Common use of Network Adequacy Clause in Contracts

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 QDPs shall comply with the network adequacy standards established by Covered California and 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- 2240-2240.5 (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.