Network Adequacy. 35.1. The CONTRACTOR shall ensure that all services covered under this Agreement are available and accessible to clients in a timely manner and in accordance with the network adequacy standards required by regulation. (42 C.F.R. §438.206 (a), (c)).
35.2. CONTRACTOR shall submit, when requested by COUNTY and in a manner and format determined by the County, network adequacy certification information to the COUNTY, utilizing a provided template or other designated format.
35.3. CONTRACTOR shall submit updated network adequacy information to the COUNTY any time there has been a significant change that would affect the adequacy and capacity of services.
35.4. To the extent possible and appropriately consistent with CCR, Title 9, §1830.225 and 42 C.F.R. §438.3 (l), the Contractor shall provide a client the ability to choose the person providing services to them.
Network Adequacy. 15.1 The Contractor shall ensure that all services covered under this Contract are available and accessible to beneficiaries in a timely manner and in accordance with the network adequacy standards required by regulation. (42 C.F.R. § 438.206 (a), (c)). See also, TIMELY ACCESS REQUIREMENTS.
15.2 Contractor shall submit, on a quarterly basis, in a manner and format determined by the MHP, network adequacy certification information to the MHP, utilizing a provided template or other designated format. This information will be compiled and analyzed by the MHP to ensure that it maintains a network of appropriate providers that is sufficient in number, mix, and geographic distribution to meet the needs of the anticipated number of beneficiaries in the service area and to provide adequate access to all services covered by the MHP, including those with limited English proficiency or physical or mental disabilities, as required by the State Contract.
15.3 Contractor shall submit updated network adequacy information to the MHP at any time there has been a significant change that would affect the adequacy and capacity of services. Significant changes include, but are not limited to, a decrease of 25% or more in services or providers available to beneficiaries, changes in geographic service area. See also, PROVIDER DIRECTORY.
15.4 To the extent possible and appropriately consistent with CCR, Title 9, §1830.225 and 42 C.F.R. §438.3 (l), the Contractor shall provide a beneficiary the choice of the person providing services.
Network Adequacy a) Network Standards. Contractor’s QHPs shall comply with the network adequacy standards established by the applicable State Regulators responsible for oversight of Contractor, including, those set forth at Health and Safety Code § 1367.03 and 28 CCR § 1300.67.2 (if Contractor is a licensed health care service plan) or Insurance Code § 10133.5 and 10 CCR § 2240 et seq. (if Contractor is regulated by CDI), and, as applicable, other laws, rules, and regulations, including, those set forth at 45 C.F.R. § 156.230. Contractor shall cooperate with Covered California to implement network changes as necessary to address concerns identified by Covered California.
b) Participating Provider Stability. Contractor shall maintain policies and procedures that are designed to preserve and enhance Contractor’s network development by facilitating the recruitment and retention of Participating Providers necessary to provide access to Covered Services. Such policies and procedures shall be consistent with applicable laws, rules and regulations, and will include an ongoing assessment of turnover rates of its Participating Providers to ensure that the turnover rates do not disrupt the delivery of quality care.
Network Adequacy. A. The Contractor shall ensure that all services covered under this Contract are available and accessible to beneficiaries in a timely manner. 42 C.F.R. § 438.206(a)
B. Maintain and monitor a network of appropriate providers that is supported by written agreements for subcontractors and that is sufficient to provide adequate access to all services covered under this contract for all beneficiaries, including those with limited English proficiency or physical or mental disabilities. The Contractor shall ensure that network providers provide physical access, reasonable accommodations, and accessible equipment for Medi-Cal beneficiaries with physical or mental disabilities. (42 C.F.R. § 438.206(b)(1) and (c)(3).)
C. The Contractor shall adhere to, in all geographic areas within the county, the time and distance standards for adult and pediatric mental health providers developed by the Department. (42 C.F.R. § 438.68(a), (b)(1)(iii), (3), 438.206(a).)
D. The Contractor may submit to the Department a request for Alternate Access Standards. The Department will evaluate requests and grant appropriate exceptions to the state developed standards.
Network Adequacy. 17.2.1 Contractor shall ensure that all services covered under this Agreement are available and accessible to clients in a timely manner and in accordance with the network adequacy standards required by regulation. (42 C.F.R. § 438.206 (a),(c)).
17.2.2 Contractor shall submit, when requested by County and in a manner and format determined by the County, network adequacy certification information to County, utilizing a provided template or other designated format.
17.2.3 Contractor shall submit updated network adequacy information to the County any time there has been a significant change that would affect the adequacy and capacity of services. Significant changes include, but are not limited to, changes in services or providers available to clients, and changes in geographic service area.
17.2.4 If Contractor reaches or exceeds 90 percent of their dedicated treatment capacity, this information must be reported to the County Alcohol & Drug Administrator and to XXXXXxxxxxxxx@xxxx.xx.xxx within seven days of reaching capacity. The subject line in the email must read “Capacity Management”.
Network Adequacy. The Contractor shall submit, in a manner and format determined by the Department, documentation to demonstrate compliance with the Department’s requirements for availability and accessibility of services, including the adequacy of the provider network. (42 C.F.R. § 438.604(a)(5).)
Network Adequacy. A. The Contractor shall ensure that all services covered under this Contract are available and accessible to beneficiaries in a timely manner (42 C.F.R. § 438.206(a)).
