Common use of Attachment F Clause in Contracts

Attachment F. Third Revised and Restated Table 1: PHP Time/Distance Standards Reference Number Service Type Urban Standard Rural Standard 1 Primary Care ≥ 2 providers within 30 minutes or 10 miles for at least 95% of Members ≥ 2 providers within 30 minutes or 30 miles for atleast 95% of Members 2 Specialty Care ≥ 2 providers (per specialty type) within 30 minutes or 15 miles for at least 95% of Members ≥ 2 providers (per specialty type) within 60 minutes or 60 miles for at least 95% of Members 3 Hospitals* ≥ 1 hospitals within 30 minutes or 15 miles for at least 95% of Members ≥ 1 hospitals within 30 minutes or 30 miles for at least 95% of Members 4 Pharmacies* ≥ 2 pharmacies within 30 minutes or 10 miles for at least 95% of Members ≥ 2 pharmacies within 30 minutes or 30 miles for at least 95% of Members 5 Obstetrics1 ≥ 2 providers within 30 minutes or 10 miles for at least 95% of Members ≥ 2 providers within 30 minutes or 30 miles for at least 95% of Members 6 Occupational, Physical, or SpeechTherapists* ≥ 2 providers (of each provider type) within 30 minutes or 10 miles for at least 95% of Members ≥ 2 providers (of each provider type) within 30 minutes or 30 miles for at least 95% of Members 7 Outpatient Behavioral HealthServices • ≥ 2 providers of each outpatient behavioral health service within 30 minutes or 30 miles ofresidence for at least 95% of Members • Research-based behavioral health treatment for Autism Spectrum Disorder (ASD): Not subject to standard • ≥ 2 providers of each outpatient behavioral health service within 45 minutes or 45 miles ofresidence for at least 95% of Members • Research-based behavioral health treatment for Autism Spectrum Disorder (ASD): Notsubject to standard 8 Location-Based Services (BehavioralHealth) ≥ 2 providers of each service within 30 minutes or 30 miles of residence for at least 95% of Members ≥ 2 providers of each service within 45 minutes or 45 miles of residence for at least 95% of Members 9 Crisis Services (Behavioral Health) ≥ 1 provider of each crisis service within each PHP Region 10 Inpatient Behavioral Health Services ≥ 1 provider of each inpatient BH service within each PHP Region 11 Partial Hospitalization (Behavioral Health) ≥ 1 provider of partial hospitalization within 30 minutes or 30 miles for at least 95% of Members ≥ 1 provider of specialized services partial hospitalization within 60 minutes or 60 miles for atleast 95% of Members 12 All State Plan LTSS (except nursing facilities)* PHP must have at least 2 LTSS provider types (Home Care providers and Home Health providers,including home health services, private duty nursing services, personal care services, and hospice services), identified by distinct NPI, accepting new patients available to deliver each State Plan LTSS in every county. PHP must have at least 2 providers accepting new patients available to deliver each State Plan LTSS inevery county; providers are not required to live in the same county in which they provide services.

