Network Composition Sample Clauses

Network Composition. The Contractor will establish and maintain a robust geographic network designed to accomplish the following goals: (1) offer an appropriate range of services, including access to preventive care, primary care, acute care, specialty care, behavioral health care, substance use disorder and long- term services and supports (including nursing homes and home and community-based care) services for the anticipated number of enrollees in the services area; (2) maintain providers in sufficient number, mix, and geographic areas; and (3) make available all services in a timely manner. Pursuant to 42 CFR 438.206(c)(3), the Contractor will ensure that its contracted providers provide physical access, reasonable accommodations, and accessible equipment for members with physical or mental disabilities. The Contractor agrees to maintain and monitor a network of appropriate providers that is supported by written agreements and can sufficiently demonstrate to EOHHS’ satisfaction the Contractor’s ability to provide Covered Services under this Agreement. The Contractor will maintain a Network Development Plan to address continuous recruitment and retention of new providers, plans for ongoing network development, and plans to create goal targets for specific numbers of providers in networks. Members must have access to services that are at least equal to, or better than community norms. Members will be allowed to choose their network provider to the extent possible and appropriate. In establishing and maintaining the network, the Contractor will consider the following: • Anticipated enrollment for the members covered under this Agreement • A sufficient number of PCPs who will accept new members within the service area to ensure the Contractor can meet the access standards required. • Ability to provide all Medicaid managed care children a full continuum of behavioral health and substance use disorder services. The Contractor’s services will address all levels of need. • Ability to provide all Medicaid managed care adults a full continuum of behavioral health and substance use services. The Contractor's services will address all levels of need. The Contractor will have a robust network of providers that meet the needs of the community. Providers should be a mix of CMHCs and community-based providers. • Expected utilization of services taking into consideration the characteristics and health care needs of members for which the Contractor is, or will be, responsible • Numbers and...

Network Composition. Contractor shall ensure and monitor an appropriate provider network, including primary care physicians, specialists, professional, allied, supportive paramedical personnel, and an adequate number of accessible inpatient facilities and service sites within each service area.

Network Composition. Within each Service Area, Contractor shall ensure and monitor an appropriate Provider Network, including adult and pediatric PCPs, OB/GYN, adult and pediatric behavioral health Providers, adult and pediatric Specialists, professional, Allied Health Personnel, supportive paramedical personnel, hospitals, and pharmacies and an adequate number of accessible inpatient facilities and service sites. In addition, Contractor shall ensure and monitor MLTSS Providers, American Indian Health Programs, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Freestanding Birthing Centers (FBCs), where available.

Network Composition. Contractor shall maintain an adequate number of inpatient Facilities, Service Sites, professional, allied, specialist and supportive paramedical personnel within their network to provide Covered Services to its Members.

Network Composition. The Contractor must ensure that its Provider Network is adequate to provide its Members in the HealthChoices zone with access to quality Member care through participating professionals, in a timely manner, and without the need to travel excessive distances. Upon request from the Department, the Contractor must supply geographic access maps detailing the number, location and specialties of their Provider Network to the Department in order to verify accessibility of Providers within their Network. The Department may require additional numbers of specialists and ancillary providers should it be determined that geographic access is not adequate. The Contractor must make all reasonable efforts to honor a Member's choice of Providers who are credentialed in the Network. Additional requirements for establishing and maintaining an acceptable Provider Network are as follows: a. The Contractor must ensure the provision of services to persons who have special health needs or who face access barriers to health care. If the Contractor does not have at least two (2) specialists or sub-specialists qualified to meet the particular needs of the individuals, then the Contractor must allow Members to pick an Out-of-Network Provider if not satisfied with the Network Provider. The Contractor must develop a system to determine prior authorization for Out-of-Plan Services, including provisions for informing the MA Consumer of how to request this authorization for Out-of-Plan Services. For children with special health needs, the Contractor must offer at least two (2) pediatric specialists or pediatric sub-specialists. b. The Contractor must ensure and must demonstrate its ability to: i. Make available to every Member a choice of at least two (2) appropriate PCPs whose offices are located within a travel time no greater than thirty (30) minutes (urban) and sixty (60) minutes (rural). This travel time is measured via public transportation, where available. Members may, at their discretion, select PCPs located further from their homes. ii. Ensure an adequate number of pediatricians to permit all Members who want a pediatrician as a PCP to have a choice of two (2) for their child(ren) within the travel time limits (30 minutes urban, 60 minutes rural). iii. Demonstrate its attempts to contract in good faith with a sufficient number of Certified Registered Nurse Practitioners (CRNP) to ensure access to CRNP services. While the Contractor may contract with a primary care practice in whi...

Network Composition. Contractor shall ensure and monitor an appropriate Provider Network within its Service Area in compliance with W&I Code section 14197, and if necessary to ensure compliance with Network adequacy requirements in this Contract, attempt to contract with Providers in adjoining counties outside of Contractor’s Service Area. Contractor’s Network must include, but not be limited to, adult and pediatric PCPs, OB/GYN, adult and pediatric behavioral health Providers, adult and pediatric Specialists, Allied Health Personnel, supportive paramedical personnel, hospitals, and an adequate number of accessible inpatient facilities and service sites. In addition, Contractor shall ensure and monitor MLTSS Providers, American Indian Health Service Programs, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Freestanding Birthing Centers (FBCs), where available. Contractor shall submit assurances to DHCS regarding its Network composition in accordance with 42 CFR section 438.207.

Network Composition. The Provider shall provide a Dental Provider Network (Network) of participating dentists for the delivery of covered services (C.3.2.1) for all non-aged, non- disabled fee- for-service beneficiaries. The Provider shall develop the Network in accordance with the following: a. The Provider shall contract directly with dentists in the District of Columbia (DC); b. The Provider’s Network shall maintain initially and on an on-going basis a minimum participation level of 10% of the DC dentists identified in Attachment J.15; c. The Provider’s Network shall include participating dentists in each xxxx of the District; d. The Provider shall maintain an open network; e. The Provider shall ensure that the dentists and service providers participating in the Network maintain current business and professional licensing in accordance with District laws and regulations (Attachments

Network Composition. The Contractor will establish and maintain a robust geographic network designed to accomplish the following goals: (1) offer an appropriate range of services, including access to preventive care, primary care, acute care, specialty care, behavioral health care, substance use disorder and long- term services and supports (including nursing homes and home and community-based care) services for the anticipated number of enrollees in the services area; (2) maintain providers in sufficient number, mix, and geographic areas; and (3) make available all services in a timely manner. Pursuant to 42 CFR 438.206(c)(3), the Contractor will ensure that its contracted providers provide physical access, reasonable accommodations, and accessible equipment for members with physical or mental disabilities.

Network Composition. 78 2. Provider Agreements ..............................................82 3.

Network Composition. The Contractor will be responsible for establishing and maintaining a geographically accessible statewide provider network comprised of general and specialty dentists in adequate numbers to meet accessibility standards and make services available in a timely manner. The RIte Smiles Contractor will develop and maintain a sufficient provider network to provide dental services to RIte Smiles eligible children. The network will include a sufficient number of general and pediatric dentists to meet the service accessibility standards outlined later in this section as well an adequate specialty network that includes the following specialty dentists: endodontist, periodontist, prosthodontist, oral surgeons, and orthodontist.