Common use of FEDERAL ACCESS STANDARDS Clause in Contracts

FEDERAL ACCESS STANDARDS. MCPs must demonstrate that they are in compliance with the following federally defined provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following: • The anticipated Medicaid membership. • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP. • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services. • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities. • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid fee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to ODJFS, in a format specified by ODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODJFS no less frequently than at the time the MCP enters into a contract with ODJFS; at any time there is a significant change (as defined by ODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP.

FEDERAL ACCESS STANDARDS. MCPs must demonstrate that they are The MCP shall provide or arrange for the delivery of all medically necessary, Medicaid-covered health services in a timely manner, and ensure compliance with the following federally defined provider panel access standards as required by 42 CFR 438.206: . a. In establishing and maintaining their its provider panel, MCPs must the MCP shall consider the following: • : i. The anticipated Medicaid membership. ii. • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP. iii. • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services. iv. • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access access, reasonable accommodations, and accessible equipment for Medicaid members with physical or mental disabilities. • MCPs must . v. The MCP shall adequately and timely cover services to provided by an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreementthis Agreement. The MCP must shall cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must The MCP shall coordinate with the out-out- of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. . b. Contracting providers must shall offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid fee-for-serviceFFS, if the provider serves only Medicaid members. MCPs must The MCP shall ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must The MCP shall establish mechanisms to ensure that panel providers comply with timely access requirements, requirements and must shall take corrective action if there is failure to comply. . c. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must shall submit documentation to ODJFSthe Ohio Department of Medicaid (ODM), in a format specified by ODJFSODM, that demonstrates it offers an appropriate range of preventive, primary care care, behavioral health, family planning, and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must shall be submitted to ODJFS ODM no less frequently than at the time the MCP enters into a contract with ODJFSODM; at any time there is a significant change (as defined by ODJFSODM) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); on an annual basis; and at any time there is enrollment of a new population in the MCP.

FEDERAL ACCESS STANDARDS. MCPs must demonstrate provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure that they are in compliance with the following federally defined provider Provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following: • The anticipated Medicaid membership. • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP. • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services. • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities. • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid fee-for-serviceFFS, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to ODJFSthe Ohio Department of Medicaid (ODM), in a format specified by ODJFSODM, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODJFS ODM no less frequently than at the time the MCP enters into a contract with ODJFSODM; at any time there is a significant change (as defined by ODJFSODM) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP.

FEDERAL ACCESS STANDARDS. MCPs must demonstrate provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure that they are in compliance with the following federally defined provider Provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following: •  The anticipated Medicaid membership. •  The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP. •  The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services. •  The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities. •  MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid fee-for-serviceFFS, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to ODJFSthe Ohio Department of Medicaid (ODM), in a format specified by ODJFSODM, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODJFS ODM no less frequently than at the time the MCP enters into a contract with ODJFSODM; at any time there is a significant change (as defined by ODJFSODM) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP.

FEDERAL ACCESS STANDARDS. MCPs must demonstrate that they are in compliance with the following federally defined provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, . MCPs must consider the following: • The anticipated Medicaid membership. • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP. • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver furnish the contracted Medicaid services. • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities. • MCPs must adequately and timely cover services to an out-of-network provider if Appendix H the MCP’s 's contracted provider panel is unable to provide the services covered under the MCP’s 's provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with w ith the applicable requirements. Contracting panel providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid fee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, . when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with w'ith these timely access requirements, . MCPs are required to regularly monitor their provider panels to determine compliance and must if necessary take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to ODJFS, in a format specified by ODJFS, OD.IFS. that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, . and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODJFS no less frequently than at the time the MCP enters into a contract with ODJFS; at any time there is a significant change (as defined by ODJFS) in the MCP’s 's operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP. Total Required Hospitals Ashtabula Cuyahoga Erie Geauga Huron Lake Xxxxxx Xxxxxx Additional Required Hospitals: Out-of-Region Preferred Hospitals: In-Region2 Preferred Hospitals: Out-of Region 1 Preferred Providers are the additional provider contracts that must be secured in order for the MCP to receive bonus points. 2 These hospitals cannot be included under any subcontract used to meet the minimum required provider panel requirements. 3 These hospitals must provide obstetrical services if such a hospital is available in the county/region. 4 The Cuyahoga hospital requirement may be met by either contracting with (1) a single hospital that includes fifty (50) pediatric beds and five (5) pediatric intensive care unit (PICU) beds OR (2) a single general hospital that includes fifty (50) pediatric beds and five (5) pediatric intensive care unit (PICU) beds and a hospital system.

