Board Certification Requirements. The Contractor shall maintain a policy with respect to Board Certification for PCPs and specialty physicians that ensures that the percentage of board-certified PCPs and specialty physicians participating in the Provider Network, at a minimum, is approximately equivalent to the community average for PCPs and specialty physicians in the Contractor’s Service Area. Specifically, the policy shall:
Board Certification Requirements. 1. The ICO shall maintain a policy with respect to board certification for primary care providers and specialty physicians that ensures that the percentage of board certified primary care providers and specialty physicians participating in the provider network, at a minimum, is approximately equivalent to the community average for primary care providers and specialty physicians in the ICO’s service area.
Board Certification Requirements. 2.7.3.11.10.1. The ICO shall maintain a policy with respect to board certification for PCPs and specialty providers participating in the Provider Network.
Board Certification Requirements. 2.9.3.2.1. The Contractor shall maintain a policy with respect to board certification for PCPs and specialty participating in the Provider Network,
Board Certification Requirements. The Contractor shall maintain a policy with respect to Board Certification for PCPs and specialty physicians that ensures that the percentage of board certified PCPs and specialty physicians participating in the Provider Network, at a minimum, is approximately equivalent to the community average for PCPs and specialty physicians in the Contractor’s Service Area(s). Specifically, the policy shall: Require that all applicant physicians, as a condition for participation in the Contractor’s Network, meet one of the following, except as otherwise set forth in paragraph b. below: Be board certified in their practicing medical specialty; Be in the process of achieving initial certification; or Provide documentation demonstrating that the physician either is currently board eligible or has been board eligible in the past. If necessary to ensure adequate access, the Contractor may contract with Providers who have training consistent with board eligibility but are neither board certified nor were ever eligible to be board certified. In such circumstances, the Contractor shall submit to EOHHS for review and approval, on a case-by-case basis, documentation describing the access need that the Contractor is trying to address; and
Board Certification Requirements. 2.7.5.11.1. The CICO shall maintain a policy with respect to board certification for PCPs and specialty Providers participating in the Provider Network.
Board Certification Requirements. The ICO shall maintain a policy with respect to board certification for PCPs and specialty providers participation in the Provider Network. Provider Payment and Reimbursement The ICO must demonstrate to MDHHS, including through submission of reports as may be requested by MDHHS, use of Alternative Payment Methodologies (APMs) that will advance the delivery system innovations inherent in this model, incentivize quality care, and improve health outcomes for Enrollees. Notwithstanding the foregoing, nothing herein shall be construed to conflict with the requirements of 42 U.S.C. 1395w-111, Sec. 1860D-11(i). Alternative Payment Methodologies or methods are defined as, methods of payment that are not solely based on FFS reimbursements; provided that, “alternative payment methodologies” may include, but shall not be limited to, bundled payments, global payments, and shared savings arrangements; provided further, that “alternative payment methodologies” may include FFS payments, which are settled or reconciled with a bundled or global payment. For services in which Medicaid is the traditional primary payer, including behavioral health and substance abuse services, the ICO must establish or assure a Provider Network using the PIHP that meets the requirements identified in the Contract and specify a reimbursement model that is mutually agreed upon and identified via contract with the PIHP. In those instances where the ICO does not maintain a direct contract with the PIHP, the ICO must establish a Provider Network that meets the access standards for behavioral health and substance abuse services. For services covered under the traditional Medicaid benefit, the ICO must offer a reimbursement model that is at least the MDHHS FFS Medicaid payment level unless an alternative payment arrangement is mutually agreed upon by both the ICO and provider. The ICO may include shared savings program for both community based and facility based LTSS providers. For items and services that are part of the traditional Medicare benefit package, the ICO will be required to pay non-contracting providers, including health care professionals and section 1861(u) providers of services, the amount the provider could collect for that service if the beneficiary were enrolled in original Medicare (less any payments under 42 C.F.R. §§ 412.105(g) and 413.76 for section 1861(u) providers), regardless of the setting and type of care for authorized out-of-network services. Out...
Board Certification Requirements a. The CICO shall maintain a policy with respect to board certification for primary care providers and specialty physicians that ensures that the percentage of board certified primary care providers and specialty physicians participating in the provider network, at a minimum, is approximately equivalent to the community average for primary care providers and specialty physicians in the CICO’s service area.
