Adequacy and Availability Clause Samples

Adequacy and Availability. Molina shall demonstrate the continuous availability and accessibility of adequate numbers of Molina Participating Providers to provide Health Care Services to Molina Members on a 24-hour basis, seven (7) days a week, including the provision of Emergency Services. Molina will have as a minimum meet all federal, state, Maxicare and NCQA standards regarding the availability, accessibility and/or continuity of care. Maxicare's current standards are included in the Maxicare Provider Manual, a copy of which will be separately provided to Molina, and which is subject to change by Maxicare upon five (5) days prior written notice to Molina, unless shorter notice is required to comply with law. Molina agrees to comply with the standards of availability and accessibility that Maxicare has filed with the DOC and DHS, and with State standards. A copy of Maxicare's standards will be provided to Molina prior to the execution of this Agreement. Currently, State availability standards require the Plan to meet the following practitioner- patient ratios and availability/accessibility standards: (i) One full-time equivalent Primary Care Physician per two thousand (2,000) prepaid persons; (ii) One full-time equivalent physician per one thousand two hundred (1,200) prepaid persons; (iii) One full-time equivalent non-physician medical practitioner per one thousand (1,000) prepaid persons; (iv) One (1) designated Emergency Services facility in Sacramento County, providing care on a 24-hour basis, seven (7) days a week; 10 of 48 (v) Travel distance to a Primary Care Physician and/or hospital must be no more than five miles in an urban area; thirty in a rural area, unless longer or shorter distances are customary in the community, in which case the community standard applies; (vi) Wait times for emergency, urgently needed and/or elective office visits must conform to the standards which Maxicare has filed with DHS and DOC; and, (vii) Wait times to see a physician once the member arrives in the office must also conform to the standards which Maxicare has filed with the DHS and DOC, as must telephone wait time.