Provider Discrimination Prohibition. In accordance with 42 CFR 438.12 and 438.214(c), United shall not discriminate with respect to the participation, reimbursement or indemnification of a provider who is acting within the scope of such provider’s license or certification under applicable State law, solely on the basis of such license or certification. Further, United shall not discriminate with respect to the participation, reimbursement or indemnification of any provider who serves high-risk Covered Persons or specializes in conditions requiring costly treatments. This provision shall not be construed as prohibiting United from limiting a provider’s participation to the extent necessary to meet the needs of Covered Persons. This provision also is not intended and shall not interfere with measures established by United that are designed to maintain quality of care practice standards and control costs.
Provider Discrimination Prohibition. United will not discriminate in 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 that license or certification. In addition, United will not discriminate against providers that serve high-risk populations or specialize in conditions that require costly treatment. This provision shall not be construed as prohibiting United from limiting a provider’s participation to the extent necessary to meet the needs of Customers. This provision also is not intended and shall not interfere with measures established by United that are designed to maintain quality of care practice standards and control costs.
Provider Discrimination Prohibition. Subcontractor and/or Health Plan shall not discriminate with respect to participation, reimbursement, or indemnification of a provider who is acting within the scope of the provider’s license or certification under applicable State law, solely on the basis of such license or certification. Subcontractor and/or Health Plan shall not discriminate against Provider for serving high-risk Covered Persons or if Provider specializes in conditions requiring costly treatments. This provision shall not be construed as prohibiting Subcontractor and/or Health Plan from limiting a provider’s participation to the extent necessary to meet the needs of Covered Persons. This provision also is not intended and shall not interfere with measures established by Subcontractor and/or Health Plan that are designed to maintain quality of care practice standards and control costs.
Provider Discrimination Prohibition. (a) In accordance with 42 CFR 438.12 and 438.214(c), Health Plan and Subcontractor shall not discriminate with respect to participation, reimbursement, or indemnification of a provider who is acting within the scope of Provider’s license or certification under applicable State law, solely on the basis of such license or certification. This provision shall not be construed as prohibiting Health Plan and/or Subcontractor from limiting a provider’s participation to the extent necessary to meet the needs of Covered Persons. This provision also is not intended and shall not interfere with measures established by Health Plan and/or Subcontractor that are designed to maintain quality of care practice standards and control costs.
(b) Health Plan and Subcontractor shall not discriminate against Provider for serving high-risk Covered Persons or if Provider specializes in conditions requiring costly treatments. Agreements shall not contain compensation terms that discourage Providers from serving any specific eligibility category; cost sharing requirements designed towards specific eligibility categories are excepted.
(c) Health Plan and Subcontractor shall not prohibit Provider from providing services for any other AHCCCS contractor.
Provider Discrimination Prohibition. Subcontractor will not discriminate in 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 that license or certification. In addition, Subcontractor will not discriminate against providers that serve high-risk populations or specialize in conditions that require costly treatment. This provision shall not be construed as prohibiting Subcontractor from limiting a provider’s participation to the extent necessary to meet the needs of Customers. This provision also is not intended and shall not interfere with measures established by Subcontractor that are designed to maintain quality of care practice standards and control costs.
Provider Discrimination Prohibition. Neither Health Plan nor Subcontractor shall exclude, sanction, terminate, discriminate against, or fail to renew Provider as a Participating Provider solely because:
(a) Provider has a practice that includes a substantial number of patients with expensive medical conditions;
(b) Provider advocated on behalf of a Covered Person for Medically Necessary and appropriate health care services consistent with the degree of learning and skill ordinarily possessed by a reputable Health Care Provider practicing according to the applicable legal standard of care; or
(c) Provider filed a grievance on behalf of and with the written consent of a Covered Person or helped a Covered Person to file a grievance.
Provider Discrimination Prohibition. United shall not discriminate with respect to the participation, reimbursement or indemnification of a provider who is acting within the scope of such provider’s license or certification under applicable State law, solely on the basis of such license or certification. Further, United shall not discriminate with respect to the participation, reimbursement or indemnification of any provider who serves high-risk Covered Persons or specializes in conditions requiring costly treatments. This provision shall not be construed as prohibiting United from limiting a provider’s participation to the extent necessary to meet the needs of Covered Persons. This provision also is not intended and shall not interfere with measures established by United that are designed to maintain quality of care practice standards and control costs.
Provider Discrimination Prohibition. In accordance with 42 CFR 438.12 and 438.214(c), Subcontractor and Health Plan shall not discriminate with respect to the participation, reimbursement or indemnification of a provider who is acting within the scope of such provider’s license or certification under applicable State law, solely on the basis of such license or certification. Further, Subcontractor and Health Plan shall not discriminate with respect to the participation, reimbursement or indemnification of any provider who serves high-risk Covered Persons or specializes in conditions requiring costly treatments. This provision shall not be construed as prohibiting Subcontractor and Health Plan from limiting a provider’s participation to the extent necessary to meet the needs of Covered Persons. This provision also is not intended and shall not interfere with measures established by Subcontractor and/or Health Plan that are designed to maintain quality of care practice standards and control costs.
Provider Discrimination Prohibition. United shall not exclude, sanction, terminate, discriminate against, or fail to renew Provider as a Participating Provider solely because:
i) Provider has a practice that includes a substantial number of patients with expensive medical conditions;
ii) Provider advocated on behalf of a Customer for Medically Necessary and appropriate health care services consistent with the degree of learning and skill ordinarily possessed by a reputable Health Care Provider practicing according to the applicable legal standard of care; or
iii) Provider filed a grievance on behalf of and with the written consent of a Customer or helped a Customer to file a grievance.
Provider Discrimination Prohibition. (a) In accordance with 42 CFR 438.12 and 438.214(c), United shall not discriminate with respect to participation, reimbursement, or indemnification of a provider who is acting within the scope of Provider’s license or certification under applicable State law, solely on the basis of such license or certification. This provision shall not be construed as prohibiting United from limiting a provider’s participation to the extent necessary to meet the needs of Covered Persons. This provision also is not intended and shall not interfere with measures established by United that are designed to maintain quality of care practice standards and control costs.
(b) United shall not discriminate against Provider for serving high-risk Covered Persons or if Provider specializes in conditions requiring costly treatments. Agreements shall not contain compensation terms that discourage Providers from serving any specific eligibility category; cost sharing requirements designed towards specific eligibility categories are excepted.
(c) United shall not prohibit Provider from providing services for any other AHCCCS contractor.
