Provider Selection. To the extent applicable to Provider in performance of the Agreement, Provider shall comply with 42 CFR 438.214, as may be amended from time to time, which includes, but is not limited to the selection and retention of providers, credentialing and recredentialing requirements and nondiscrimination. If Subcontractor and/or Health Plan delegate credentialing to Provider, Subcontractor and/or Health Plan will provide monitoring and oversight and Provider shall ensure that all licensed medical professionals are credentialed in accordance with Health Plan’s and the State Contract’s credentialing requirements.
Provider Selection. To the extent applicable to Provider in performance of the Agreement, Provider shall comply with 42 CFR 438.214, as may be amended from time to time, which includes, but is not limited to the selection and retention of providers, credentialing and recredentialing requirements and nondiscrimination. If United delegates credentialing to Provider, United will provide monitoring and oversight and Provider shall ensure that all licensed medical professionals are credentialed in accordance with United’s and the State Contract’s credentialing requirements.
Provider Selection. Subject to all conditions, exclusions, and limitations, if the Insured uses the services of a Provider who is a licensed Practitioner in the state in which he is practicing and who is operating within the scope of his license, then such services shall be treated as though they had been performed by a Physician.
Provider Selection. 14.5.1. CONTRACTOR will not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, physical or mental handicap, disability, age or status as a disabled veteran or veteran of the Vietnam era. The CONTRACTOR will take affirmative action to ensure that qualified applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, national origin, physical or mental handicap, disability, age or status as a disabled veteran or veteran of the Vietnam era. Such action shall include, but not be limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and career development opportunities and selection for training, including apprenticeship.
14.5.2. CONTRACTOR agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the Federal Government or DHCS, setting forth the provisions of the Equal Opportunity clause, Section 503 of the Rehabilitation Act of 1973 and the affirmative action clause required by the Vietnam Era Veterans' Readjustment Assistance Act of 1974 (38 U.S.C. 4212). Such notices shall state the CONTRACTOR'S obligation under the law to take affirmative action to employ and advance in employment qualified applicants without discrimination based on their race, color, religion, sex, national origin physical or mental handicap, disability, age or status as a disabled veteran or veteran of the Vietnam era and the rights of applicants and employees.
Provider Selection. A. The Contractor shall have written policies and procedures for selection and retention of providers. (42 C.F.R. § 438.214(a).)
B. Contractor’s policies and procedures for selection and retention of providers must not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. (42 C.F.R. §§ 438.12(a)(2), 438.214(c).)
C. In all subcontracts with network providers, the Contractor must follow the Department’s uniform credentialing and re-credentialing policy. The Contractor must follow a documented process for credentialing and re- credentialing of network providers. (42 C.F.R. §§ 438.12(a)(2), , 438.214(b).)
D. The Contractor shall not employ or subcontract with providers excluded from participation in Federal health care programs under either section 1128 or section 1128A of the Act. (42 C.F.R. § 438.214(d).)
E. The Contractor may not discriminate in the selection, 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. (42 C.F.R. § 438.12(a)(1).)
Provider Selection a. The Contractor may not preclude any potential provider who is acting within the scope of his or her license or certification under state law from participating in the Network or refuse to make payments to a Provider, solely on the basis of that license or certification.
b. The Contractor must submit written policies and procedures for the selection and retention of Network Providers within fifteen (15) days after signing this Agreement for approval by the Department. Those policies and procedures must include standards and procedures for credentialing and recredentialing Network Providers that are consistent with this Section and include the following criteria:
a. Network Providers must have applicable licenses or certifications as required by Pennsylvania law.
b. Network Providers must have board certification or eligibility, as applicable.
c. Network Providers must not have been excluded from participating in Medicare or any State Medicaid or other health care program.
d. Network Providers must be enrolled in the Medical Assistance Program.
e. Network Providers must have malpractice/liability insurance.
f. Network Providers must disclose any past or pending lawsuits or litigation.
c. The Contractor may not discriminate against potential providers who serve high-risk populations or specialize in conditions that require costly treatment.
d. In establishing and maintaining a Network sufficient to provide prompt access to Capitation Services and other Covered Services, the Contractor must consider the following:
a. The anticipated number of Participants.
b. The expected utilization of services considering the needs of the population being served.
c. The numbers and types (in terms of training, experience, and specialization) of Network Providers required to furnish Capitation Services and other Covered Services in a timely manner.
d. The geographic location of Network Providers compared to Participants, considering distance, travel time, the means of transportation ordinarily used by Medical Assistance recipients, and whether the location provides physical access for Medical Assistance recipients with disabilities.
e. The number of Network Providers who are not accepting new Participants.
f. The ability of Network Providers to communicate with limited English proficient Participants in their preferred language.
g. The ability of Network Providers to ensure physical access, reasonable accommodations, culturally competent communications, and accessible equi...
