Documentation of Network Adequacy. A. The Contractor shall give assurances to the Department and provide supporting documentation that demonstrates Contractor has the capacity to serve the expected enrollment in its service area in accordance with the network adequacy standards developed by the Department as required by departmental guidance and regulation. (42 C.F.R. § 438.207(a).)
B. The Contractor shall submit documentation to the Department, in a format specified by the Department, to demonstrate that it complies with the following requirements:
1) Offers an appropriate range of specialty services that are adequate for the anticipated number of beneficiaries for the service area.
2) Maintains a network of providers that is sufficient in number, mix, and geographic distribution to meet the needs of the anticipated number of beneficiaries in the service area. (42 C.F.R. § 438.207(b).)
C. The Contractor shall submit the documentation as specified by the Department, but no less frequently than the following:
1) At the time it enters into this Contract with the Department;
2) On an annual basis; and
3) At any time there has been a significant change, as defined by the Department, in Contractor’s operations that would affect the adequacy and capacity of services, including the following:
a) A decrease of 25 percent or more in services or providers available to beneficiaries;
b) Changes in benefits;
c) Changes in geographic service area;
d) Composition of or payments to Contractor’s provider network; or
e) Enrollment of a new population in Contractor’s county. (42 C.F.R. § 438.207(c).)
D. The Contractor shall include details regarding the change and Contractor’s plans to ensure beneficiaries continue to have access to adequate services and providers.
Documentation of Network Adequacy. A. The Contractor shall give assurances to the Department and provide supporting documentation that demonstrates Contractor has the capacity to serve the expected enrollment in its service area in accordance with BHIN 20-023 and its attachments, or in subsequent guidance issued by the Department. the network adequacy standards developed by the Department as required by departmental guidance and regulation. (42 C.F.R. § 438.207(a); Welf. & Inst. Code section 14197(f).)
B. The Contractor shall submit documentation to the Department, as specified in BHIN 20-023 and its attachments, or in subsequent guidance issued by the Department in a format specified by the Department, to demonstrate that it complies with the following requirements:
1) Offers an appropriate range of specialty services that are adequate for the anticipated number of beneficiaries for the service area.
2) Maintains a network of providers that is sufficient in number, mix, and geographic distribution to meet the needs of the anticipated number of beneficiaries in the service area. (42 C.F.R. § 438.207(b).)
C. The Contractor shall submit the documentation at the times as specified in BHIN 20-023 and its attachments, or in subsequent guidance issued by the Department, but no less frequently than the following:
1) At the time it enters into this Contract with the Department;
2) On an annual basis; and
3) Within 10 business days of a significant change in the MHP’s operations that would affect the capacity and services, including changes in Contractor services, benefits, geographic service area, composition of, or payments to its provider network; or enrollment of a new population. 42 C.F.R. § 438.207(c)(3)(i)(ii) : At any time there has been a significant change, as defined by the Department, in Contractor’s operations that would affect the adequacy and capacity of services, including the following:
a) A decrease of 25 percent or more in services or providers available to beneficiaries;
b) Changes in benefits;
c) Changes in geographic service area;
Documentation of Network Adequacy. A. The Contractor shall give assurances to the Department and provide supporting documentation that demonstrates Contractor has the capacity to serve the expected enrollment in its service area in accordance with BHIN 21-023 and its enclosures, or in subsequent guidance issued by the Department. (42 C.F.R. § 438.207(a); Welf. & Inst. Code section 14197(f).)
B. The Contractor shall submit documentation to the Department, as specified in BHIN 21-023 and its enclosures, or in subsequent guidance issued by the Department to demonstrate that it complies with the following requirements:
1) Offers an appropriate range of specialty services that are adequate for the anticipated number of beneficiaries for the service area.
2) Maintains a network of providers that is sufficient in number, mix, and geographic distribution to meet the needs of the anticipated number of beneficiaries in the service area. (42 C.F.R. § 438.207(b).)
C. The Contractor shall submit the documentation at the times specified in BHIN 21-023 and its enclosures, or in subsequent guidance issued by the Department, but no less frequently than the following:
1) At the time it enters into this Contract with the Department;
2) On an annual basis; and
3) Within 10 business days of a significant change in the Contractor’s operations that would render the Contractor non-compliant with standards for network adequacy and capacity including, but not limited to, the following types of changes:
a) Changes in services;
b) Changes in benefits;
c) Changes in geographic service area;
d) Changes in the composition of or payments to the Contractor’s provider network; or
e) Enrollment of a new population in the Contractor’s county. (42 C.F.R. § 438.207(c).);
f) The Contractor is required to notify DHCS by email of one of the listed changes at XXXXXxxxxXxxx@xxxx.xx.xxx.
D. The Contractor shall include details regarding the change and the Contractor’s plans to ensure beneficiaries continue to have access to adequate services and providers.
