ACCESS TO CARE STANDARDS Sample Clauses

ACCESS TO CARE STANDARDS. The Contractor must demonstrate annually that its Provider Network meets the stricter of the following standards:
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ACCESS TO CARE STANDARDS. 4.2.1. The Contractor’s PCMP Network shall have a sufficient number of PCMPs so that each Member has a PCMP and each Member has their choice of at least two (2) PCMPs within their zip code or within thirty (30) minutes of driving time from their location, whichever area is larger. For rural and frontier areas, the Department may adjust this requirement based on the number and location of available providers.
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ACCESS TO CARE STANDARDS. 5.1. The Contractor must provide or purchase age, linguistic, and culturally competent community behavioral health services for Individuals for whom services are medically necessary and clinically appropriate pursuant to:
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ACCESS TO CARE STANDARDS. The Contractor shall assess the adequacy of its provider network at least on a quarterly basis. The Contractor must certify through submission of quarterly reports to the Department the adequacy of its provider network and notify the Department of any major initiatives or changes to program design (e.g., expanded benefits). Refer to the Medallion 4.0 Network Requirements Submission Manual (NRSM) for network reporting format requirements. The Contractor shall report any network deficiencies as soon as identified, and no later than within five (5) business days. The Contractor must also submit a request for an exemption using the Medallion Network Exemption Request Form for any circumstance whereby the Contractor is unable to meet the Department’s network time and distance standards. Such a request may be granted only in circumstances where there exists a shortage of the number of providers in a specialty practicing in the region (i.e., provider shortage area). The Contractor’s request for exemption shall also identify the Contractor’s strategy (for its enrolled members) for ensuring timely access to care for all contract covered services. The Department will review and reserves the right to request changes to the provider network, which must be completed within specified timeframes. The Contractor shall contract with a broad range of providers to meet the complex needs of its members. Services shall be delivered in the most integrated setting possible while offering opportunities for active community living and workforce participation. The Department shall be the sole determiner of the Contractor’s network sufficiency. The Department, as part of the program development cycle, will set network adequacy for new population group expansions. These standards shall be considered as operational guidelines.‌
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ACCESS TO CARE STANDARDS. 24. Subsection 5.8.1 is amended by deleting and replacing, as follows: 5.8.1 Provider types, including primary care Providers, Behavioral Health Providers, OB/GYNs, dental
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Related to ACCESS TO CARE STANDARDS

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