Common use of Provider Selection Clause in Contracts

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 Contractor is not located outside of the United States. (42 C.F.R. § 602(i).)