FEDERAL ACCESS STANDARDS. MCPs must demonstrate that they are in compliance with the following federally defined provider panel access standards as required by 42 CFR 438.206: Appendix H Page 9 In establishing and maintaining their provider panel, MCPs must consider the following: • The anticipated Medicaid membership. • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP. • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services. • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities. • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid fee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to ODJFS, in a format specified by ODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODJFS no less frequently than at the time the MCP enters into a contract with ODJFS; at any time there is a significant change (as defined by ODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP. MCPs are to follow the procedures specified in the current MCP PVS Instructional Manual, posted on the ODJFS website, in order to comply with these federal access requirements.

FEDERAL ACCESS STANDARDS. MCPs must demonstrate that they are in compliance with the following federally defined provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following: • The anticipated Medicaid membership. • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP. • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services. • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities. • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Appendix H Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid fee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to ODJFS, in a format specified by ODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODJFS no less frequently than at the time the MCP enters into a contract with ODJFS; at any time there is a significant change (as defined by ODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP. MCPs are to follow the procedures specified in the current MCP PVS Instructional Manual, posted on the ODJFS website, in order to comply with these federal access requirements. 1 1 1 1 Hospital system includes; physician networks and therefore these physicians could be considered when fulfilling contracts for PCP and non-PCP provider panel requirements. Hospital System1 1 1 1 Hospital system includes; physician networks and therefore these physicians could be considered when fulfilling contracts for PCP and non-PCP provider panel requirements. Hospital System1 2 2 1 Hospital system includes; physician networks and therefore these physicians could be considered when fulfilling contracts for PCP and non-PCP provider panel requirements. Hospital System1 2 2 1 Hospital system includes; physician networks and therefore these physicians could be considered when fulfilling contracts for PCP and non-PCP provider panel requirements. Hospital System2 1 1 1 Hospital system includes; physician networks and therefore these physicians could be considered when fulfilling contracts for PCP and non-PCP provider panel requirements. Hospital System1 1 1 1 Hospital system includes; physician networks and therefore these physicians could be considered when fulfilling contracts for PCP and non-PCP provider panel requirements. PCPs Total Required Ashtabula Cuyahoga Erie Geauga Huron Lake Xxxxxx Xxxxxx Additional Required: In-Region * Capacity 14,196 799 10,587 283 117 228 541 1,372 269 Number of Eligibles 25,810 1453 19249 514 212 415 983 2495 489 1 Acceptable PCP specialty types include Family/General Practice or Internal Medicine PCPs Total Required Columbiana Mahoning Trumbull Additional Required: In- Region * Capacity 4,230 798 2,028 1,405 PCPs1 11 3 4 4 Number of Eligibles 7,691.00 1,450 3,687 2,554 1 Acceptable PCP specialty types include Family/General Practice or Internal Medicine Capacity 