Sec. 301. Provider participation and standards
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/bill/113/hr/1200/ih/section-301·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
An individual or other entity furnishing any covered service under a State health security program under this Act is not a qualified provider unless the individual or entity— is a qualified provider of the services under section 302; has filed with the State health security program a participation agreement described in subsection (b); and meets such other qualifications and conditions as are established by the Board or the State health security program under this Act. A participation agreement described in this subsection between a State health security program and a provider shall provide at least for the following:
Services to eligible persons will be furnished by the provider without discrimination on the ground of race, national origin, income, religion, age, sex or sexual orientation, disability, handicapping condition, or (subject to the professional qualifications of the provider) illness. Nothing in this subparagraph shall be construed as requiring the provision of a type or class of services which services are outside the scope of the provider’s normal practice. No charge will be made for any covered services other than for payment authorized by this Act.
The provider agrees to furnish such information as may be reasonably required by the Board or a State health security program, in accordance with uniform reporting standards established under section 401(g)(1), for— quality review by designated entities; the making of payments under this Act (including the examination of records as may be necessary for the verification of information on which payments are based); statistical or other studies required for the implementation of this Act; and such other purposes as the Board or State may specify.
The provider agrees not to bill the program for any services for which benefits are not available because of section 204(d). In the case of a provider that is not an individual, the provider agrees not to employ or use for the provision of health services any individual or other provider who or which has had a participation agreement under this subsection terminated for cause. In the case of a provider paid under a fee-for-service basis under section 612, the provider agrees to submit bills and any required supporting documentation relating to the provision of covered services within 30 days (or such shorter period as a State health security program may require) after the date of providing such services.
Participation agreements may be terminated, with appropriate notice— by the Board or a State health security program for failure to meet the requirements of this title; or by a provider. Providers shall be provided notice and a reasonable opportunity to correct deficiencies before the Board or a State health security program terminates an agreement unless a more immediate termination is required for public safety or similar reasons.