Attachment F. Third Revised and Restated Table 1: PHP Time/Distance Standards Reference Number Service Type Urban Standard Rural Standard 1 Primary Care ≥ 2 providers within 30 minutes or 10 miles for at least 95% of Members ≥ 2 providers within 30 minutes or 30 miles for atleast 95% of Members 2 Specialty Care ≥ 2 providers (per specialty type) within 30 minutes or 15 miles for at least 95% of Members ≥ 2 providers (per specialty type) within 60 minutes or 60 miles for at least 95% of Members ofMembers 3 Hospitals* ≥ 1 hospitals within 30 minutes or 15 miles for at least 95% of Members ≥ 1 hospitals within 30 minutes or 30 miles for at least 95% of Members 4 Pharmacies* ≥ 2 pharmacies within 30 minutes or 10 miles for at least 95% of Members ≥ 2 pharmacies within 30 minutes or 30 miles for at least 95% of Members 5 Obstetrics1 ≥ 2 providers within 30 minutes or 10 miles for at least 95% of Members ≥ 2 providers within 30 minutes or 30 miles for at least 95% of Members 6 Occupational, Physical, or SpeechTherapists* ≥ 2 providers (of each provider type) within 30 minutes 30minutes or 10 miles for at least 95% of Members ≥ 2 providers (of each provider type) within 30 minutes or 30 miles for at least 95% of Members 7 Outpatient Behavioral HealthServices • ≥ 2 providers of each outpatient behavioral health service within 30 minutes or 30 miles ofresidence for at least 95% of Members • Research-based behavioral health treatment for Autism Spectrum Disorder (ASD): Not subject to standard • ≥ 2 providers of each outpatient behavioral health service within 45 minutes or 45 miles ofresidence for at least 95% of Members • Research-based behavioral health treatment for Autism Spectrum Disorder (ASD): Notsubject Not subject to standard 8 Location-Based Services (BehavioralHealth) ≥ 2 providers of each service within 30 minutes or 30 miles of residence for at least 95% of Members ≥ 2 providers of each service within 45 minutes or 45 miles of residence for at least 95% of Members 9 Crisis Services (Behavioral Health) ≥ 1 provider of each crisis service within each PHP Region 10 Inpatient Behavioral Health Services ≥ 1 provider of each inpatient BH service within each PHP Region 11 Partial Hospitalization (Behavioral HealthBehavioralHealth) ≥ 1 provider of partial hospitalization within 30 minutes or 30 miles for at least 95% of Members ≥ 1 provider of specialized services partial hospitalization within 60 minutes or 60 miles for atleast 95% of Members 12 All State Plan LTSS (except LTSS(except nursing facilities)* PHP must have at least 2 LTSS provider types (Home Care providers and Home Health providers,including home health services, private duty nursing services, personal care services, and hospice services), identified by distinct NPI, accepting new patients available to deliver each State Plan LTSS in every county. PHP must have at least 2 providers accepting new patients available to deliver each State Plan LTSS inevery county; providers are not required to live in the same county in which they provide services.

Attachment F. Third Second Revised and Restated Table 1: PHP Time/Distance Standards Reference Number Service Type Urban Standard Rural Standard 1 Primary Care ≥ 2 providers within 30 minutes or 10 miles for at least 95% of Members ≥ 2 providers within 30 minutes or 30 miles for atleast 95% of Members 2 Specialty Care ≥ 2 providers (per specialty type) within 30 minutes or 15 miles for at least 95% of Members ≥ 2 providers (per specialty type) within 60 minutes or 60 miles for at least 95% of Members 3 Hospitals* ≥ 1 hospitals within 30 minutes or 15 miles for at least 95% of Members ≥ 1 hospitals within 30 minutes or 30 miles for at least 95% of Members 4 Pharmacies* ≥ 2 pharmacies within 30 minutes or 10 miles for at least 95% of Members ≥ 2 pharmacies within 30 minutes or 30 miles for at least 95% of Members 5 Obstetrics1 ≥ 2 providers within 30 minutes or 10 miles for at least 95% of Members ≥ 2 providers within 30 minutes or 30 miles for at least 95% of Members 6 Occupational, Physical, or SpeechTherapistsSpeech Therapists* ≥ 2 providers (of each provider type) within 30 minutes or 10 miles for at least 95% of Members ≥ 2 providers (of each provider type) within 30 minutes or 30 miles for at least 95% of Members 7 Outpatient Behavioral HealthServices Health Services • ≥ 2 providers of each outpatient behavioral health service within 30 minutes or 30 miles ofresidence for at least 95% of Members • Research-based behavioral health treatment for Autism Spectrum Disorder (ASD): Not subject to standard • ≥ 2 providers of each outpatient behavioral health service within 45 minutes or 45 miles ofresidence for at least 95% of Members • Research-based behavioral health treatment for Autism Spectrum Disorder (ASD): Notsubject Not subject to standard 8 Location-Based Services (BehavioralHealth) ≥ 2 providers of each service within 30 minutes or 30 miles of residence for at least 95% of Members ≥ 2 providers of each service within 45 minutes or 45 miles of residence for at least 95% of Members 9 Crisis Services (Behavioral Health) ≥ 1 provider of each crisis service within each PHP Region 10 Inpatient Behavioral Health Services ≥ 1 provider of each inpatient BH service within each PHP Region 11 Partial Hospitalization (Behavioral Health) ≥ 1 provider of partial hospitalization within 30 minutes or 30 miles for at least 95% of Members ≥ 1 provider of specialized services partial hospitalization within 60 minutes or 60 miles for atleast 95% of Members 12 All State Plan LTSS (except nursing facilities)* PHP must have at least 2 LTSS provider types (Home Care providers and Home Health providers,including home health services, private duty nursing services, personal care services, and hospice services), identified by distinct NPI, accepting new patients available to deliver each State Plan LTSS in every county. PHP must have at least 2 providers accepting new patients available to deliver each State Plan LTSS inevery county; providers are not required to live in the same county in which they provide services.