7,415 152 134 83 479 710 1,870 3,051 458 480 Number of Eligbles 13,482 276 243 150 871 1,290 3,400 5,547 833 872 1 Acceptable PCP specialty types include Family/General Practice or Internal Medicine County Capacity PCPs1 Number of Eligbles Athens 724 2 1,317 Belmont 654 2 1,189 Coshocton 234 1 426 Gallia 457 2 830 Guernsey 395 2 718 Xxxxxxxx 172 1 313 Xxxxxxx 483 2 879 Jefferson 795 3 1,445 Xxxxxxxx 1,154 4 2,098 Meigs 393 2 714 Monroe 134 1 244 Morgon 175 1 319 Muskingum 889 3 1,617 Noble 86 1 157 Vinton 197 1 359 Washington 490 2 891 Additional Required: In-Region * 1 Acceptable PCP specialty types include Family/General Practice or Internal Medicine County Capacity PCPs1 Number of Eligibles Xxxxxxxx 258 2 469 Delaware 226 2 410 Fairfield 528 3 960 Fayette 207 2 377 Franklin 6,592 17 11,985 Hocking 237 2 431 Xxxx 282 2 512 Licking 682 4 1,240 Xxxxx 168 2 305 Madison 149 1 270 Xxxxxx 496 3 902 Xxxxxx 133 1 241 Perry 334 3 608 Pickaway 306 2 557 Pike 524 3 952 Xxxx 741 4 1,348 Scioto 1,687 5 3,068 Union 111 1 202 Additional Required: In-Region 1 Acceptable PCP specialty types include Family/General Practice or Internal Medicine PCPs Total Required Champaign Xxxxx Xxxxx Xxxxxx Miami Xxxxxxxxxx Xxxxxx Xxxxxx Additional Required: In-Region * Capacity 5,965 138 986 171 498 316 3,537 147 174 Number of Eligibles 10,846 250 1,793 311 905 574 6,430 267 316 1 Acceptable PCP specialty types include Family/General Practice or Internal Medicine PCPs Total Required Xxxxx Xxxxx Xxxxxx Clermont Xxxxxxx Xxxxxxxx Highland Xxxxxx Additional Required: In-Region * Capacity 8,615 502 248 1,581 717 212 4,696 315 344 PCPs1 22 3 1 4 3 1 6 2 2 Number of Eligibles 15,663 912 451 2,875 1,303 386 8,539 572 625 1 Acceptable PCP specialty types include Family/General Practice or Internal Medicine County Capacity PCPs1 Number of Eligibles Xxxxx 591 3 1,075 Auglaize 105 1 190 Defiance 150 1 272 Xxxxxx 93 1 169 Xxxxxxx 212 2 385 Xxxxxx 182 2 330 Xxxxx 54 1 99 Xxxxx 3,963 9 7,206 Xxxxxx 102 1 185 Ottawa 103 1 188 Paulding 90 1 163 Xxxxxx 72 1 130 Sandusky 240 2 436 Seneca 243 2 442 Van Xxxx 111 1 202 Xxxxxxxx 128 1 233 Wood 253 2 460 Wyandot 57 1 104 Additional Required: In- Region * 1 Acceptable PCP specialty types include Family/General Practice or Internal Medicine This chart was finalized 10/14/05 and supercedes the one distributed 9/20/05. The provider panel charts are a summary of the provider panel requirements. For the complete requirements, see RFA - Regional Provider Panel Specifications. Provider Types Total Required Providers1 Ashtabula Cuyahoga Erie Geauga Huron Lake Xxxxxx Xxxxxx Additional Required Providers2 Gastroenterology 3 2 1 Nephrology 2 1 1 Neurology 3 2 1 Oncology 1 1 Otolaryngologist 3 1 1 1 Physical Med Rehab 3 2 1 Psychiatry 11 5 3 3 Urology 4 2 2 1 All required providers must be located within the region. 2 Additional required providers may be located anywhere within the region. Provider Types Total Required Providers1 Columbiana Mahoning Trumbull Additional Required Providers 2 Cardiovascular 2 1 1 Dentists 7 1 3 3 Gastroenterology 1 1 General Surgeons 3 1 1 1 Nephrology 1 1 Neurology 1 1 Otolaryngologist 1 1 Physical Med Rehab 1 1 Urology 1 1 1 All required providers must be located within the region. 2 Additional required providers may be located anywhere within the region. Provider Types Total Required Providers1 Ashland Xxxxxxx Xxxxxx Portage Richland Xxxxx Summit Tuscarawas Xxxxx Additional Required Providers 2 Cardiovascular 3 1 1 1 Dentists 14 1 2 4 6 1 Gastroenterology 2 2 General Surgeons 7 1 1 2 1 2 Nephrology 1 1 Neurology 2 2 OB/GYNs 6 2 4 Otolaryngologist 2 1 1 Physical Med Rehab 2 2 Psychiatry 6 2 3 1 Urology 2 2 1 All required providers must be located within the region. 