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)).
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)
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.
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.
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. Carrier shall comply with network adequacy policies set forth in State and federal laws and regulations, including, but not limited to, 45 CFR §156.230, and the Carrier Reference Manual and MHBE Interim Procedures.
Network Adequacy. A. IDHW will regularly monitor the Health Plan’s network and will impose corrective action in accordance with the terms of the contract when the Health Plan fails to meet the network adequacy standards.
Network Adequacy. 2.7.1.1. The ICO must maintain a Provider Network sufficient to provide all Enrollees with access to the full range of Covered Services, including the appropriate range of preventive, primary care, and specialty services, behavioral health services, other specialty services, and all other services required in 42 C.F.R. §§422.112, 423.120, and 438.206, and under this Contract (see Covered Services in Appendix A), taking into consideration:
Network Adequacy. State Medicaid standards shall be utilized for long-term supports and services, as described below, or for other services for which Medicaid is exclusive, and Medicare standards shall be utilized for pharmacy benefits and for other services for which Medicare is primary, unless applicable Medicaid standards for such services 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 Medicaid standards. MDCH has developed transition requirements that specify continuation of existing providers for LTSS (see Table 7-C, “ICO Transition Requirements at Enrollment” below). MDCH and CMS also require that ICOs provide and arrange for timely access to all medically-necessary services covered by Medicare and Medicaid. Both MDCH and CMS will monitor access to services through survey, utilization, and complaints data to assess needs for ICO network corrective actions. In addition to these protections, minimum LTSS standards for ICOs are below. Michigan will finalize the standards, based on administrative data and based on stakeholder input. CMS and MDCH will monitor access to care and the prevalence of needs indicated through enrollee assessments, and, based on those findings, may require that ICOs initiate further network expansion over the course of the Demonstration. The ICO is required to assure provider network adequacy and choice of providers. ICOs must have at least two available providers with sufficient capacity to accept enrollees, allowing enrollee choice of providers, including those providing supports coordination. When an ICO cannot assure choice within 30 miles for each enrollee, it may request a rural exception from MDCH. The ICO will directly employ or contract with independent care providers of the enrollee’s choice, if the individual meets MDCH qualification requirements, to provide Medicaid Personal Care services. People who currently receive personal care services from an independent care provider may elect to continue to use that provider or select a new provider so long as that provider meets the state qualifications. The ICO must meet the Medicare requirements for any covered services for which Medicare requires a more rigorous network adequacy standard than Medicaid (including time, distance, and/or minimum number of providers or facilities). Medicare network standards account for...
Network Adequacy. The Contractor must maintain a Provider Network sufficient to provide all Enrollees with access to the full range of Covered Services, including the appropriate range of preventive, Primary Care, and specialty services, behavioral health services, other specialty services, and all other services required in 42 C.F.R. §§422.112, 423.120, 438.68, and 438.206, and under this Contract (see Covered Services in Appendix A), taking into consideration:
