Provider Discrimination Sample Clauses

Provider Discrimination. The Contractor may not discriminate with respect to 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. If the Contractor declines to include an individual or groups of providers in its provider network, it will provide the affected providers with written notice of the reason for its decision.
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Provider Discrimination. Neither Health Plan nor Subcontractor shall discriminate with respect to participation, reimbursement, or indemnification of a provider who is acting within the scope of the 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 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 that are designed to maintain quality of care practice standards and control costs consistent with Health Plan’s responsibilities under the applicable State Contract.
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Provider Discrimination. Neither Health Plan nor Subcontractor shall discriminate with respect to participation, reimbursement, or indemnification of a provider who is acting within the scope of the 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 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 that are designed to maintain quality of care practice standards and control costs consistent with Health Plan’s responsibilities under the applicable State Contract. 5.3 Provider / Covered Person Communications. Neither Health Plan nor Subcontractor shall prohibit or otherwise restrict Provider, when acting within the lawful scope of Provider’s licensure and practice, from advising or advocating on behalf of a Covered Person who is Provider’s patient for the following: (a) The Covered Person’s health status, medical care, or treatment options, including any alternative treatment that may be self-administered; (b) Any information the Covered Person needs in order to decide among all relevant treatment options; (c) The risks, benefits, and consequences of treatment or non-treatment; (d) The Covered Person’s right to participate in decisions regarding his or her health care, including the right to refuse treatment, and to express preferences about future treatment decisions; or
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Provider Discrimination. ‌ Neither Contractor, Subcontractor, nor representatives of Contractor shall provide false or misleading information to providers in an attempt to recruit providers for Contractor’s network. The Contractor shall not discriminate against providers with respect to participation, reimbursement, or indemnification for any provider acting within the scope of that provider’s license or certification under applicable State law or regulation solely on the basis of the provider’s license or certification. Contractor shall 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 based on the license or certification. Contractor shall not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. If Contractor declines to include individual or groups of providers in its network, it must provide the affected providers written notice of the reason for its decision. Denials of provider enrollment due to excess network capacity must receive DOM approval prior to provider notification. Nothing in this provision, however, shall preclude Contractor from using a fee schedule for different specialties or for different practitioners in the same specialty, or preclude Contractor from establishing measures that are designed to maintain quality of services and control costs and are consistent with its responsibilities to Members. Contractor shall not employ or contract with providers excluded from participation in Federal health care programs under either Section 1128 or Section 1128A of the Act. Contractor is prohibited from employing or contracting a provider that has been excluded by DOM, other state Medicaid agencies, or other state CHIP.
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Provider Discrimination. The Contractor 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. Declining providers. If Contractor declines to include individual or groups of providers in its network, it must give the affected providers written notice of the reason for its decision. 42CFR 438.12 (a)of this section may not be construed to: • Require the MAO to contract with providers beyond the number necessary to meet the needs of its enrollee. • Preclude the MAO from using different reimbursement amounts for different specialties or for different practitioners in the same specialty; or • Preclude the MAO from establishing measures that are designed to maintain quality of services and control costs and is consistent with its responsibilities to enrollee.
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Related to Provider Discrimination

  • ANTI-DISCRIMINATION It is the policy of the District that in connection with all work performed under Contracts there be no discrimination against any employee engaged in the work because of race, color, ancestry, national origin, religious creed, physical disability, medical condition, marital status, sexual orientation, gender, or age and therefore the Consultant agrees to comply with applicable Federal and California laws including, but not limited to the California Fair Employment and Housing Act beginning with Government Code Section 12900 and Labor Code Section 1735 and District policy. In addition, the Consultant agrees to require like compliance by all of its subcontractor(s).

  • NON-DISCRIMINATION In the performance of this Contract, Contractor agrees that it will comply with the requirements of Section 1735 of the California Labor Code and not engage nor permit any subcontractors to engage in discrimination in employment of persons because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, or sex of such persons. Contractor acknowledges that a violation of this provision shall subject Contractor to penalties pursuant to Section 1741 of the California Labor Code.

  • Discrimination and Harassment All employees have the right to work in an environment free from all forms of harassment, including sexual harassment. DEFINITION Discrimination is perceived or actual behaviour and includes sexual harassment as a type of discrimination which, generally, is: a) Discriminatory in nature based on race, colour, age, ancestry, place of origin, political belief, religion, marital status, family status, physical or mental disability, gender, sexual orientation, Union or association membership, or because that person has been charged or convicted of a criminal offence that is unrelated to the position; and/or, b) Objectionable because the person committing such behaviour knows or ought to reasonably know that the behaviour creates an environment which is not conducive to work. For the purposes of paragraph 2.09 (b), objectionable behaviour includes, but is not limited to: i) Verbal abuse or threats; ii) Offensive remarks, jokes, innuendoes, or taunting; iii) Display of pornographic, racist, or other offensive or derogatory material; iv) Persistent unwelcome invitations or requests whether direct or indirect; v) Unwelcome physical contact such as touching, patting, pinching or punching; and, vi) Leering, badgering, or intimidating actions. Sexual Harassment is defined as unwelcome sexual advances, request for sexual favours, and other verbal, written, or physical conduct of a sexual nature when: vii) Submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment; viii) Submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual; ix) Such conduct interferes with an individual’s work performance or creates an intimidating, hostile or offensive work environment.