Provider Discrimination Prohibition. (i) 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. (ii) 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. (iii) Health Plan and Subcontractor shall not prohibit Provider from providing services for any other AHCCCS contractor.
Appears in 1 contract
Samples: Arizona Medicaid and Chip Program Regulatory Requirements Appendix
Provider Discrimination Prohibition. (i) 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.
(ii) 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.
(iii) Health Plan and Subcontractor shall not prohibit Provider from providing services for any other AHCCCS ADES/DDD contractor.
Appears in 1 contract
Samples: Arizona Medicaid Developmentally Disabled Program Regulatory Requirements Appendix
Provider Discrimination Prohibition. (ia) 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.
(iib) 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.
(iiic) Health Plan and Subcontractor shall not prohibit Provider from providing services for any other AHCCCS contractor.
Appears in 1 contract
Samples: Arizona Long Term Care Program Regulatory Requirements Appendix
Provider Discrimination Prohibition. (ia) In accordance with 42 CFR 438.12 and 438.214(c), Health Plan and and/or 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.
(iib) 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.
(iiic) Health Plan and Subcontractor shall not prohibit Provider from providing services for any other AHCCCS contractor.
Appears in 1 contract
Samples: Arizona CRS State Program Regulatory Requirements Appendix
