 contracts
Samples: Provider Agreement, Medicaid and Chip Regulatory Requirements Appendix, Provider Agreement
No Incentives to Limit Medically Necessary Services. Health Plan and Subcontractor shall not structure compensation provided to individuals or entities that conduct utilization management and concurrent review activities so as to provide incentives for the individual or entity to deny, limit, or discontinue Medically Necessary services to any Covered Person. Additionally, Health Plan and Subcontractor will ensure that all behavioral health authorization and utilization management activities are in compliance with 42 U.S.C. 1396u-2(b)(8).
Appears in 6 contracts
Samples: Massachusetts Government Programs Regulatory Requirements Appendix, Massachusetts Government Programs Regulatory Requirements Appendix, Massachusetts Government Programs Regulatory Requirements Appendix
No Incentives to Limit Medically Necessary Services. Health Plan and Subcontractor shall not structure compensation provided to individuals or entities that conduct utilization management and concurrent review activities so as to provide incentives for the individual or entity to deny, limit, or discontinue Medically Necessary services Covered Services to any Covered Person.
Appears in 4 contracts
Samples: Provider Agreement, Provider Agreement, Provider Agreement
No Incentives to Limit Medically Necessary Services. Neither Health Plan and nor Subcontractor shall not structure compensation provided to individuals or entities that conduct utilization management and concurrent review activities so as to provide incentives for the individual or entity to deny, limit, or discontinue Medically Necessary services to any Covered Person.
Appears in 4 contracts
Samples: Medicaid Provider Agreement, Medicaid Provider Agreement, Medicaid Provider Agreement
No Incentives to Limit Medically Necessary Services. Subcontractor and/or Health Plan and Subcontractor shall not structure compensation provided to individuals or entities that conduct utilization management and concurrent review activities so as to provide incentives for the individual or entity to deny, limit, or discontinue Medically Necessary services to any Covered Person.
Appears in 4 contracts
Samples: Provider Agreement, Provider Agreement, Provider Agreement
No Incentives to Limit Medically Necessary Services. Health Plan and and/or Subcontractor shall not structure compensation provided to individuals or entities that conduct utilization management and concurrent review activities so as to provide incentives for the individual or entity to deny, limit, or discontinue Medically Necessary services to any Covered Person.
Appears in 3 contracts
Samples: Arizona Medicaid Developmentally Disabled Program Regulatory Requirements Appendix, Arizona Medicaid and Chip Program Regulatory Requirements Appendix, Arizona Long Term Care Program Regulatory Requirements Appendix
No Incentives to Limit Medically Necessary Services. Neither Subcontractor nor Health Plan and Subcontractor shall not structure compensation provided to individuals or entities that conduct utilization management and concurrent review activities so as to provide incentives for the individual or entity to deny, limit, or discontinue Medically Necessary services to any Covered Person.
Appears in 3 contracts
Samples: Ohio State Program Regulatory Requirements Appendix, Provider Agreement, Provider Agreement
No Incentives to Limit Medically Necessary Services. Neither Subcontractor nor Health Plan and Subcontractor shall not structure compensation provided to individuals or entities that conduct utilization management and concurrent review activities so as to provide incentives for the individual or entity to deny, limit, or discontinue Medically Necessary services to any Covered PersonMedicaid Managed Care Member.
Appears in 2 contracts
Samples: Provider Agreement, Provider Agreement
No Incentives to Limit Medically Necessary Services. Neither Subcontractor nor Health Plan and Subcontractor shall not structure compensation provided to individuals or entities that conduct utilization management and concurrent review activities so as to provide incentives for the individual or entity to deny, limit, or discontinue Medically Necessary services to any Covered Person.the
Appears in 2 contracts
Samples: Provider Agreement, Medicaid and Chip Regulatory Requirements Appendix
No Incentives to Limit Medically Necessary Services. Health Plan and Subcontractor shall not structure compensation provided to individuals or entities that conduct utilization management and concurrent review activities so as to provide incentives for the individual or entity to deny, limit, or discontinue Medically Necessary services to any Covered Person.utilization
Appears in 1 contract
Samples: Downstream Provider Medicaid Program Regulatory Requirements Appendix
