Common use of Network Requirements Clause in Contracts

Network Requirements. (A) The Contractor shall maintain and monitor a network of appropriate, Participating Providers that is supported by written agreements and is sufficient to provide adequate access to all services covered under this Contract. In establishing and maintaining the network of Participating Providers the Contractor must consider the following: (1) The anticipated Medicaid enrollment; (2) The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the Contractor’s Service Area; (3) The numbers and types (in terms of training, experience, and specialization) of Providers required to furnish the contracted Medicaid services; (4) The number of Participating Providers who are not accepting new Medicaid patients; and (5) The geographic location of Participating Providers and Medicaid Enrollees, considering distance, travel time, the means of transportation ordinarily used by Medicaid Enrollees, and whether the location provides physical access for Medicaid Enrollees with disabilities.

Network Requirements. (A) The Contractor shall maintain and monitor a network of appropriate, Participating Network Providers that is supported by written agreements and is sufficient to provide adequate access to all services covered under this Contract. In establishing and maintaining the network of Participating Network Providers the Contractor must consider the following: (1) The anticipated Medicaid enrollment; (2) The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the Contractor’s Service Area; (3) The numbers and types (in terms of training, experience, and specialization) of Providers required to furnish the contracted Medicaid services; (4) The number of Participating Network Providers who are not accepting new Medicaid patients; and (5) The geographic location of Participating Network Providers and Medicaid Enrollees, considering distance, travel time, the means of transportation ordinarily used by Medicaid Enrollees, and whether the location provides physical access for Medicaid Enrollees with disabilities. (B) The Contractor shall ensure that each Enrollee is able to choose his or her network Provider to the extent possible and appropriate.