Provider Discrimination Prohibited. The Contractor shall not discriminate for the participation, reimbursement, or indemnification of any provider who is acting within the scope of his or her license or certification under applicable State law, solely on the basis of the license or certification. The Contractor shall not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. If the Contractor declines to include individual or groups of providers in its network, it must give the affected providers written notice of the reason for its decision. Nothing in this provision, however, shall require the Contractor to contract with providers beyond the number necessary to meet the needs of Enrollees or preclude the Contractor from using different reimbursement amounts for different specialties or for different practitioners in the same specialty, or preclude the Contractor from establishing measures that are designed to maintain quality of services and control costs and are consistent with its responsibilities to Enrollees. The Contractor shall not employ or contract with providers excluded from participation in federal health care programs under either Section 1128 or Section 1128A of the Social Security Act.
Appears in 6 contracts
Samples: medicaid.ms.gov, medicaid.ms.gov, medicaid.ms.gov
