42 CFR § 438.12 - Provider discrimination prohibited.
(a) General rules.
(1) An MCO, PIHP, or PAHP may not discriminate in 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 an MCO, PIHP, or PAHP declines to include individual or groups of providers in its provider network, it must give the affected providers written notice of the reason for its decision.
(b) Construction. Paragraph (a) of this section may not be construed to -