Network Capacity. Contractor shall maintain a Provider Network adequate to serve sixty percent (60%) of all Eligible Beneficiaries, including SPD beneficiaries within Contractor’s Service Area and provide the full scope of benefits. Contractor will increase the capacity of the Network as necessary to accommodate enrollment growth beyond the sixty percent (60%). However, after the first 12 months of operation, if Enrollments do not achieve seventy-five percent (75%) of the required Network capacity, the Contractor's total Network capacity requirement may be renegotiated.
Network Capacity. The Contractor shall maintain and monitor an appropriate and adequate provider network, supported by written agreements, sufficient to provide all Contracted Services under this Contract. The Contractor may provide Contracted Services through Non-Participating Providers, at a cost to the individual that is no greater than if the Contracted Services were provided by Participating Providers, if its network of Participating Providers is insufficient to meet the Behavioral Health needs of Individuals in a manner consistent with this Contract. This provision shall not be construed to require the Contractor to cover such services without authorization. To the extent necessary to provide non-crisis Behavioral Health services covered under this Contract, the Contractor may offer contracts to providers in other RSAs in the state of Washington and to providers in bordering states. The Contractor may not contract for Crisis Services (SUD or Mental Health) or ITA-related services out of Washington State. For non-crisis behavioral health services funded by GFS: The Contractor shall provide non-crisis Behavioral Health services funded by GFS, within Available Resources, to Individuals who meet financial eligibility standards in this Contract and meet one of the following criteria: Have insurance, but are unable to pay the co-pay or deductible for services; Are using excessive Crisis Services due to inability to access non-crisis behavioral health services; and Have more than five (5) visits over six (6) months to the emergency department, withdrawal management facility, or a sobering center due to a SUD. The Contractor must submit a network of contracted service providers adequate to serve the population in the Contractor’s RSA annually by November 1. If the Contractor fails to provide evidence of or HCA is unable to validate contracts with a sufficient number of providers, HCA may terminate this Contract. The network must have sufficient capacity to serve the RSA and include, at a minimum: 24/7/365 Telephone Crisis Intervention; Designated Crisis Responder (DCR); Evaluation and treatment (E&T) and Secure Withdrawal Management and Stabilization capacity to serve the RSA’s non-Medicaid population; Psychiatric inpatient beds to serve the RSA’s non-Medicaid population, including direct contracts with community hospitals at a rate no greater than that outlined in the HCA Fee-for-Service schedule; The Contractor shall notify HCA ninety (90) calendar days prior to terminating...
Network Capacity. The Contractor shall maintain and monitor an appropriate and adequate provider network, supported by written agreements, sufficient to provide GFS services under this Contract to its Enrollees. Any other changes that result in the Contractor being unable to meet access including a decrease in the number or frequency of a required service, employee strike or other work stoppage related to union activities, or any changes that results in the Contractor being unable to provide timely services. The Contractor shall notify HCA ninety (90) days prior to terminating any of its Subcontracts with entities that provide direct services or entering into new subcontracts with entities that provide direct services. This notification shall occur prior to any public announcement of this change. If a Subcontract is terminated in less than ninety (90) days or a site closure occurs in less than ninety (90) days, the Contractor shall notify HCA as soon as possible and prior to a public announcement. If a subcontract is terminated or a site closes, the Contractor shall submit a plan to HCA that includes at a minimum: Notification to Ombuds services; Individual notification plan; Plan for provision of uninterrupted services; and Any information released to the media. The Contractor shall incorporate the following requirements when developing its network: The Contractor shall, in partnership with the BH-ASO, assist the state to expand community-based alternatives for crisis stabilization, such as mobile crisis or crisis residential and respite beds. The Contractor shall assist the state to expand community-based, recovery‑oriented services and research- and evidence-based practices. The Contractor shall implement an adequate plan to provide Evaluation and Treatment services to Enrollees, which may include the development of less restrictive alternative to involuntary treatment or prevention programs reasonably calculated to reduce the demand for Evaluation and Treatment services. If the Contractor, in HCA’s sole opinion, and in conjunction with recommendations provided by the ACH, fails to maintain an adequate network of Behavioral Health providers in any contracted service area for two (2) consecutive quarters, and after notification following the first quarter, HCA reserves the right to immediately terminate the Contractor’s services for that service area. The network established under the Contract must complement and support the network of Medicaid providers established by th...
Network Capacity. A. Contractor shall maintain a provider network that meets adequacy and access requirements stipulated in STC 72.
B. Contractor must maintain a network of appropriate providers that is supported by written agreements.
C. In establishing and maintaining the network, the entity must consider the following:
a) The anticipated enrollment,
b) The expected utilization of services, taking into consideration the characteristics and health care needs of specific populations represented,
c) The numbers and types (in terms of training, experience, and specialization) of provider required to furnish the contracted services,
d) The number of network providers who are not accepting new LIHP patients, and
e) The numbers of network providers and Enrollees, considering distance, travel time, the means of transportation ordinarily used by LIHP Enrollees, and whether the location provides physical access for Enrollees with disabilities.
Network Capacity. I-Link's Network facilities currently have sufficient capacity to handle the traffic currently generated by the Existing and Legacy Customers plus all other existing traffic from other existing customers. I-Link's e-mail and Internet access is sufficient to meet the existing requirements of the Existing and Legacy Customers and currently meets the communication and Web requirements of the I-Link LLC Representative sales force.
Network Capacity. Report the number and type of all Providers in the network by the type of services rendered.
Network Capacity. The Contractor must maintain and monitor an appropriate provider network, supported by written agreements, sufficient to provide adequate access to all services covered under the Contract for all Enrollees, including those with limited English proficiency or physical or mental disabilities (42 C.F.R. § 438.206(b)(1)).
Network Capacity. 6.1.1 The Contractor shall maintain and monitor an appropriate and adequate provider network, supported by written agreements, sufficient to provide all contracted services under this Contract. The Contractor may provide contracted services through Non-Participating Providers, at a cost to the individual that is no greater than if the contracted services were provided by Participating Providers, if its network of Participating Providers is insufficient to meet the Behavioral Health needs of individuals in a manner consistent with this Contract. This provision shall not be construed to require the Contractor to cover such services without authorization. To the extent necessary to provide non-crisis Behavioral Health services covered under this Contract, the Contractor may offer contracts to providers in other RSAs in the state of Washington and to providers in bordering states. The Contractor may not Contract for Crisis Services (SUD or Mental Health) or ITA-related services out of Washington State.
6.1.1.1 The Contractor shall submit a network of its Crisis Services to the HCA prior to the start of this contract, and upon request. The network must have sufficient capacity to serve the RSA and include, at a minimum:
Network Capacity. The Contractor will maintain a provider network adequate to serve sixty percent (60%) of the Eligible Beneficiaries in the proposed county and provide the full scope of benefits. Contractor will increase the capacity of the network as necessary to accommodate Enrollment growth beyond the sixty percent (60%). However, after the first twelve months of operation, if Enrollments do not achieve seventy-five (75%) of the required network capacity, the Contractor's total network capacity requirement may be renegotiated.
Network Capacity. The Contractor shall maintain and monitor an appropriate provider network, supported by written agreements, sufficient to serve enrollees enrolled under this Contract (42 C.F.R. § 438.206(b)(1)).
