NETWORK ADEQUACY AND MAXIMUM ENROLLMENT LEVELS Sample Clauses

NETWORK ADEQUACY AND MAXIMUM ENROLLMENT LEVELS a. On a quarterly basis, except as otherwise specified by the DEPARTMENT, the DEPARTMENT shall evaluate the adequacy of the MCO's provider network. Such evaluations shall use ratios of Members to specific types of providers based on Medicaid fee-for-service experience in order to ensure that access in the MCO is at least equal to access experienced in the Medicaid fee-for-service program for a similar population. For each county the maximum ratio of Members to each provider type shall be: 1. adult PCPs, including general practice specialists counted at 60.8%, internal medicine specialists counted at 88.9%, family practice specialists counted at 66.9%, nurse practitioners of the appropriate specialties, and physician assistants, 387 Members per provider; 2. children's PCPs, including pediatric specialists counted at 100%, general practice specialists counted at 39.2%, internal medicine specialists counted at 11.1%, family practice specialists counted at 33.1%, nurse practitioners of the appropriate specialties, and physician assistants, 301 Members per provider; obstetrics and gynecology providers, including obstetrics and gynecology specialists, nurse midwives, and nurse practitioners of the appropriate specialty, 835 Members per provider; 3. dental providers, including general and pediatric dentists counted at 100%, and dental hygienists counted at 50%, 486 Members per provider; and 4. behavioral health providers, including psychiatrists, psychologists, social workers, and psychiatric nurse practitioners, 459 Members per provider. b. In the event that the number of Members in a given county equals or exceeds ninety percent (90%) of the capacity determined in accordance with section a noted above, the DEPARTMENT shall evaluate the adequacy of the MCO's network on a monthly basis.

NETWORK ADEQUACY AND MAXIMUM ENROLLMENT LEVELS. Primary Care Providers and Dentists a. On a quarterly basis, except as otherwise specified the DEPARTMENT, the DEPARTMENT shall evaluate the adequacy of the MCO's provider network. Such evaluations shall use ratios of Members to specific types of providers based on fee-for-service experience in order to ensure that access in the MCO is at least equal to access experienced in the fee-for-service Medicaid program for a similar population. For each county the maximum ratio of Members to each provider type shall be: 1. Adult PCPs, including general practice specialists counted at 60.8%, internal medicine specialists counted at 88.9%, family practice specialists counted at 66.9%, nurse practitioners of the appropriate specialties, and physician assistants, 387 Members per provider; 2. Children's PCPs, including pediatric specialists counted at 100%, general practice specialists counted at 39.2%, internal medicine specialists counted at 11.1%, family practice specialists counted at 33.1%, nurse practitioners of the appropriate specialties, and physician assistants, 301 Members per provider;