Common use of Network Adequacy Clause in Contracts

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.