Provider Selection. A. The Contractor shall have written policies and procedures for selection and retention of providers. (42 C.F.R. § 438.214(a).)
B. Contractor’s policies and procedures for selection and retention of providers must not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. (42 C.F.R. §§ 438.12(a)(2), 438.214(c).)
C. In all subcontracts with network providers, the Contractor must follow the Department’s uniform credentialing and re-credentialing policy. The Contractor must follow a documented process for credentialing and re- credentialing of network providers. (42 C.F.R. §§ 438.12(a)(2), , 438.214(b).)
D. The Contractor shall not employ or subcontract with providers excluded from participation in Federal health care programs under either section 1128 or section 1128A of the Act. (42 C.F.R. § 438.214(d).)
E. The Contractor may not discriminate in the selection, 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. (42 C.F.R. § 438.12(a)(1).)
F. The Contractor shall give practitioners or groups of practitioners who apply to be MHP contract providers and with whom the MHP decides not to contract written notice of the reason for a decision not to contract. (42 C.F.R. § 438.12(a)(1).)
G. Paragraphs A-F, above, may not be construed to:
1) Require the Contractor to subcontract with providers beyond the number necessary to meet the needs of its beneficiaries;
2) Preclude the Contractor from using different reimbursement amounts for different specialties or for different practitioners in the same specialty; or
3) Preclude the Contractor from establishing measures that are designed to maintain quality of services and control costs and are consistent with its responsibilities to beneficiaries. (42 C.F.R. § 438.12(b).)
H. Upon request, Contractor shall demonstrate to the Department that its providers are credentialed as required by paragraph C. (42 C.F.R. § 438.206(b)(6)
I. The Contractor shall establish individual, group and organizational provider selection criteria as provided for in Cal. Code Regs., tit. 9, § 1810.435.
J. Contractor shall only use licensed, registered, or waivered providers acting within their scope of practice for services that require a license, waiver, or registration. (Cal. Code Regs., tit. 9, § 1840.314(d).)
K. The Cont...
Provider Selection. To the extent applicable to Subcontractor and Provider in performance of the Agreement, Subcontractor shall, and shall require Provider to comply with 42 CFR 438.214, as may be amended from time to time, which includes but is not limited to the selection and retention of providers, credentialing and recredentialing requirements, and
Provider Selection. To the extent applicable to Subcontractor and Provider in performance of the Agreement, Subcontractor shall, and shall require Provider to comply with 42 CFR 438.214, as may be amended from time to time, which includes but is not limited to the selection and retention of providers, credentialing and recredentialing requirements, and nondiscrimination. If United delegates credentialing to Subcontractor, United will provide monitoring and oversight and Subcontractor shall ensure that all licensed medical professionals are credentialed in accordance with United’s and the State Contract’s credentialing requirements.
Provider Selection. A. The Contractor shall have written policies and procedures for selection and retention of providers. (42 C.F.R. § 438.214(a).)
B. Contractor’s policies and procedures for selection and retention of providers must not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. (42 C.F.R. §§ 438.12(a)(2), 438.214(c).)
C. In all subcontracts with network providers, the Contractor must follow the Department’s uniform credentialing and re-credentialing policy. The Contractor must follow a documented process for credentialing and re- credentialing of network providers. (42 C.F.R. §§ 438.12(a)(2), 438.214(b).)
D. The Contractor shall not employ or subcontract with providers excluded from participation in Federal health care programs under either section 1128 or section 1128A of the Act. (42 C.F.R. § 438.214(d).)
E. The Contractor may not discriminate in the selection, 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. (42 C.F.R. § 438.12(a)(1).)
F. The Contractor shall give practitioners or groups of practitioners who apply to be MHP contract providers and with whom the MHP decides not to contract written notice of the reason for a decision not to contract. (42 C.F.R. § 438.12(a)(1).)
