CCN's Provider Network Composition. The CCN shall not discriminate against 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. The CCN shall not discriminate against the participation, reimbursement, or indemnification of any provider who serves high-risk populations or specializes in conditions that require costly treatment. If the CCN declines to include individual or groups of providers in its network, it must give the affected providers written notice of the reason for its decision. The CCN must maintain and monitor a primary care provider network that is supported by written agreements and is sufficient to provide timely and adequate access. When designing this network, the CCN must take into consideration all the requirements specified in the Provider Agreement’s terms and conditions. This includes, but is not limited to, access standards and guidelines for delivery of primary care services; and referrals and coordination to specialists and hospitals. The CCN network providers shall comply with all requirements set forth in this Provider Agreement and the CCN-S Policy and Procedure Guide.
CCN's Provider Network Composition. The CCN is not required to contract with providers beyond the number necessary to meet the needs of its enrollees. The CCN may use different reimbursement amounts for different specialties or for different practitioners in the same specialty and may establish measures that are designed to maintain quality of services and control costs consistent with its responsibilities to enrollees. The CCN will be required to maintain specific member-to-specialist provider ratios. The CCN shall provide adequate access, as determined by DHH, either through employment or contracting, to providers for Primary Care Provider (PCP) referrals, specialty services and/or ancillary medical services to ensure