B. Maintain and monitor a network of appropriate providers that is supported by written agreements for subcontractors and that is sufficient to provide adequate access to all services covered under this contract for all beneficiaries, including those with limited English proficiency or physical or mental disabilities. The Contractor shall ensure that network providers provide physical access, reasonable accommodations, and accessible equipment for Medi-Cal beneficiaries with physical or mental disabilities. (42 C.F.R. § 438.206(b)(1) and (c)(3).)
C. The Contractor shall adhere to, in all geographic areas within the county, the time and distance standards for adult and pediatric mental health providers, as specified in BHIN 20-023 and its attachments, or in subsequent guidance issued in BHINs developed by the Department. (42 C.F.R. § 438.68(a), (b)(1)(iii), (3), 438.206(a); Welf. & Inst. Code § 14197.)
D. The Contractor may must submit to the Department a request for an Alternate Access Standards upon notification that the Contractor is deficient in network adequacy standards. The Department will evaluate requests and grant appropriate exceptions to the state developed standards, as specified in BHIN 20-023 and its attachments, or in subsequent guidance issued by BHINs by the Department. (42 C.F.R.
E. The Contractor shall comply with network adequacy standards developed by the Department to implement 42 C.F.R. §§ 438.68, 438.206, and 438.207, including provider ratios and other network capacity requirements, as specified in BHIN 20-023 and its attachments, or in subsequent guidance issued by BHIN by the Department.
Network Adequacy. (a) Network Standards. Contractor’s QDPs shall comply with the network adequacy standards established by the applicable State Regulators responsible for oversight of Contractor, including those requirements applicable to specialized health care service plans as set forth at Health and Safety Code § 1367.03 and 28 CCR § 1300.67.2.2 (if Contractor is a licensed health care service plan) or Insurance Code § 10133.5 and 10 CCR §§ 2240- 2240.5 (if Contractor is regulated by CDI), and, as applicable, other laws, rules and regulations, including those set forth at 45 C.F.R. § 156.230. Contractor shall cooperate with Covered California to implement network changes as necessary to address reasonable concerns identified by Covered California.
(b) Participating Provider Stability. Contractor shall maintain policies and procedures that are designed to preserve and enhance Contractor’s network development by facilitating the recruitment and retention of Participating Providers necessary to provide access to Specialized Health Care Services. Such policies and procedures shall be consistent with applicable laws, rules and regulations and will include an ongoing assessment of turnover rates of its Participating Providers to ensure that the turnover rates do not disrupt the delivery of quality care.
Network Adequacy.
a) Network Standards. Contractor’s QHPs shall comply with the network adequacy standards established by Covered California and the applicable State Regulators responsible for oversight of Contractor, including, those set forth at Health and Safety Code § 1367.03 and 28 CCR § 1300.67.2 or Insurance Code § 10133.5 and 10 CCR § 2240 et seq., and, as applicable, other laws, rules, and regulations, including, those set forth at 45 C.F.R. § 156.230. Contractor shall cooperate with Covered California to implement network changes as necessary to address concerns identified by Covered California.
b) Participating Provider Stability. Contractor shall maintain policies and procedures that are designed to preserve and enhance Contractor’s network development by facilitating the recruitment and retention of Participating Providers necessary to provide access to Covered Services. Such policies and procedures shall be consistent with applicable laws, rules and regulations, and will include an ongoing assessment of turnover rates of its Participating Providers to ensure that the turnover rates do not disrupt the delivery of quality care.
Network Adequacy. Medi-Cal standards shall be utilized for long term services and supports, as described below, or for other services for which Medi-Cal is exclusive, and Medicare standards shall be utilized for pharmacy benefits and for other services for which Medicare is primary, unless applicable Medi-Cal standards are more stringent. Home health and durable medical equipment requirements, as well as any other services for which Medicaid and Medicare may overlap, shall be subject to the more stringent of the applicable Medicare and Medi-Cal standards. California has developed transition requirements that specify continuation of existing providers (see section V). Both the State and CMS will monitor access to services through survey, utilization, and complaints data to assess needs to Participating Plan network corrective actions. Participating Plans are responsible for access to services for beneficiaries. In addition to these protections, minimum LTSS standards for Participating Plans are below. CMS and the State will monitor access to care and the prevalence of needs indicated through enrollee assessments, and, based on those findings, may require that Participating Plans initiate further network expansion over the course of the Demonstration.
i. Specifically, CMS and the state will require that Participating Plans: - Meet enrollees’ needs by contracting with a sufficient number of health facilities and providers that comply with applicable state and Federal laws, including, but not limited to, physical accessibility and the provision of health plan information in alternative formats. - Maintain an updated, accurate, and accessible listing of a provider's ability to accept new patients, which shall be made available to beneficiaries, at a minimum, by phone, written material, and Internet web site, upon request. - Maintain an appropriate provider network that includes an adequate number of specialists, primary care physicians, hospitals, long-term care providers and accessible facilities within each service area, per applicable Federal and state rules. - Contract with safety net and traditional providers, as defined state regulations, to ensure access to care and services. - Employ care managers directly or contract with care management organizations in sufficient numbers to provide coordinated care services for long-term services and supports as needed for all members.