2 Additional required providers may be located anywhere within the region. Provider Types Total Required Providers1 Athens Belmont Coshocton Gallia Guernsey Xxxxxxxx Xxxxxxx Jefferson Xxxxxxxx Xxxxx Xxxxxx Xxxxxx Muskingum Noble Xxxxxx Xxxxxxxxxx Additional Required Providers 2 Gastroenterology 2 2 Nephrology 1 1 Neurology 2 2 Otolaryngologist 2 1 1 Physical Med Rehab 2 2 Psychiatry 6 2 1 1 2 Urology 2 2 1 All required providers must be located within the region. 2 Additional required providers may be located anywhere within the region. Provider Types Total Required Providers1 Xxxxxxxx Delaware Fairfield Fayette Xxxxxxxx Xxxxxxx Xxxx Licking Logan Madison Xxxxxx Xxxxxx Xxxxx Pickaway Xxxx Xxxx Scioto Union Additional Required Providers 2 Cardiovascular 5 2 3 Gastroenterology 3 1 2 Nephrology 2 1 1 Neurology 3 1 2 Otolaryngologist 3 1 2 Physical Med Rehab 3 1 2 Psychiatry 11 1 1 5 4 Urology 4 1 All required providers must be located within the region. 2 Additional required providers may be located anywhere within the region. Provider Types Total Required Providers1 Xxxxx Xxxxx Xxxxxx Clermont Xxxxxxx Xxxxxxxx Highland Xxxxxx Additional Required Providers2 Dentists 15 3 1 8 1 1 1 Gastroenterology 2 2 General Surgeons 9 1 1 1 3 2 1 Nephrology 1 1 Neurology 2 2 OB/GYNs 7 1 1 4 1 Oncology 1 1 Otolaryngologist 2 1 1 Physical Med Rehab 2 2 Psychiatry 7 3 4 Urology 3 3 1 All required providers must be located within the region. 2 Additional required providers may be located anywhere within the region. Provider Types Total Required Providers1 Champaign Xxxxx Xxxxx Xxxxxx Miami Xxxxxxxxxx Xxxxxx Xxxxxx Additional Required Providers 2 Cardiovascular 3 1 2 Dentists 5 1 3 1 Gastroenterology 1 1 General Surgeons 5 1 1 1 2 Nephrology 1 1 Neurology 2 2 OB/GYNs 5 1 1 3 Otolaryngologist 2 1 1 Physical Med Rehab 2 2 Psychiatry 5 1 2 2 Urology 2 2 Vision 7 1 1 3 2 1 All required providers must be located within the region. 2 Additional required providers may be located anywhere within the region. Provider Types Total Required Providers1 Xxxxx Auglaize Defiance Xxxxxx Xxxxxxx Xxxxxx Xxxxx Xxxxx Xxxxxx Ottawa Paulding Xxxxxx Sandusky Seneca Van Xxxx Xxxxxxxx Xxxx Wyandot Additional Required Providers 2 Cardiovascular 3 1 2 Gastroenterology 2 1 1 General Surgeons 5 1 2 1 1 Nephrology 1 1 Neurology 2 1 1 Otolaryngologist 2 1 1 Physical Med Rehab 2 1 1 Psychiatry 6 1 3 1 1 1 All required providers must be located within the region. 2 Additional required providers may be located anywhere within the region. MCPs must comply with all applicable program integrity requirements, including those specified in 42 CFR 455 and Subpart H.

FEDERAL ACCESS STANDARDS. MCPs must demonstrate that they are in compliance with the following federally defined provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following: • The anticipated Medicaid membership. • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP. • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver furnish the contracted Medicaid services. • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities. • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting panel providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid fee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with these timely access requirements, . MCPs are required to regularly monitor their provider panels to determine compliance and must if necessary take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 437.207 stipulates that the MCP must submit documentation to ODJFS, in a format specified by ODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODJFS no less frequently than at the time the MCP enters into a contract with ODJFS; at any time there is a significant change (as defined by ODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP. MCPs are to follow the procedures specified in the current MCP PVS Instructional Manual in order to comply with these federal access requirements.