CONTRACTOR Provider Network. The CONTRACTOR shall establish and maintain, through written agreements, an appropriate Provider network necessary for the provision of the services under this contract. This includes, but is not limited to primary care Providers (PCPs), specialty Providers, hospitals and other health care service Providers as identified by the Department. For geographic areas lacking Providers sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the Service Area, the Department at its sole discretion may waive requirements.
6.2.1. Contract with required Providers based on the standards outlined within the Managed Care Policy and Procedure Guide.
6.2.2. Primary Care Providers (PCP) The CONTRACTOR shall:
6.2.2.1. Implement Procedures to ensure that each Medicaid Managed Care Member has a person or entity, formally designated, as a PCP, primarily responsible for coordinating their health care services.
6.2.2.2. Ensure each Member has access to at least one PCP with an open panel. Additional guidance is contained within the Managed Care Policy and Procedure Guide.
6.2.2.3. Ensure its contracted PCPs have an appointment system that meets the following access standards:
6.2.2.3.1. Xxxxxxx visits scheduled within four (4) to six (6) weeks.
6.2.2.3.2. Urgent, Non-Emergent visits within forty-eight (48) hours.
6.2.2.3.3. Emergent visits immediately upon presentation at a service delivery site.
6.2.2.3.4. Waiting times that do not exceed forty-five (45) minutes for a scheduled appointment of a routine nature.
6.2.3. Specialists
CONTRACTOR Provider Network. The CONTRACTOR shall establish and maintain, through written agreements, an appropriate Provider Network necessary for the provision of the services under this Contract. This includes, but is not limited to Primary Care Providers (PCPs), Specialty Providers, Hospitals and other Health Care Service Providers as identified by the Department. For geographic areas lacking Providers sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area, the Department at its sole discretion may waive the distance requirement.
6.2.1. Primary Care Provider (PCP) The CONTRACTOR shall: Implement procedures to ensure that each Medicaid Managed Care Member has a person or entity, formally designated, as primarily responsible for coordinating their health care services. Ensure each Member has access to at least one PCP with an open panel. Additional guidance is contained within the managed care policy and procedure guide. Ensure its contracted PCPs have an appointment system that meets the following access standards:
6.2.1.3.1. Xxxxxxx visits scheduled within four (4) weeks.
6.2.1.3.2. Xxxxxx, non-emergent visits within forty-eight (48) hours.
6.2.1.3.3. Emergent visits immediately upon presentation at a service delivery site.
6.2.1.3.4. Waiting times that do not exceed forty-five (45) minutes for a scheduled appointment of a routine nature.
6.2.1.3.5. Walk-in patients with non-urgent needs should be seen if possible or scheduled for an appointment consistent with written scheduling procedures.
6.2.1.3.6. Provide twenty-four (24) hour coverage by direct access or through arrangement with a triage system.
6.2.1.3.7. The CONTRACTOR must monitor the adequacy of its appointment processes.
6.2.2. Specialists General Requirements The CONTRACTOR shall:
6.2.2.1.1. Be required to contract with required specialists based on the standards outlined within the Managed Care Policy and Procedure Manual.
6.2.2.1.2. Ensure each Member has access to Specialists with an open panel. Additional guidance is stated within the managed care policy and procedure guide.
6.2.2.1.3. Accept the Department’s instruction to include additional specialists for a specific geographic area, when necessary.
6.2.2.1.4. Make available a choice of at least two (2) required contracted specialists and/or subspecialists who are accepting new patients within the geographic area.
6.2.2.1.5. For specialty referrals, provide for:
6.2.2.1.5.1. Emergent visits immediatel...
CONTRACTOR Provider Network. The CONTRACTOR shall establish and maintain, through written agreements, an appropriate Provider Network necessary for the provision of the services under this Contract. This includes, but is not limited to Primary Care Providers (PCPs), Specialty Providers, Hospitals and other Health Care Service Providers as identified by the Department. For geographic areas lacking Providers sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area, the Department at its sole discretion may waive the distance requirement.
6.2.1. Primary Care Provider (PCP) The CONTRACTOR shall:
6.2.1.1. Implement procedures to ensure that each Medicaid Managed Care Member has a person or entity, formally designated, as primarily responsible for coordinating their health care services.
6.2.1.2. Ensure each Member has access to at least one PCP with an open panel. Additional guidance is contained within the managed care policy and procedure guide.
6.2.1.3. Ensure its contracted PCPs have an appointment system that meets the following access standards:
6.2.1.3.1. Xxxxxxx visits scheduled within four (4) to six (6) weeks.
6.2.1.3.2. Xxxxxx, non-emergent visits within forty-eight (48) hours.
6.2.1.3.3. Emergent visits immediately upon presentation at a service delivery site.
6.2.1.3.4. Waiting times that do not exceed forty-five (45) minutes for a scheduled appointment of a routine nature.
6.2.1.3.5. Walk-in patients with non-urgent needs should be seen if possible or scheduled for an appointment consistent with written scheduling procedures.
6.2.1.3.6. Provide twenty-four (24) hour coverage by direct access or through arrangement with a triage system.
6.2.1.3.7. The CONTRACTOR must monitor the adequacy of its appointment processes.
6.2.2. Specialists
CONTRACTOR Provider Network. The CONTRACTOR shall establish and maintain, through written agreements, an appropriate Provider network necessary for the provision of the services under this contract. This includes but is not limited to primary care Providers (PCPs), specialty Providers, hospitals and other health care service Providers as identified by the Department. For geographic areas lacking Providers sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the Service Area, the Department at its sole discretion may waive requirements.
6.2.1 Contract with required Providers based on the standards outlined within the Managed Care Policy and Procedure Guide.
6.2.2 Primary Care Providers (PCP) The CONTRACTOR shall:
6.2.2.1 Implement procedures to ensure that each Medicaid Managed Care Member has a person or entity, formally designated, as a PCP, primarily responsible for coordinating their health care services.
6.2.2.2 Ensure each Member has access to at least one PCP with an open panel. Additional guidance is contained within the Managed Care Policy and Procedure Guide.
6.2.2.3 Ensure its contracted PCPs have an appointment system that meets the following access standards:
6.2.2.3.1 Routine visits scheduled within four (4) to six (6) weeks.
6.2.2.3.2 Urgent, Non-Emergent visits within forty- eight (48) hours.
6.2.2.3.3 Emergent visits immediately upon presentation at a service delivery site.
6.2.2.3.4 Waiting times that do not exceed forty-five (45) minutes for a scheduled appointment of a routine nature.
6.2.2.3.5 Walk-in patients with non-urgent needs should be seen if possible or scheduled for an appointment consistent with written scheduling Procedures.
6.2.2.3.6 Provide twenty-four (24) hour coverage by direct access or through arrangement with a triage system.
6.2.2.3.7 The CONTRACTOR must monitor the adequacy of its appointment processes.
