Provider Procurement. The PIHP is responsible for the development of the service delivery system and the establishment of sufficient administrative capabilities to carry out the requirements and obligations of this contract. Where the PIHP and affiliated CMHSPs fulfill these responsibilities through subcontracts, they shall adhere to applicable provisions of federal procurement requirements as specified in Attachment P 6.
4.1.1. In complying with these requirements and in accordance with 42 CFR 438.12, the PIHP:
a. May 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 that license or certification;
b. Must give those providers not selected for inclusion in the network written notice of the reason for its decision; Is not required to contract with providers beyond the number necessary to meet the needs of its beneficiaries, and is not precluded from using different practitioners in the same specialty. Nor is the PIHP prohibited from establishing measures that are designed to maintain quality of services and control costs and are consistent with its responsibilities to its beneficiaries. In addition, the PIHP's selection policies and procedures cannot discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatments. Also, the PIHP must ensure that it does 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.
Provider Procurement. Procurement management services are not within the scope of Services. However, In event that at Williams's request, Provider procures products and services from a third party on behalf of Williams or an Eligible Recipient (as distinguished from procurement on Provider's own behalf for use under this Agreement), Provider shall: (i) give Williams and the Eligible Recipients the benefit of Provider's most favorable vendor arrangements to the extent permitted under vendor's terms with the applicable vendor; (ii) use commercially reasonable efforts to obtain the most favorable pricing and terms and conditions then available from any customary vendor sources for such products and services; (iii) use the aggregate volume of Provider's procurements on behalf of itself, Williams and other customers as leverage in negotiating such pricing or other terms and conditions if permitted by the applicable vendor(s); (iv) use commercially reasonable efforts to enable Williams to receive at least an equitable and proportionate share of the total refunds, credits, discounts, rebates, incentives and other benefits then available to Provider directly in connection with such procurements; and (v) adhere to the procurement procedures specified in the Policy and Procedures Manual, as such procedures may be modified from time to time by Williams. In performance of the activities contemplated by this paragraph, Provider shall adhere to Williams's product, services and contract standards and shall not deviate from such standards without Williams's prior approval. To the extent an authorized Williams representative specifies the vendor, pricing and/or terms and conditions for a procurement contemplated by this paragraph, Provider shall not deviate from such instructions without Williams's prior approval. Unless otherwise agreed by the Parties, the procurement price of such products and services shall be treated as a Pass Through Expense in accordance with SECTION 11.2. Final Confidential and Proprietary Information of IBM and Williams
Provider Procurement. The PIHP is responsible for the development of the service delivery system and the establishment of sufficient administrative capabilities to carry out the requirements and obligations of this contract. Where the PIHP fulfills these responsibilities through subcontracts, they shall adhere to applicable provisions of federal procurement requirements as specified in Attachment P 6.
Provider Procurement. The PIHP is responsible for the development of the service delivery system and the establishment of sufficient administrative capabilities to carry out the requirements and obligations of this contract. Where the PIHP and affiliated CMHSPs fulfill these responsibilities through subcontracts, they shall adhere to applicable provisions of
4.1.1. In complying with these requirements and in accordance with 42 CFR 438.12, the PIHP:
a. May 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 that license or certification;
b. Must give those providers not selected for inclusion in the network written notice of the reason for its decision; Is not required to contract with providers beyond the number necessary to meet the needs of its beneficiaries, and is not precluded from using different practitioners in the same specialty. Nor is the PIHP prohibited from establishing measures that are designed to maintain quality of services and control costs and are consistent with its responsibilities to its beneficiaries. In addition, the PIHP's selection policies and procedures cannot discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatments. Also, the PIHP must ensure that it does 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.
