Common use of Network Composition Clause in Contracts

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 types (in terms of training, experience, and specialization) of providers, specifically specialty providers, required to furnish the services contracted for herein • Numbers of providers who are not accepting new Medicaid patients • Geographic location of providers and members, considering distance, travel time, the means of transportation ordinarily used by members, and whether the location provides physical access for members with disabilities.

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 types (in terms of training, experience, and specialization) of providers, specifically specialty providers, required to furnish the services contracted for herein • Numbers of providers who are not accepting new Medicaid patients • Geographic location of providers and members, considering distance, travel time, the means of transportation ordinarily used by members, and whether the location provides physical access for members with disabilities.

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 types (in terms of training, experience, and specialization) of providers, specifically specialty providers, required to furnish the services contracted for herein •  Numbers of providers who are not accepting new Medicaid patients •  Geographic location of providers and members, considering distance, travel time, the means of transportation ordinarily used by members, and whether the location provides physical access for members with disabilities.

Network Composition. ‌ The Contractor will shall 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- 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 shall consider the following: • Anticipated Rhody Health Options 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 specific Rhody Health Options populations for which the Contractor is, or will be, responsible • Numbers and types (in terms of training, experience, and specialization) of providers, specifically specialty providers, required to furnish the services contracted for herein • Numbers of providers who are not accepting new Medicaid Rhody Health Options patients • Geographic location of providers and members, considering distance, travel time, the means of transportation ordinarily used by members, and whether the location provides physical access for members with disabilities. • “Disability Competency” of providers and the physical accessibility of their offices. “Disability Competency” is defined as the capacity of health professionals and health educators to support the health and wellness of people with disabilities through their disability knowledge, experience and expertise. Contractor shall develop and maintain its network to maximize the availability of primary and specialty care access to reduce utilization of emergency services, preventable hospital admission/re-admissions, and the use of avoidable costly medical procedures. Contractor shall include in their network current fee-for-service providers as “essential community” providers, unless the Contractor demonstrates a valid reason for not including them. If Contractor declines to include individual or groups of providers in its network, Contractor agrees to give the affected providers written notice of the reason for its decision. These essential community providers include but are not limited to: Rite@Home agencies and providers, Tri-Town Community Action, PARI, OSCIL; NeuroRestorative RI group homes; Xxxxx Xxxxx Group Home in Tiverton; Spurwink habilitation program, Xxxxxxx Rehabilitation, United Cerebral Palsy, To LIFE Incorp habilitation program, and other essential providers determined by the State. Contractor agrees that if the network is unable to provide necessary services, covered under this Agreement, to a particular member, Contractor must adequately and on a timely basis cover these services out of network, for as long as Contractor is unable to provide them. Contractor agrees to ensure that all in-plan services covered under the Medicaid State Plan and provided for in Attachment A are available and accessible to members, according to 42 CFR 438.206. Refer to Section 2.10 of this Agreement for service accessibility standards. Contractor agrees to ensure that providers will meet the State standards for timely access to care and services, taking into account the urgency of need for services. Refer to Section 2.10 for service accessibility standards. Contractor agrees to ensure that the network providers offer hours of operation that are no less than the hours of operation offered to commercial enrollees or comparable to Medicaid fee-for-service, if the provider serves only members. Nothing in this section may be construed to: • Require Contractor to contract with providers beyond the number necessary to meet the needs of members; • Preclude Contractor from using different reimbursement amounts for different specialties or for different practitioners in the same specialty; • Preclude Contractor from establishing measures that are designed to maintain quality of services control costs and are consistent with its responsibilities to members; or • Allow Contractor to reimburse FQHCs/RHCs at a rate less than that paid for comparable services provided by non-FQHC/RHC based providers. For members, with the exception of PCP as defined in this contract, this may require the Contractor’s inclusion of providers who practice or are located outside of the State and/or allowing such members to retain established relationships to preserve continuity of care with non-network providers, including traditional Medical Assistance providers. Contractor shall be obligated to offer a provider agreement to become a Participating Provider to any such providers. Contractor may inquire as to member’s interest in switching to a closer in-State, in-network provider. Each physician in the network must have a unique identifier assigned to them. The Contractor shall have written policies and procedures for the selection and retention of providers that comply with 42 CFR 438.214 and with the State’s policy for credentialing and recredentialing.

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 types (in terms of training, experience, and specialization) of providers, specifically specialty providers, required to furnish the services contracted for herein • Numbers of providers who are not accepting new Medicaid patients • Geographic location of providers and members, considering distance, travel time, the means of transportation ordinarily used by members, and whether the location provides physical access for members with disabilities.