Common use of RURAL HEALTH PROVIDERS Clause in Contracts

RURAL HEALTH PROVIDERS. 7.14.1 In rural areas of the service area, HMO must seek the participation in its provider network of rural hospitals, physicians, home and community support service agencies, and other rural health care providers who: 7.14.1.1 are the only providers located in the service area; and 7.14.1.2 are Significant Traditional Providers. 7.14.2 In order to contract with HMO, rural health providers must: 7.14.2.1 agree to accept the prevailing provider contract rate of HMO based on provider type; and 7.14.2.2 have the credentials required by HMO, provided that lack of board certification or accreditation by JCAHO may not be the only grounds for exclusion from the provider network. 7.14.3 HMO must reimburse rural hospitals with 100 or fewer licensed beds in counties with fewer than 50,000 persons for acute care services at a rate calculated using the higher of the prospective payment system rate or the cost reimbursed methodology authorized under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). Hospitals reimbursed under TEFRA cost principles shall be paid without the imposition of the TEFRA cap. 7.14.4 HMO must reimburse physicians who practice in rural counties with fewer than 50,000 persons at a rate using the current Medicaid fee schedule, including negotiated fee-for-service.

RURAL HEALTH PROVIDERS. 7.14.1 In rural areas of the service area, HMO must seek the participation in its provider network of rural hospitals, physicians, home and community support service agencies, and other rural health care providers who: 7.14.1.1 are the only providers located in the service area; and 7.14.1.2 are Significant Traditional Providers. 7.14.2 In order to contract with HMO, rural health providers must: 7.14.2.1 7.142.1 agree to accept the prevailing provider contract rate of HMO based on provider type; and 7.14.2.2 7.142.2 have the credentials required by HMO, provided that lack of board certification or accreditation by JCAHO may not be the only grounds for exclusion from the provider network. 7.14.3 HMO must reimburse rural hospitals with 100 or fewer licensed beds in counties with fewer than 50,000 persons for acute care services at a rate calculated using the higher of the prospective payment system rate or the cost reimbursed methodology authorized under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). Hospitals reimbursed under TEFRA cost principles shall be paid without the imposition of the TEFRA cap. 7.14.4 HMO must reimburse physicians who practice in rural counties with fewer than 50,000 persons at a rate using the current Medicaid fee schedule, including negotiated fee-for-service.

RURAL HEALTH PROVIDERS. 7.14.1 In rural areas of the service area, HMO must seek the participation in its provider network of rural hospitals, physicians, home and community support service agencies, and other rural health care providers who: 7.14.1.1 are the only providers located in the service area; and 7.14.1.2 are Significant Traditional Providers. 7.14.2 In order to contract with HMO, rural health providers must: 7.14.2.1 agree to accept the prevailing provider contract rate of HMO based on provider type; andand 1999 Renewal Contract Harrxx Xxxvice Area 81 August 9, 1999 7.14.2.2 have the credentials required by HMO, provided that lack of board certification or accreditation by JCAHO may not be the only grounds for exclusion from the provider network. 7.14.3 HMO must reimburse rural hospitals with 100 or fewer licensed beds in counties with fewer than 50,000 persons for acute care services at a rate calculated using the higher of the prospective payment system rate or the cost reimbursed methodology authorized under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). Hospitals reimbursed under TEFRA cost principles shall be paid without the imposition of the TEFRA cap. 7.14.4 HMO must reimburse physicians who practice in rural counties with fewer than 50,000 persons at a rate using the current Medicaid fee schedule, including negotiated fee-for-service.

RURAL HEALTH PROVIDERS. 7.14.1 In rural areas of the service area, HMO must seek the participation in its provider network of rural hospitals, physicians, home and community support service agencies, and other rural health care providers who: 7.14.1.1 are the only providers located in the service area; and 7.14.1.2 are Significant Traditional Providers. 7.14.2 In order to contract with HMO, rural health providers must: 7.14.2.1 agree to accept the prevailing provider contract rate of HMO based on provider type; and 7.14.2.2 have the credentials required by HMO, provided that lack of board certification or accreditation by JCAHO may not be the only grounds for exclusion from the provider network. 7.14.3 HMO must reimburse rural hospitals with 100 or fewer licensed beds in counties with fewer than 50,000 persons for acute care services at a rate calculated using the higher of the prospective payment system rate or the cost reimbursed methodology authorized under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). Hospitals reimbursed under TEFRA cost principles shall be paid without the imposition of the TEFRA cap. 7.14.4 HMO must reimburse physicians who practice in rural counties with fewer than 50,000 persons at a rate using the current Medicaid fee schedule, including negotiated fee-for-service.