NETWORK CHANGES. The Contractor agrees to notify EOHHS monthly of any changes in its network's composition. The Contractor also agrees to notify EOHHS within three (3) calendar days of any changes to the composition of its provider network that materially affects the Contractor’s ability to make available all capitated services in a timely manner. The Contractor agrees to have procedures to address changes in its network that negatively affect the ability of members to access services. The Contractor agrees to follow policies and procedures contained in the attached “Provider Terminations and Network Changes Policy V1.2”. Pursuant to 42 CFR 438.68, the Contractor must ensure its network is compliant with the State established provider-specific network adequacy standards. The Contractor will give written notice of termination of a contracted provider, within fifteen (15) calendar days after receipt or issuance of the termination notice, to each member who received his or her primary care from, or was seen on a regular basis by, the terminated provider. The criteria the Contractor employs in the creation of selective provider networks must be transparent to EOHHS and must be reviewed and approved by EOHHS prior to the implementation of network changes. If a Selective Network is to be created, EOHHS and the Contractor will work together in good faith to come to mutual agreement on Selective Contracting concepts prior to the Contractor's implementing a Selective Contracting initiative. The Contractor will notify EOHHS in writing of any actions undertaken to terminate or suspend a practitioner from the Contractor’s network due to quality, Medicaid fraud or abuse, or integrity, within ten (10) calendar days. Pursuant to 42 CFR 438.10(f)(1), the Contractor will make a good faith effort to provide written notice of a terminated provider, within fifteen (15) calendar days of issuing the termination, to any member who received primary care from or was seen on a regular basis by the terminated provider.
Appears in 5 contracts
Samples: Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement
