Common use of Network Adequacy Clause in Contracts

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. ‌ 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.